Following a December-made promise for more clarification of current sleep apnea guidelines for medical examiners, the Federal Motor Carrier Safety Administration posted earlier this month a bulletin telling examiners that if they suspect a driver may have sleep apnea, then he or she should be sent to a sleep specialist for evaluation.
The agency did not publicize the bulletin, which was published on the agency’s National Registry of Certified Medical Examiners website.
The clarification says FMCSA “recommends that, if a medical examiner believes the driver’s respiratory condition is in any way likely to interfere with the driver’s ability to safely control and drive a commercial motor vehicle, the driver should be referred to a specialist for further evaluation and therapy.”
Further, if an examiner suspects a driver may have sleep apnea or the driver reports a diagnosis, the examiner should “consider referring the driver to a specialist for evaluation” before the driver receives medical certification.
The agency has taken heat over its lack of clear-cut guidelines for medical examiners on screening for and treating obstructive sleep apnea. Its hands were also tied by Congress in 2013, when lawmakers passed a bill that forbids FMCSA from pursuing guidance to address sleep apnea screening and rather directed the trucking regulator to use the formal rulemaking process instead.
The bulletin, published Jan. 12, is a reminder to medical examiners that there is no guidance, and instead refers them to advisory materials published in 2000, which notes the above recommendations on screening and evaluation.
The agency also “encourages” examiners to consider several other points:
AHI > or = 15: Drivers with “moderate-to-severe” obstructive sleep apnea are the primary targets for necessary treatment. Crucially, the bulletin defines moderate-to-severe apnea as a condition illustrated by an “apnea-hypopnea index (AHI) of greater than or equal to 15.”
Drivers with apnea not automatically unfit: Drivers are not required to be “considered unfit to continue their driving careers” — medical examiners should “make a determination whether they need to be evaluated and, if warranted, demonstrate they are managing their OSA to reduce the risk of drowsy driving.”
Examiners have wide latitude on screening: Though the bulletin acknowledges that FMCSA has no current advisory guidance on screening of drivers for undiagnosed apnea, “medical examiners should consider common OSA symptoms such as loud snoring, witnessed apneas, or sleepiness during the major wake periods.” Risk factors like high body-mass-index measurements, neck size, incidence of a single-vehicle crash and others are also mentioned.
Drivers/specialists have options on testing: In diagnosing apnea, examiners should rely on “in-laboratory polysomnography, at-home polysomnography, or other limited-channel ambulatory testing devices which ensure chain of custody.”
Drivers have wide latitude on treatment options: FMCSA underscores that sleep apnea “is a treatable condition, and drivers with moderate-to-severe OSA can manage the condition effectively to reduce the risk of drowsy driving.” The bulletin goes on to encourage options not limited to Continuous Positive Airway Pressure (CPAP) therapy but also weight loss, dental appliances and/or treatments utilized in combination.