Obstructive Sleep Apnea and Transportation: Medicolegal Issues

Obstructive sleep apnea (OSA) is associated with neurocognitive deficits, particularly in the domains of attention/vigilance, delayed long-term visual and verbal memory, visuospatial/constructional abilities, and executive function. Patients with OSA with sleep restriction have further impairments in neurocognitive function and driving ability. Subjective and objective testing have been used to assess daytime functioning. Limitations of these tests preclude definitive policies based solely on testing to identify those patients at risk for driving accidents. Legal culpability for an accident depends on the level of consciousness of the individual as well as the degree of understanding that an action will result in harm. Thus, education of the patient and public on the risk of OSA on driving ability is a critical role of the clinician. Laws and regulations regarding OSA and driving vary by region, and physicians are responsible for familiarizing themselves with policies that govern their jurisdiction.