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Excessive daytime sleepiness and reduced cognitive functioning secondary to obstructive sleep apnea (OSA) have been identified as an important health-related risk in commercial transportation with, possibly, an increased chance of road accidents. This has resulted in a variety of policies and restrictions imposed on commercial drivers. Here we review current knowledge to assess whether available data are sufficient to guide policy decisions concerning restrictions for non-commercial drivers. The review shows that there is a lack of uniformity among different consensus conferences and guidelines as to how to deal with drivers with OSA. Clear guidelines are limited and few are evidence based. It is unclear which aspect of OSA is the most valid measure of severity (e.g., apnea-hypopnea index vs oxygen desaturation index). Traditionally, sleepiness has been invoked as a major risk factor for impaired driving. Recently, there also has been an awareness that daytime fatigue, as distinct from sleepiness, has an impact on driving behavior. However, the precise effect of fatigue on driving, as well as its role in the formulation of guidelines, remain to be evaluated. We conclude that there are at least two major difficulties for the driving recommendation process: a) there is no accurate metric quantifying severity of driving risk associated with OSA, and b) there are substantial individual differences among those with OSA, both experiential and behavioral. We present implications from this review for future research and policy formulation., (Crown Copyright © 2017. Published by Elsevier Ltd. All rights reserved.)

Objective: The present investigation was designed to explore the role and implications of both daytime sleepiness and fatigue in obstructive sleep apnea syndrome with respect to sleep, perceived health quality, and psychological functioning., Methods: Our participants consisted of two groups: 124 older community volunteers who completed a polysomnographic sleep study and were diagnosed with sleep apnea, and 19 healthy controls. All participants completed self-report measures of sleepiness, fatigue, sleep quality, health quality, and psychological functioning., Results: The apnea sample was divided according to clinically relevant cut-offs on sleepiness and fatigue. When those with mid-range scores were ruled out, the following groups remained: low sleepiness/low fatigue (LL, n=23), high sleepiness/high fatigue (HH, n=28), high sleepiness/low fatigue (HS, n=10) and low sleepiness/high fatigue (HF, n=13). The respiratory disturbance index did not differ significantly among these groups and only the two highly fatigued groups (HH and HF) experienced significantly lower average oxygen saturation than the control group. Analyses revealed that the HH group was significantly worse than the LL and control groups on most sleep, health quality, and psychological measures. On these same measures, the groups for whom fatigue was low (LL and HS), regardless of sleepiness, were similar to controls., Conclusion: When patients with sleep apnea are classified into different sleepiness/fatigue categories, the results show that high fatigue is associated with more severe dysfunction than high sleepiness. The current debate on whether to treat apnea patients with low sleepiness needs to consider the impact of fatigue., (Copyright © 2011 Elsevier Inc. All rights reserved.)

Objective: To explore how individuals with chronic fatigue syndrome (CFS) describe their fatigue experience and examine how this differs from descriptions of fatigue in healthy controls. Methods: Fifty-two individuals with CFS and 27 controls listed words that described their fatigue. These words were grouped into 18 categories. Results: Individuals with CFS used more categories to describe their fatigue and more descriptors within each category. The most popular category used by both groups was energy depletion/physical weakness. CFS participants also experienced their fatigue as limiting their ability to function, frustrating, permanent/persistent, out of their control, depressing, and pervading all aspects of their lives. Controls reported that when they experienced fatigue, it was temporary, and they felt unmotivated, sleepy, and comfortable. Conclusion: The multidimensional descriptive pattern characterizing the fatigue of individuals with CFS differs dramatically from the experienced fatigue of healthy individuals, suggesting their "language of fatigue" has a distinctive quality. [ABSTRACT FROM AUTHOR]

• Driving profiles at baseline did not predict adherence to treatment. • Sleepiness and AHI are associated with official driving record violations. • Fatigue is associated with self-reported driving violations. • Fatigue and sleepiness should be assessed and analyzed separately in studies of driving risk. The present investigation examines the role of daytime sleepiness and fatigue and how these relate to driving behaviors and risk assessment in people newly diagnosed with obstructive sleep apnea (OSA). We recruited 47 individuals, (24 female, 23 male), between the ages of 25 and 71 (mean age = 51, SD = 11.28). Of those, 24 individuals were newly diagnosed with OSA and 23 individuals were in a comparison sample with similar proportions of biological sex and ages, who tested negative for OSA. All participants completed questionnaire measures related to sleep, psychological adjustment, driving behavior, sleepiness and fatigue, immediately after their follow-up appointment. We collected data on driving violations from registered driving records for the 5 years preceding their enrolment in the study, as well as sleep-related data for all participants. Results show that individuals with OSA (M = 1.08, SD = 1.38) do not commit more driving violations than control participants (M = 0.64, SD = 1.26). Although drivers with OSA indicate significantly worse scores for fatigue (M = 7.73, SD = 3.71) compared with controls (M = 4.26, SD = 3.66), there was no significant difference for sleepiness between drivers with OSA (M = 10, SD = 3.57) and Controls (M = 8, SD = 3.69). An association between driving violations and sleepiness was found for drivers with OSA – r (24) = −0.45, p <.05 – but not for Controls – r (23) = −0.22, p >.05. Fatigue, and sleepiness should be assessed as distinct constructs, and each should be taken into account separately in studies of driving risk. [ABSTRACT FROM AUTHOR]