Medical board’s rec’s to FMCSA on sleep apnea could preview rule

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Updated Aug 25, 2016

sleep apneaThe Medical Review Board of the Federal Motor Carrier Safety Administration outlined this week its official recommendations to the agency on screening and disqualification criteria for truck drivers who are suspected of having moderate to severe obstructive sleep apnea.

The board’s preliminary recommendations, which have not yet been approved by the board, encourage FMCSA to require a trucker to be screened for sleep apnea if he or she:

(1) has a body mass index greater than 40, or

(2) has a body mass index greater than 33 and meets three of the following: is older than 42, is male, is a postmenopausal female, has diabetes, has high blood pressure, has a neck size greater than 17 inches (males) or 15.5 inches (females), has a history of heart disease, snores loudly, has witnessed apneas, has a small airway, has untreated hypothyroidism or has micrognathia or retrognathia.

So male truck operators older than 42 and who have a BMI of 33 would only need to meet one of the other criterion to automatically qualify for screening.

The board also would recommend that FMCSA allow truckers with a sleep apnea diagnosis to continue to operate if they’re being “treated effectively,” which is defined as “the resolution of moderate to severe OSA to mild or better, as determined by a certified sleep specialist,” according to the board’s preliminary discussion report.

These recommendations — and the others discussed by the board this week — are not yet final, however, as the board did not vote to approve them. Another meeting will be needed to finalize and approve the recommendations. No meeting date is set yet.

Also, the recommendations are only recommendations. FMCSA has no legal requirement to adopt any of the board’s suggestions, but it will likely lean on them when developing a sleep apnea rule, if it chooses.

The board based its recommendations on multiple public meetings held this year, in which board members heard testimony from truckers and industry advocacy groups, along with expert testimony from doctors. The board also relied on formal public comments made on its “pre-rule” questionnaire to the industry about apnea’s prevalence, screening and treatment, costs and more.

The meetings and the formal questionnaire were not only initiated to determine what a sleep apnea rule may look like, but to determine if a rule was needed at all. Some commenters in the meetings and in the pre-rule comments nipped the agency for not seeking data on sleep apnea’s correlation to crashes.

There are also industry-wide concerns about the costs associated with a sleep apnea rule, particular to truckers, as screening and treatment often require costly out-of-pocket expenses, even if they’re insured.

Among other preliminary recommendations outlined by the board this week is a provision to limit truckers who’ve received a sleep apnea diagnosis to a yearly medical certification, even if the diagnosis was for mild apnea.

This means truckers with any type of apnea diagnosis would need to be recertified at least annually, if not more often, rather than the standard every-other-year certification.

The board also spelled out screening and treatment requirements and a conditional certification measure. Medical examiners under the board’s recommendations would be able to issue 90-day condition medical certifications to truckers who’ve been referred for sleep screening based on the aforementioned risk factors (BMI, etc.). Such truck operators would be required to be tested and begin treatment within the allotted 90 days.

A full year’s certification could be issued afterward.

Discussed treatment options in the board’s preliminary report include (1) use of PAP machine or other oral appliance, (2) bariatric surgery, (3) oropharyngeal surgery or facial bone surgery and (4) tracheostomy.