Obesity linked to sleep apnea in drivers

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A new study has confirmed previous research that obesity-driven testing identifies commercial truck drivers with a high likelihood of obstructive sleep apnea and suggests that requiring OSA screenings could reduce the risk of truck crashes resulting from driver fatigue and sleepiness.

“Truck drivers with sleep apnea have up to a sevenfold increased risk of being involved in a motor vehicle crash,” said Dr. Philip Parks, medical director of employee health and occupational services at healthcare provider Lifespan and the study’s lead author. The study results were published Thursday, April 2, in the Journal of Occupational and Environmental Medicine.

OSA is a syndrome characterized by sleep-disordered breathing, resulting in excessive daytime sleepiness, sleep attacks, psychomotor deficits and disrupted nighttime sleep. About 2.4 million to 3.9 million licensed commercial drivers in the United States are believed to have OSA. In addition to being unrecognized or unreported by drivers, OSA often remains undiagnosed by many primary care clinicians despite the fact that OSA increases the risks of hypertension, diabetes and heart disease.

Over the 15-month study period, 456 commercial drivers were examined from more than 50 different employers; 78, or 17 percent, met the screening criteria for suspected OSA. These drivers were older and more obese, and had a higher average blood pressure.

Of the 53 drivers who were referred for sleep studies, 33 did not comply with the referral and were lost to follow-up. The remaining 20 all were confirmed to have OSA, but after diagnosis, only one of these 20 drivers with confirmed OSA complied with treatment recommendations.

“Although it is not surprising, it is concerning that we found that drivers with sleep apnea frequently minimize or underreport symptoms such as snoring and daytime sleepiness,” Parks said. “In our study, the majority of truck drivers did not follow through on physician recommendations for sleep studies and sleep apnea treatment. As a result, it is possible that many of the 14 million truck drivers on American roads have undiagnosed or untreated sleep apnea.”

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Dr. Stefanos N. Kales, medical director of Employee and Industrial Medicine at Cambridge Health Alliance, which assisted with the study, said it is “very likely that most of the drivers who did not comply with sleep studies or sleep apnea treatment sought medical certification from examiners who do not screen for sleep apnea and are driving with untreated or inadequately treated sleep apnea.”

The Federal Motor Carrier Safety Administration is considering recommendations to require sleep apnea screening for all obese drivers based on body mass index or BMI, which is calculated based on height and weight. FMCSA requires medical certification of licensed commercial drivers at least every two years. “OSA screenings of truck drivers will be ineffective unless they are federally mandated or required by employers,” Kales said.

The study’s authors also are opposed to so-called “doctor shopping” by drivers. “Such action would prohibit drivers diagnosed with a serious disorder that might limit driving or require treatment to seek out more lenient or less rigorous medical examiners,” Kales said.

Lifespan is Rhode Island’s largest healthcare system, and Cambridge Health Alliance is a healthcare system with three hospitals based in Somerville, Mass.