Crash Rates Are More Than 5 Times for Stubborn Apnea Truck Drivers (Who Don’t Use Device)

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Truck drivers who ignore their sleep apnea treatment have a five times higher preventable crash rate than drivers without apnea, says a new study in Sleep journal.

A 2002 study found that up to 28.1% of heavy truck drivers have mild, moderate or severe sleep apnea, according to the the Federal Motor Carrier Safety Administration (FMCSA). the most common of several types of sleep disorders, in which breathing repeatedly stops and starts during sleep.

This new study is called “Non-Adherence with Employer-Mandated Sleep Apnea Treatment and Increased Risk of Serious Truck Crashes,” Sleep, March 21, 2016. Lead author is Stephen V. Burks, Professor of Economics and Management at the University of Minnesota, Morris (UMM).

In this study 1613 drivers at Schneider National, who were diagnosed with sleep apnea, were prescribed positive airway pressure (PAP) therapy and provided with a self-adjusting CPAP machine. Results of the study were compared to a control group of the same number of drivers.

“We found that truck drivers with untreated obstructive sleep apnea are at dramatically greater risk of serious, preventable truck crashes, consistent with the greatly increased risk of motor vehicle crashes among automobile drivers with untreated obstructive sleep apnea,” said study co-author Charles A. Czeisler, PhD, MD, FRCP, chief of the Division of Sleep and Circadian Disorders at Brigham and Women’s Hospital, and Baldino Professor of Sleep Medicine at Harvard Medical School in Boston.

Drivers with sleep apnea who did not follow therapy eventually were terminated after given the another chance and choice to stick to the treatment.

Facts about Sleep Apnea

Sleep apnea is a treatable sleep disorder.

“An apnea is defined as complete or near cessation of airflow for a minimum of 10 sec with or without associated oxygen destaturation and sleep fragmentation.” Principles and Practice of Sleep Medicine 5th ed.

OSA, if untreated, can lead to daytime sleepiness and increases fall-asleep-crash risk.

Over 10% of truck drivers have moderate to severe OSA.

This high prevalence of OSA in truck drivers is unsurprising, as they tend to be middle-aged, male, and obese, according to a paper cited by the NCBI.

OSA remains largely undiagnosed in commercial truck drivers.

Doctors usually can’t detect the condition during routine office visits. Also, no blood test can help diagnose the condition.  U.S. National Heart, Lung, and Blood Institute

Polysomnography (PSG) aka sleep study or Sleep Lab (technologist attended), is only accurate test, know as the gold standard, as the Portable monitoring study while a less costly alternative method is not as accurate.

The Problem(s)

Several people I have spoken who were prescribed CPAP machines don’t use them because they don’t like the mask. Some don’t the feel of the mask or don’t like getting wrapped up in the hose at night. Older machines tended to be loud at night. Truck driver Christopher Hill says it’s no big deal.

Another problem is cost. Sleep studies can run into thousands of dollars and are generally an out-of-pocket expense as sleep studies are not covered by health insurance. The CPAP machine runs into hundreds of dollars and the mask and head-straps have to be replaced several times a year. As these items are federally regulated medical devices, nothing is ever cheap.

Public law 113-45, signed into law on October 15, 2014, requires  the FMCSA to enact rules “if the agency decides to establish requirements for commercial truckers to address certain sleep disorders among drivers.”

In January 2015, the Federal Motor Carrier Safety Administration (FMCSA) issued a Bulletin on the physical qualification requirements for drivers with obstructive sleep apnea (OSA).  The American Trucking Association stated this was in error as it contained no specific guidelines and violated the spirit of PL 113-45 which requires an objective cost-benefits analysis.

On Tuesday, March 8th, 2016 the FMCSA opened a ninety day period for public comments on sleep apnea.

While we can expect FMCSA rulemaking in the future, the controversy about truck drivers and sleep apnea will probably not end there.

Is there a problem with truck drivers with sleep apnea? If so, who should make that determination?

Thank you for reading this.