Obstructive sleep apnoea is a condition that can have far reaching health, economic and safety implications for the individual inflicted with the condition, as well as those in their immediate and wider surroundings. Having the freedom to drive taken away from an individual can be devastating and can result in a cascading downhill spiral in their lives and livelihoods. Non-surgical treatments of OSA are often cumbersome and poorly tolerated. The role of surgery has been debated for quite some time and, interestingly, this paper shows a significant benefit in both subjective and objective measures. Although the numbers are small and the results must be interpreted in context, if the data can be reproduced at a larger scale it may help more definitively establish or quell the role of surgery for these patients! We thank all our reviewers and team for all the hard work and contributions in 2021 and wish everyone a wonderful festive period and all the best for the coming New Year!
Nazia Munir and Hannah Cooper
Since the recent NICE guidelines change to tentatively recommend surgery for patients with obstructive sleep apnoea in the UK, a number of articles have been released extolling the benefits of surgery in this patient group. In this study, 32 obstructive sleep apnoea patients, who were also regarded as ‘active’ drivers, were put through a battery of driving-related tests. These included sleepiness and neurocognitive assessments with what appeared to be relatively rigorous driving simulation tests. Drivers and their partners before their intervention considered themselves to have good driving skills and exercised proper caution depending on the driving conditions. Rather embarrassingly, after this initial round of testing, the drivers’ partners were significantly less comfortable falling asleep in a car driven by their partners having seen them in action. These patients were put through a collection of surgical operations depending on their diagnosis and were tested again at three-to-six months postoperatively. There were significant subjective and objective improvements in driving ability with the rest of the other parameters trending towards improvement (but not showing significance probably due to the small sample size and a clearly underpowered study). On the driving simulation test, there was a significant decrease in the mean number of collisions and average time spent above the speed limit (p = 0.021 and p = 0.047, respectively). Haraldsson et al found that surgery resulted in a 77% reduction in road traffic accidents five years after sleep apnoea surgery. Unsurprisingly, weight loss surgery in obese sleep apnoea patients has not been shown to have much of an effect on driving ability, further dispelling the myth that weight loss is the most important treatment factor in this population. So, despite the rather clickbait title for this article review, it does seem that surgery for sleep apnoea has been found to improve the driving safety of patients. It has been estimated that 40% of fatal road traffic accidents in this country can be attributed to sleep disorders, anything that might reduce this figure can only be seen as welcome news.