Limited data from commercial drivers is a major reason for the U.S. Federal Motor Carrier Safety Administration's failure to require screening for obstructive sleep apnea (OSA). Experts estimate that between 7% and 20% of all large truck crashes are due to drowsy/fatigued driving. Therefore, in the United States, from 2004 to 2013, 3,133 to 8,952 deaths and 77,000 to 220,000 serious injuries (mostly among the traveling public) are likely attributable to fatigued/sleepy commercial motor vehicle (CMV) drivers. OSA is the most common cause of daytime sleepiness and fatigue in the USA. Among the estimated 1.7 to 3.9 million active U.S. commercial drivers, 17% to 28% or 0.29–1.1 million are expected to have OSA based on prevalence studies conducted within the trucking industry. It is estimated that sleep apnea increases the incidence of MVA’s in noncommercial drivers 1.5 to 4.9 fold.
In this study, each OSA-diagnosed driver (n = 2,225), was matched to a randomly drawn control driver from those screened as Low Priority for a PSG (i.e. unlikely to have OSA; n = 3,732) who had the same level of experience (at hire) and job tenure (measured at the calendar week of the diagnosed driver's PSG, called the “matching date” for the control).
The findings are truly eye opening. Drivers nonadherent with CPAP had a crash rate for preventable DOT-reportable crashes of 0.070/100,000 miles, or nearly five-fold more. On the other hand, drivers adherent with CPAP were no more likely to be involved in preventable accidents than controls who did not have sleep apnea.
It should be noted that the FMCSA has not yet acted on the recommendations of its own Medical Expert Panel (in 2007) and Medical Review Board (in 2008 and 2011), the Motor Carrier Safety Advisory Committee (in 2011), and that of the National Transportation Safety Board (in 2009), that safety regulations should require comprehensive OSA screening and diagnosis of commercial drivers.
Based on the results of this study, the authors state that their results strongly sup-port federal regulations that would mandate sleep apnea screening, diagnosis, and monitoring drivers' treatment adherence for all commercial drivers.
Fortunately, the state of Arizona had adopted a more stringent policy. I know that there are a lot of unhappy truck drivers being referred to my and other sleep centers. Hopefully, after reading this you will have a more persuasive argument as to why it is a matter of public safety that they be screened.
Summarized by: Robert S. Rosenberg, DO, FCCP, is the medical director of the Sleep Disorders Center of Prescott Valley, Arizona and sleep medicine consultant for Mountain Heart Health Services in Flagstaff, Arizona. Dr. Rosenberg is Board Certified in Sleep Medicine, Pulmonary Medicine, and Internal Medicine. His book Sleep Soundly Every Night, Feel Fantastic Every Day is a best seller. Dr Rosenberg’s latest book is The Doctor’s Guide to Sleep Solutions for Stress & Anxiety. Visit Dr Rosenberg’s website www.AnswersForSleep.com which offers a wealth of information on sleep topics.
Nonadherence with Employer-Mandated Sleep Apnea Treatment and Increased Risk of Serious Truck Crashes
Burks SV, Anderson JE, Bombyk M, Haider R, Ganzhorn D, Jiao X, Lewis C, Lexvold A, Liu H, Ning J, Toll A, Hickman JS, Mabry E, Berger M, Malhotra A, Czeisler CA, Kales SN
Sleep Volume 79, Issue 49 http://journalsleep.org/ViewAbstract.aspx?pid=30605
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