Drugs, driving and traffic safety in sleep apnea

Sleep apnea affects 2-4 % of the population. It is characterised by repetitive episodes of brief upper airway obstruction during sleep, with associated arousal from sleep. Consequences of untreated sleep apnea include excessive daytime sleepiness and impaired cognitive functioning and driving performance. Sleep apnea is also associated with a number of co-morbidities, including hypertension, insomnia and cardiovascular disease. As such, many sleep apnea patients are on medications that can potentially affect their sleep apnea severity and daytime functioning, including driving performance. Centrally-acting depressant drugs, including alcohol, antihypertensives, narcotics and sedatives, can cause respiratory depression and worsen sleep apnea. They may increase sleepiness and further impair driving performance either through direct actions on the central nervous system or through increasing sleep apnea severity. This chapter describes the effects of sleep apnea on daytime sleepiness, cognitive functioning and driving performance, as well as the drugs affecting waking and nocturnal respiration.