Assessing readiness to drive in adolescents with narcolepsy: what are providers doing?
- 37 Downloads
There are no universally accepted guidelines for assessing driving readiness in adolescents with narcolepsy. The purpose of the present study was to survey pediatric sleep medicine providers regarding their current practice patterns for assessing driving readiness in adolescents with narcolepsy, knowledge of their state laws regarding physician reporting of unsafe drivers, and opinions regarding what physician duty ought to be.
This was an anonymous web-based survey distributed via the PedSleep listserv, which serves as a hub of communication for pediatric sleep medicine providers.
A total of 52 pediatric sleep providers from 25 different states completed the survey. Eighty-eight percent of providers routinely assess driving readiness in adolescents with narcolepsy. Factors rated as “absolutely essential” by at least 50% of respondents included the following: history of previous fall-asleep crash or near miss, sleepiness (reported by patient), sleepiness (reported by caregiver), and cataplexy (reported by patient). Providers included maintenance of wakefulness testing: never (34%), if patient reports no/mild sleepiness (10%), if patient reports moderate/severe sleepiness (25%), or always regardless of patient symptoms (30%), and the median minimally acceptable result was 30 min (25–75th: 20–40 min). There was substantial lack of knowledge regarding legal obligations for reporting.
These results demonstrate great variability in practice patterns among pediatric sleep medicine providers for assessing driving readiness in adolescents with narcolepsy. In addition, it shows limited knowledge of the providers about their respective states’ laws. Further studies are required to identify the best approach to assess residual sleepiness in this population.
KeywordsNarcolepsy Pediatric Drowsy driving
Maintenance of Wakefulness Test
Multiple Sleep Latency Test
Compliance with ethical standards
Conflict of interest
Dr. Ingram has served as a consultant and is on the speaker’s bureau for Jazz Pharmaceuticals. All other authors decline any potential conflict of interest.
This study was approved by the IRB at Children’s Mercy Hospital, #17120726, and was determined to be exempt under category 2—Research involving the use of educational tests, survey procedures, interview procedures or observations of public behavior. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
- 3.Liu SY, Perez MA, Lau N (2018) The impact of sleep disorders on driving safety-findings from the Second Strategic Highway Research Program naturalistic driving study. Sleep 41(4). https://doi.org/10.1093/sleep/zsy023
- 4.Scammell TE (2018) In: Eichler AF (ed) Treatment of narcolepsy in adults. UpToDate, Waltham. (Accessed on September 7, 2018)Google Scholar
- 6.Littner MR, Kushida C, Wise M, Davila DG, Morgenthaler T, Lee-Chiong T, Hirshkowitz M, Daniel LL, Bailey D, Berry RB, Kapen S, Kramer M, Standards of Practice Committee of the American Academy of Sleep Medicine (2005) Practice parameters for clinical use of the multiple sleep latency test and the maintenance of wakefulness test. Sleep 28(1):113–121CrossRefGoogle Scholar
- 8.Division of Sleep Medicine at Harvard Medical School. Living with Narcolepsy - Safety. 2018. http://healthysleep.med.harvard.edu/narcolepsy/living-with-narcolepsy/safety. Accessed 7 Sept 2018
- 9.Zandieh S, Ramgopal S, Khatwa U, Sangiuliano M, Gunnuscio M, Zarowski M et al (2013) The maintenance of wakefulness test in pediatric narcolepsy. Pediatr Neurol 48(6):443–446. https://doi.org/10.1016/j.pediatrneurol.2013.02.007 CrossRefGoogle Scholar
- 10.Philip P, Chaufton C, Taillard J, Capelli A, Coste O, Leger D et al (2014) Modafinil improves real driving performance in patients with hypersomnia: a randomized double-blind placebo-controlled crossover clinical trial. Sleep 37(3):483–487. https://doi.org/10.5665/sleep.3480 CrossRefPubMedCentralGoogle Scholar
- 11.Erman M, Emsellem H, Black J, Mori F, Mayer G (2017) Correlation between the Epworth Sleepiness Scale and the Maintenance of Wakefulness Test in patients with narcolepsy participating in two clinical trials of sodium oxybate. Sleep Med 38:92–95. https://doi.org/10.1016/j.sleep.2017.07.015 CrossRefGoogle Scholar