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Regina v Wrighton - sleep apnoea is a major killer, which GPs, the Health and Safety Executive, and road haulage companies should tackle

Please go to the current (March 2008) version of this piece.

This longer than usual post is not particularly written for subscribers to Fortnightly Mailing, though I know that readers who are friends or associates will be interested. Instead it is for people landing here having searched the Internet on terms like "sleep apnoea", "road traffic accident", "death by dangerous driving", "road safety".

Last summer Toby Tweddell (one of my sister's grown up sons) was killed while waiting in a stationary queue of traffic on the motorway into Liverpool. Colin Wrighton, the driver of a 35 tonne heavy good vehicle, had fallen asleep at the wheel. His vehicle ploughed into a the back of the queue, killing my nephew, whose Nissan Micra was near the the back of the queue.

On Monday 1 October 2007 the Crown Prosecution Service decided to offer no evidence against Wrighton, in a prosecution for causing death by dangerous driving . The reason for this was that Wrighton had been diagnosed (after the accident, and in the process of preparing his defence) as suffering from sleep apnoea, which apparently can cause sufferers to fall asleep, uncontrollably,  with no warning whatever. Disturbingly, Wrighton had several time consulted his GP in the previous few years about tiredness, but sleep apnoea had never been diagnosed.

(Sufferers of sleep apnoea are starved of oxygen during the night. They awake momentarily many times each night, without being aware of this, and as a result they experience waking symptoms ranging from general drowsiness and tiredness through to suddenly falling asleep.)

The 7 page statement put to the court on Monday by the prosecution barrister [100 kB PDF] to explain the decision to offer no evidence deserves to be widely read, as it captures clearly the nature of the problem of sleep apnoea, its potentially devastating consequences, and the way in which "obvious" cases are not picked up in the health service. [7/12/2007 addition.] Occasionally, the "sleep apnoea" defence does not work, as seems to have been the case in today's conviction of Ian King for causing the death of four members of the Dowling family on the A34 near  Oxford, on 31 July 2006.

On delving a bit into the problem of sleep apnoea it appears that:

  1. up to 1 in 6 heavy goods vehicle drivers may suffer from it;
  2. more people are killed on the roads as a result of it in the UK than are killed as a result of drunk driving;
  3. effective treatments for sleep apnoea exist, but waiting lists to get it are long;
  4. GPs do not understand sleep apnoea well, and failure to diagnose it correctly (as in this particular case) when the sufferer’s job involves driving, puts people at grave risk;
  5. the Health and Safety Executive, in its two main official guides (Health and safety in road haulage [link to large PDF file], and Managing work-related road safety) [link to large PDF file], and in its current internal guidance on when to investigate work-related road traffic fatalities [link to large PDF file] seems to be giving no priority whatever to the issue;
  6. the UK's Road Haulage Association (trade body for the road haulage industry) is silent on the problem (compare, for example, what it has to say about "tachograph", with what it has to say about "sleep" - similar zero returns are found with other suitable terms);
  7. in March 2006 an attempt made in the House of Lords by labour peer Baroness Gibson of Market Rasen (previously a national official of the trade union MSF) to get sleep apnoea and measures to lessen its impact on road safety made a prominent feature of UK legislation was rebuffed by the Government.

The line of argument used by the Government's Lord Davies of Oldham in opposing a change in the law was as follows:

"We rely on educating drivers about the risks, but the police can take action and prosecute irresponsible drivers who drive carelessly or dangerously because they are sleepy. The courts take this issue seriously. Falling asleep at the wheel is treated as an aggravating rather than a mitigating factor when considering sentencing in respect of accidents that have occurred through careless or dangerous driving."

and is completely at odds with the facts of the case described above.

What should be done?

If 1 in 6 heavy good vehicle drivers suffers from sleep apnoea, and if sleep apnoea is a bigger cause of death on the roads than drunk driving, then the law needs changing to ensure that road haulage contractors and/or government instigate compulsory testing of drivers for sleep apnoea, with a view to providing treatment (which is available), and to preventing continuing sufferers from driving.

The Health and Safety Executive should be:

  • investigating fatal accidents on the roads when there is prima facie evidence that the vehicle doing the damage was driven by someone at work, who may have fallen asleep at the wheel;
  • giving prominent emphasis to sleep apnoea in its guidance publications;
  • considering the introduction of technical safeguards against drivers of HGVs falling asleep or losing consciousness (as is already the case in trains);
  • actively raising awareness of sleep apnoea and its terrible consequences amongst GPs and in the road haulage industry.

If you have personal experiences relating to this post, or professional, political, or legal views to express, in person or anonymously, feel free to comment below.

Update: 12/2/2008 - Letter in the 12/2/2008 Guardian from my sister and my brother in law.

Comments

I have sleep apnoea. The key to diagnosis isn't the tiredness - this can be caused by a wide number of things, including narcolepsy. It is the irregular heartbeat.

As you describe, people with sleep apnoea stop breathing hundreds of times during the night, depriving the brain of oxygen and waking them up. This causes strain on the heart and lungs as they labour to function without oxygen.

The major consequence of sleep apnoea isn't traffic accidents - though I don't downplay the seriousness of driving while sleepy. It is heart failure, caused by years of irregular heartbeats. People suffering from sleep apnoea simply drop dead in their sleep, never knowing what hit them.

The treatment for sleep apnoea can consist either of moving the obstruction through surgery (less common) or through forcing air into the lungs during sleep (more common). This requires the use of a Continuous Positive Airway Pressure (CPAP) machine during sleep.

Users wear a breathing mask which is attached to the CPAP. The machine monitors breathing patterns and increases air pressure if breathing slows.

The CPAP is expensive ($2000) and the masks ($200 per) are fragile. They are not covered under Canada health care and only partially covered by group health insurance. So they are a significant expense.

That said, they are worth every penny. I have suffered from sleep apnoea since I was young, but having a CPAP over the last four years or so has made a huge difference in my quality of life. I really notice it on those rare days when I don't use it or when I am having trouble with a mask (as I am now).

It means I have to take the CPAP with me when I travel, so I get to know airport security people very well. The machine is large (1 foot long) and too fragile (and important) for baggage, so it consumes most of my carry-on space. And hotels are stingy with power plug-ins, so setting it up on the road can require acrobatics.


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