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Waking up to sleep apnea dangers

NORTHBROOK, Ill. -- A joint task force south of the border has recommended that motor carriers screen their drivers...


NORTHBROOK, Ill. — A joint task force south of the border has recommended that motor carriers screen their drivers for sleep apnea symptoms.

The American College of Chest Physicians (ACCP), American College of Occupational and Environmental Medicine (ACOEM), and the National Sleep Foundation (NSF) combined to offer an updated approach to the screening and management of obstructive sleep apnea (OSA) among commercial motor vehicle (CMV) operators.

Recommendations include a more thorough screening and evaluation process, modified criteria for returning to work after treatment and they provide follow-up and recertification recommendations.

“Sleepiness and inattention contribute to a significant number of commercial motor vehicle crashes each year and OSA has been shown to significantly increase a driver’s risk of driving drowsy. Yet, current CMV screening and treatment procedures for OSA are ambiguous and not reflective of the latest advancements in the diagnosis and management of OSA,” said Nancy Collop, MD, FCCP, Sleep Institute, American College of Chest Physicians. “Conflicting approaches to screening and management of OSA have left drivers undiagnosed, which puts the driver and general public at risk. We hope our joint recommendations will assist the Federal Motor Carrier Safety Administration and states to update screening and treatment guidelines for sleep apnea which, in turn, may help identify and treat more CMV drivers who suffer from this serious condition.”

Existing guidelines for the diagnosis and treatment of sleep apnea from the FMCSA are based in a 1991 report. The joint task force says its report is based on the most up-to-date sleep apnea research available. Sleep apnea sufferers experience partial or complete obstruction of their upper airway during sleep, which results in sleep disruption among other effects.

“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 In addition, outdated guidance from the FMCSA has left medical examiners in conflict with current sleep guidelines,” said Natalie P. Hartenbaum, MD, MPH, FACOEM, American College of Occupational and Environmental Medicine. “With recommendations based on current literature, and accepted by both occupational medicine and sleep medical organizations, a more consistent process for medical certification of these drivers can occur, decreasing the risk of accidents.”

The task force recommends a screening process should be put into place by carriers and that drivers who suffer from severe sleep apnea should be prevented from working until they receive a medical evaluation. The task force also suggests expanding the screening process to identify risk factors such as body mass index, neck circumference and the drivers family history.

Treatment for sleep apnea includes the use of 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. The recommendations set forth by the task force involve a shorter return to work time, the organizations point out. Drivers will be able to return to work one month after treatment is initiated and in some cases as quickly as two weeks.

“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 Barbara Phillips, MD, FCCP, National Sleep Foundation. “With appropriate therapy and compliance, drivers who suffer from sleep apnea will be addressing a significant risk for impaired performance on the job.”

Studies have suggested that as many as one-third of commercial truck drivers suffer from sleep apnea. For more information or to receive the recommendations, visit www.sleepfoundation.org or call 847-818-1800.


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