Can a dedicated 'fast track' sleep service successfully establish vocational drivers on CPAP within four weeks of referral?

BAM Downie, G Olds, M Tomlinson, SD West. Newcastle Regional Sleep Service, Freeman Hospital, Newcastle Upon Tyne, UK 10.1136/thoraxjnl-2015-207770.251

Introduction and objectives.
Sleepiness due to Obstructive Sleep Apnoea (OSA) can impair driving, and OSA has been implicated in road traffic accidents. DVLA guidelines state that those with "sleepiness sufficient to impair driving" should cease driving until they have been investigated and treated. This may have a significant effect on the ability of vocational drivers to earn a living. Fear of lengthy investigations and licence regulations may deter these patients from seeking treatment. We developed a dedicated service that aimed to diagnose OSA and successfully establish vocational drivers on CPAP within 4 weeks of referral.

The service was advertised to local GPs, encouraging identification of vocational drivers at point of referral. Patients were seen by a nurse specialist and underwent domiciliary sleep studies, returning the following day for results and CPAP therapy. Those who were not identified via GP referral were fasttracked from first clinic appointment. Compliance and Epworth Sleepiness Score (ESS) were evaluated after one week of treatment on CPAP, or as soon as the patient could attend thereafter.

Between September 2014 and July 2015, 29 drivers were referred; one failed to attend. Fifteen held a type 1 drivers' licence and 13 a type 2 licence. At presentation, the mean age was 48 years (range 25-61), mean BMI was 34 (27-51) and mean ESS was 10 (0-21). Sleep studies showed a mean ODI of 30 (0-93), with moderate or severe OSA in 18 (64%). Twenty two patients were commenced on CPAP (79%). Seventeen patients attended for review on CPAP, a mean of 16 days after initiation. Mean ESS was 5.4 and mean CPAP usage was 5.3 h/ night. Of these, six people were reviewed between six and eight days after CPAP initiation; their mean compliance was 6.2 h/ night (4.1-8.3). Mean time from referral (or first clinic visit) to review on CPAP was 33 days.

A fast track service is practical and effective at diagnosing OSA and establishing vocational drivers on CPAP. There were some delays due to patient non-attendance or re-scheduling. It is vital that GPs are aware of the service and refer patients as vocational drivers.



"Our work has shown that falling asleep at the wheel, due to OSA, is one of the most likely causes for them having a serious road accident, with all the implications, not only for them and other road users, but also for those driversí families".Professor Jim Horne, Sleep Research Centre, Loughborough University.