Driving for safety on our roads
===============================

* Morley Lertzman
* Satyendra Sharma

The questionnaire used by Shawn Marshall and Nathalie Gilbert to assess the knowledge of Saskatchewan physicians of risk factors related to medical fitness to drive1 has 2 significant omissions.

First, it is well documented that patients with sleep disorders have more motor vehicle accidents than control groups. The prevalence of obstructive sleep apnea in the North American population is between 2% and 4% and increases with age.2 The odds ratios for vehicular accidents have been reported as 1.5-4,3 2.99,4 and 7.3.5 Furthermore, the accident rate decreases significantly when patients are treated with nasal continuous positive air pressure (CPAP) therapy (from 0.8 to 0.15 per 100 000 km).6

Second, epilepsy should have been considered. There is certainly abundant information on this subject, including recommendations regarding fitness to drive.7

## References

1.  1. Marshall SC, Gilbert N. Saskatchewan physicians' attitudes and knowledge regarding assessment of medical fitness to drive. CMAJ 1999;160(12):1701-4.
    
    [Abstract/FREE Full Text](http://www.cmaj.ca/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6NDoiY21haiI7czo1OiJyZXNpZCI7czoxMToiMTYwLzEyLzE3MDEiO3M6NDoiYXRvbSI7czoyMjoiL2NtYWovMTYxLzYvNjg3LjEuYXRvbSI7fXM6ODoiZnJhZ21lbnQiO3M6MDoiIjt9) 

2.  2. Lertzman M, Wali SO, Kryger M. Sleep apnea a risk factor for poor driving [letter]. CMAJ 1995;153(8):1063.
    
    

3.  3. Aldrich MS. Automobile accidents in patients with sleep disorders. Sleep 1989;12:487-94.
    
    [PubMed](http://www.cmaj.ca/lookup/external-ref?access_num=2595172&link_type=MED&atom=%2Fcmaj%2F161%2F6%2F687.1.atom) 
    
    [Web of Science](http://www.cmaj.ca/lookup/external-ref?access_num=A1989CB98600001&link_type=ISI) 

4.  4. Wu H, Yan-Go F. Self-reported automobile accidents involving patients with obstructive sleep apnea. Neurology 1996;46:1254-7.
    
    [Abstract/FREE Full Text](http://www.cmaj.ca/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6OToibmV1cm9sb2d5IjtzOjU6InJlc2lkIjtzOjk6IjQ2LzUvMTI1NCI7czo0OiJhdG9tIjtzOjIyOiIvY21hai8xNjEvNi82ODcuMS5hdG9tIjt9czo4OiJmcmFnbWVudCI7czowOiIiO30=) 

5.  5. Young T, Blustein J, Finn L, Palta M. Sleep-disordered breathing and motor vehicle accidents in a population-based sample of employed adults. Sleep 1997;20:608-12.
    
    [PubMed](http://www.cmaj.ca/lookup/external-ref?access_num=9351127&link_type=MED&atom=%2Fcmaj%2F161%2F6%2F687.1.atom) 
    
    [Web of Science](http://www.cmaj.ca/lookup/external-ref?access_num=A1997YC04500002&link_type=ISI) 

6.  6. Cassel W, Ploch T, Becker C, Dugnus D, Peter JH, von Wichert P. Risk of traffic accidents in patients with sleep-disordered breathing: reduction with nasal CPAP. Eur Respir J 1996;9:2606-11.
    
    [Abstract](http://www.cmaj.ca/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6MzoiZXJqIjtzOjU6InJlc2lkIjtzOjk6IjkvMTIvMjYwNiI7czo0OiJhdG9tIjtzOjIyOiIvY21hai8xNjEvNi82ODcuMS5hdG9tIjt9czo4OiJmcmFnbWVudCI7czowOiIiO30=) 

7.  7. Fauci AS, Braunwald E, Isselbacher Kj, Wilson JD, Martin JB, Kasper DL, et al. *Harrison's principles of internal medicine.* New York: McGraw-Hill; 1998. p. 2324.