Fitness to Drive & OSA: What GPs Must Document (Austroads 2022)

Fitness to Drive & OSA: What GPs Must Document (Austroads 2022)

Obstructive sleep apnoea (OSA) is common and can impair alertness, cognition, and reaction time—raising crash risk. For GPs and sleep clinicians, duty of care includes assessing driving risk and documenting advice and follow-up, not just diagnosing and treating OSA. The Austroads 2022 Assessing Fitness to Drive guidelines set the national standard; clear notes protect both patients and clinicians.

When OSA Affects Driving Fitness

OSA is relevant to licensing when it causes excessive daytime sleepiness or otherwise increases crash risk. Assess and record:

  • Symptoms: excessive sleepiness; drowsy driving/near-misses/crashes; loud snoring, witnessed apnoeas/gasping; impaired concentration or fatigue in safety-critical tasks.

  • Diagnosis & severity: sleep study confirming OSA. Report AHI and key indices but note that fitness to drive is not determined by AHI alone; daytime sleepiness and functional impairment are decisive.

    • Mild: AHI 5–14/h

    • Moderate: AHI 15–29/h

    • Severe: AHI ≥30/h

What GPs Should Document

Include, at minimum:

  • Symptoms & screening: Epworth Sleepiness Scale (ESS), STOP-Bang or other tools; history of drowsy driving/crashes.

  • Exam: BMI, neck circumference, airway features.

  • Sleep study details: type/date; AHI, ODI, T90; brief interpretation.

  • Treatment: CPAP/other therapy start date, pressures/mask, early troubleshooting; objective adherence at review.

  • Advice given: do not drive if sleepy; legal duty to notify licensing authority (state/territory); follow-up plan and any referrals.

  • Communication: copy of letters to specialists/employers (with consent) and any licensing authority contact.

Private vs Commercial License Standards

Private (Group 1):

  • Fit to drive if OSA is effectively treated and excessive sleepiness is absent.

  • Review typically every 1–3 years (more frequent for severe OSA).

  • If untreated/poorly controlled: advise not to drive until effective therapy.

Commercial (Group 2):

  • Must show effective treatment and objective adherence (e.g., CPAP downloads).

  • Annual review mandatory; some workplaces require 6–12-monthly checks.

  • Severe untreated OSA disqualifies commercial driving until controlled.

Always document residual symptoms, adherence, and the advice discussed.

Monitoring & Follow-up

  • Initial review: 1–3 months after starting CPAP/other therapy—check adherence, symptom change, side-effects.

  • Ongoing: private drivers at 1–3 year intervals by severity; commercial drivers annually.

  • If non-adherent or therapy ineffective: reassess driving fitness promptly and consider restrictions until resolved.

Communicating Responsibilities

  • Patients: must notify their licensing authority of conditions that may impair driving and must not drive when sleepy—document that this was explained.

  • GPs: provide accurate assessment/advice and record it. If a patient poses a serious and imminent risk and refuses to act, mandatory or permissive notification may apply per local law—document your rationale.

  • Employers (commercial): communicate with consent and record any correspondence.

Sleep Studies & Referral

Use HSAT for uncomplicated suspected OSA; refer for polysomnography/specialist review when:

  • Significant cardiopulmonary comorbidity, suspected central apnoea/hypoventilation.

  • HSAT is inconclusive/borderline.

  • A commercial driver requires detailed assessment and ongoing monitoring.

Flag driving status and any licensing timelines in referral letters.

Medico-Legal Pointers

In the event of a crash, records are scrutinised. Reduce risk by:

  • Using clear wording for driving advice and restrictions.

  • Providing written patient information where possible.

  • Keeping copies of all correspondence and updating notes at every review.

Key Takeaways for GPs

  • Prioritise daytime sleepiness and functional risk over AHI alone.

  • Record licence type (private vs commercial), screening scores, study indices, treatment details, adherence, and explicit driving advice with patient acknowledgement.

  • Refer when OSA is severe/complex or control is suboptimal, and follow state/territory reporting obligations.
    A structured, consistent approach supports safe care and defensible decision-making aligned with Austroads 2022.

Conclusion

OSA intersects clinical care and public safety when driving is involved. Applying Austroads 2022 with diligent documentation, clear patient counselling, and scheduled follow-up helps GPs and specialists protect patients, the public, and their own medico-legal position.

References

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