A joint task force comprised of the American College of Chest Physicians (ACCP), American College of Occupational and Environmental Medicine (ACOEM), and the National Sleep Foundation (NSF) is urging the Federal Motor Carrier Safety Administration (FMCSA) to adopt new guidelines to improve screening and management of obstructive sleep apnea (OSA) among commercial motor vehicle operators.
Published as a supplement to the September issue of the Journal of Occupational and Environmental Medicine, these recommendations include:
- An updated description of sleep apnea to include those with repetitive partial or complete obstruction of upper airway tissues during sleep, resulting in sleep disruption, gas exchange abnormalities, and cardiovascular changes, with the diagnosis and severity of sleep apnea be established using the apnea-hypopnea index.
- A screening process that bases driver certification on severity of sleep apnea; for example, certifying a driver at lower risk for sleep apnea for a maximum of three months, pending a medical evaluation (in-service evaluations), while drivers with more severe risk factors or a motor vehicle crash likely related to sleep disturbances should be prohibited from returning to work until they receive a medical evaluation (out-of-service evaluations).
- Include a more extensive medical and physical history, flagging such risk factors as body mass index, neck circumference, family history of OSA, and history of comorbidities. For those diagnosed with sleep apnea, use a positive airway pressure for a minimum of four hours within a 24-hour period via a machine that is able to measure time on pressure.
- Reduce return-to-work time to two weeks after treatment initiation in certain situations. Reevaluation after four weeks to ensure compliance with therapy and improvement in symptoms is also recommended.
“Sleepiness and inattention contribute to a significant number of commercial truck crashes each year, and OSA has been shown to significantly increase a driver’s risk of driving drowsy,” said ACCP’s Nancy Collop, MD. “Yet, current truck driver screening and treatment procedures for OSA are ambiguous and not reflective of the latest advancements in the diagnosis and management of OSA.”
She added that a study sponsored by the FMCSA and the American Trucking Assns. estimated that nearly one in three commercial truck drivers suffers from mild to severe OSA. The study also found that the risk of having sleep apnea depended on two major factors, age and degree of obesity, with prevalence increasing with both.
Population projections by FMCSA indicate the number of older drivers will increase by 50% over the next twenty years. Other research demonstrates that drivers with undiagnosed OSA have an increased risk (2 to 7 times) for falling asleep at the wheel. It also increases the possibility of an individual developing significant health problems, such as hypertension, stroke, and ischemic heart disease.
“Difficulty in identifying those drivers at highest risk of OSA and accidents due to OSA has been a significant challenge for the commercial driver medical examiner. In addition, outdated guidance from the FMCSA has left medical examiners in conflict with current sleep guidelines,” said ACOEM’s Natalie Hartenbaum, MD.
“Sleep apnea is a highly treatable disorder. The new return-to-work standards we suggest are more reflective of current clinical knowledge related to the treatment of sleep apnea,” said NSF’s Barbara Phillips, MD. “With appropriate therapy and compliance, drivers who suffer from sleep apnea will be addressing a significant risk for impaired performance on the job.”
For a copy of the recommendations, visit http://www.acoem.org
