Sleep disorders and driving licence: the current Italian legislation and medico-legal issues.

Road traffic accidents (RTA) are a serious issue in all industrialized countries and have dramatic social and healthcare-related implications. Fatigue (sleepiness) is the principal identifiable and preventable cause of road traffic accidents. Obstructive sleep apnoea syndrome (OSAS) and narcolepsy are two of the leading causes of excessive daytime sleepiness. In this article, the authors analyze the current Italian legislation regarding driving licence issuance and fitness to drive, in order to evaluate the potential implications of sleep disorders, particularly OSAS and narcolepsy. In European Legislation and in Italy, OSAS and narcolepsy are not included among the illnesses or invalidating conditions that limit the fitness to drive for driving licence issuance purposes. In fact, they are not included in the Annex III of the European Council Directive 91/439/EEC of the 29th of July 1991 on driving licences. Some Countries of the European Union (Belgium, France, Finland, Great Britain, the Netherlands, Spain and Sweden) had implemented the 91/439/EEC Directive with national restrictions on driving licence issuance policies in case of OSAS and narcolepsy. Given the well-established scientific evidence available, in Italy, the lack of legislation regulating the assessment of the psychophysical requisites for the issuance and renewal of driving licences of individuals affected by sleep disorders seems extremely worrying. Furthermore, the current lack of legal obligation in Italy for healthcare facilities to disclose such diagnoses to the organs responsible for issuing driving licences (such as the Motorizzazione Civile - the Department of motor vehicles) remains the subject of heated debate.

The case of "Judge Nodd" and other sleeping judges--media, society, and judicial sleepiness.

STUDY OBJECTIVES: Review cases of judicial sleepiness and subsequent outcomes, including media and community attitudes. DESIGN: Index case report and Internet search in English language at 2 recent time points. PARTICIPANTS: Index case and 14 other cases of judicial sleepiness reported on the Internet. MEASUREMENTS: Qualitative review of media and Internet reports. RESULTS: The index and other cases highlighted the role of the media seeking a punitive approach to occupational sleepiness, similar to that observed within the transport sector. In the index case, the judge's driver's license was withdrawn, despite official acknowledgement of effective treatment of sleep apnea. In 10 cases, judicial sleepiness resulted in a retrial and, in up to 5 cases, resulted in dismissal or retirement of the judge. In most cases, the cause of sleepiness was not determinable. CONCLUSION: Judicial sleepiness is not uncommon and is viewed negatively by the media, community, and judicial system. Active monitoring of the judiciary for sleepiness and sleep disorders is suggested.