|A new study has confirmed previous findings that obesity-driven testing strategies identify commercial truckdrivers with a high likelihood of obstructive sleep apnea (OSA) and suggests that mandating OSA screeningscould reduce the risk of truck crashes. OSA is a syndrome characterized by sleep-disordered breathing,resulting in excessive daytime sleepiness; sleep attacks, psychomotor deficits, and disrupted nighttime sleep. Itincreases the risk of motor vehicle accidents, and is common among truck drivers. Approximately 2.4 to 3.9 million licensed commercial drivers in the U.S. are expected to have OSA. In addition to being unrecognized or unreported by drivers, OSA often remains undiagnosed by many primary care clinicians despite the fact that OSA increases the risks of hypertension, diabetes mellitus, and heart disease.
Philip Parks, MD, MPH, medical director of Lifespan Employee Health and Occupational Services, is thestudy's lead author. He worked with researchers at the Cambridge Health Alliance on the study published in the March 2009 edition of the Journal of Occupational and Environmental Medicine. Park says, "It is well-known that obesity, a leading risk factor for obstructive sleep apnea, is on the rise in the United States. Truck drivers with sleep apnea have up to a 7-fold increased risk of being involved in a motor vehicle crash."
Over the 15-month study period, 456 commercial drivers were examined from over 50 different employers.
Seventy-eight (17%) met the screening criteria for suspect OSA. These drivers were older and more obese, and had a higher average blood pressure. Of the 53 drivers who were referred for sleep studies, 33 did not comply with the referral and were lost to follow-up. The remaining 20 were all confirmed to have OSA, but after diagnosis, only one of these 20 drivers with confirmed OSA complied with treatment recommendations.
Stefanos N. Kales, MD, MPH, Medical Director of Employee and Industrial Medicine at Cambridge Health Alliance, is the study's senior author. Kales says, "It is very likely that most of the drivers who did not comply with sleep studies or sleep apnea treatment sought medical certification from examiners who do not screen for sleep apnea and are driving with untreated or inadequately treated sleep apnea."
The study, published today by the Journal of Occupational and Environmental Medicine, has significant policy ramifications, as the Federal Motor Carrier Safety Administration is currently deliberating recommendations to require sleep apnea screening for all obese drivers based on body mass index or "BMI" (BMI is calculated based on height and weight). The Administration requires medical certification of licensed commercial drivers at least every two years. These occupational medicine exams present a unique opportunity for detecting OSA as part of determining a driver's safety behind the wheel.
Symptoms of Obstructive Sleep Apnea
Symptoms that may be observed include:
• Abnormal daytime sleepiness, including falling asleep at inappropriate times
• Awaken unrefreshed in the morning
• Depression (possibly)
• Episodes of no breathing (apnea)
• Loud snoring
• Memory difficulties
• Morning headaches
• Personality changes
• Poor concentration
• Restless sleep
• Additional symptoms that may be associated with this disease:
• Hyperactive behavior, especially in children
• Leg swelling (if severe)
How do the Federal Motor Carrier Safety regulations address Sleep Apnea
SLEEP APNEA AND DRIVER QUALIFICATION 49 CFR 391.41 .
Here is the FMCSA's official statement regarding this matter :
Drivers should be disqualified until the diagnosis of sleep apnea has been ruled out
or has been treated successfully. As a condition of continuing qualification, it is
recommended that a CMV driver agree to continue uninterrupted therapy such as CPAP, etc. / monitoring and undergo objective testing as required.
A driver with a diagnosis of (probable) sleep apnea or a driver who has Excessive Daytime Somnolence (EDS) should be temporarily disqualified until the condition is either ruled out by objective testing or successfully treated.
Narcolepsy and sleep apnea account for about 70% of EDS. EDS lasting from a few days to a few weeks should not limit a driver's ability in the long run. However, persistent or chronic sleep disorders causing EDS can be a significant risk to the driver and the public. The examiner should consider general certification criteria at the initial and follow-up examinations:
• Severity and frequency of EDS;
• Presence or absence of warning of attacks;
• Possibility of sleep during driving;
• Degree of symptomatic relief with treatment; and
• Compliance with treatment.
Idealease Safety Bulletin is provided for Idealease affiliates and their customers and is not to be construed as a complete or exhaustive source of compliance or safety information. The Idealease Safety Bulletin is advisory in nature and does not warrant, guarantee, or otherwise certify compliance with laws, regulations, requirements, or guidelines of any local, state, or Federal agency and/or governing body, or industry standards.