Cough syncope in Heavy Goods Vehicle drivers.
Sir,

We have recently become aware of four cases of serious road traffic accidents involving Heavy Goods Vehicle (HGV) drivers, all of whom avoided prosecution from dangerous driving based upon medico-legal reports supporting the diagnosis of cough syncope.

One case resulted in the death of two pedestrians. The three other cases involved head-on collisions, two of which resulted in the death of the car drivers involved, one of which resulted in serious injury. All denied previous syncopal episodes with coughing. The accounts given from each of the HGV drivers remained consistent from the time immediately following the accident.

The alternative diagnosis of falling asleep at the wheel, secondary to obstructive sleep …