Experts seek new procedures for sleep apnea screening

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A task force of medical experts is calling for new screening procedures for obstructive sleep apnea among drivers of commercial vehicles. In a supplement to the September issue of the Journal of Occupational and Environmental Medicine, the task force recommends a more thorough screening and evaluation process and modified criteria for follow-up, recertification and returning to work after treatment.

A 2002 study sponsored by the Federal Motor Carrier Safety Administration and the American Trucking Associations estimated that nearly one in three commercial truck drivers suffers from mild to severe obstructive sleep apnea — a struggle to breathe during sleep, usually accompanied by terrible snoring. Besides sleeplessness, apnea can cause acid reflux and other health problems, and can be life-threatening if combined with heart trouble. Reggie White, a member of the Pro Football Hall of Fame, died in 2004 of an apnea attack at age 43.

The latest task force is made up of representatives of the American College of Chest Physicians, the American College of Occupational and Environmental Medicine and the National Sleep Foundation.

“Sleepiness and inattention contribute to a significant number of CMV crashes each year, and OSA has been shown to significantly increase a driver’s risk of driving drowsy,” said Dr. Nancy Collop of the ACCP Sleep Institute. “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.” Conflicting approaches to screening have left too many drivers undiagnosed, which puts them and the public at risk, Collop said.

Current FMCSA guidelines for the diagnosis and treatment of sleep apnea are based on a 1991 report sponsored by the Federal Highway Administration. The guidelines say that drivers must have “no established medical history or clinical diagnosis of respiratory dysfunction likely to interfere with the ability to control and drive a commercial motor vehicle.”

The task force recommends a more extensive screening of drivers’ medical and physical history, flagging such risk factors as body mass index, neck circumference or a family history of apnea. It also recommends that medical certification for drivers be based on the severity of sleep apnea. Low-risk drivers should be certified for a maximum of three months, and drivers with more severe risk factors should be prevented from returning to work until they receive a medical evaluation, the task force says.

Although the task force recommends stricter screening, it also suggests a shorter return-to-work time. Under current FMCSA guidelines, drivers being treated for sleep apnea can return to work one month after initial treatment. The task force recommends reducing that period to two weeks, with a re-evaluation after four weeks.

“Sleep apnea is a highly treatable disorder,” said Dr. Barbara Phillips of the National Sleep Foundation. “The new return-to-work standards we suggest are more reflective of current clinical knowledge related to the treatment of sleep apnea.” In many cases, apnea now is treated not by medication or surgery but by simply wearing a breathing mask through which air gently flows, to keep the airways clear.

Ian Grossman, a spokesman for the FMCSA, said a medical review board was established last spring to address a number of driver issues, including sleep apnea. “We anticipate that the recommendations released by the joint task force will be considered when the medical review board reviews this and related issues as pertains to commercial driver health and safety,” Grossman said. There is no timeframe for when that will happen, but sleep apnea and sleep medicine are priorities on the board’s agenda, Grossman said.

For a copy of the recommendations, call (847) 818-1800. For more information, go to www.acoem.org, www.chestnet.org and www.sleepfoundation.org.