From The Desk Of Assistant Medical Director,
Ron Lamontagne, MS, APRN, BC:
SLEEP APNEA SCREENING AND THE DOT DRIVER
The Federal Motor Carrier Safety Administration (FMCSA) has for years been looking at sleep disorders and how they affect the commercial motor vehicle driver (CMV).
Sleep apnea is a serious, potentially life-threatening disorder. A person with this disorder may stop breathing for as long as 10 seconds or more during sleep. This interrupts the sleep-rest cycle and leaves the person feeling tired during the day and even falling asleep uncontrollably.
A Harvard University study showed that those with sleep apnea are 242% more likely to have a vehicle crash.
The prevalence of sleep apnea increases with age and degree of obesity.
It has become clear that the FMCSA will make a move in the near future on a regulatory change concerning screening and treatment of Obstructive Sleep Apnea (OSA).
After 6 months of public comment (Jan-June 2016) the Medical Review Board as well as the Motor Carrier Safety Advisory Committee at the October 24, 2016 meeting made the following recommendations:
- Individuals who report excessive sleepiness while driving
- Individuals who experience a crash associated with falling asleep
- Individuals who have been observed sleeping behind the wheel while operating the vehicle
- Individuals found non-compliant with OSA treatment
- Individuals with body mass index (BMI) equal or greater than 40 mg/kg
- Individuals with BMI equal to 33 or less than 40 mg/kg in addition to and at least 3 or more of the following:
- Hypertension (treated or untreated)
- Type 2 diabetes (treated or untreated)
- History of stroke, coronary artery disease, or arrhythmias
- Small or regressed chin
- Loud snoring
- Witnessed episodes of not breathing
- Small airway classification (Mallampati Classification)
- Neck size > 17” (male), > 15.5” (female)
- Hypothyroidism (untreated)
- Age 42 and above
- Male or post-menopausal female
METHODS OF SCREENING
Methods of diagnosis include in lab polysomnography (preferred especially in light of other co-existing medical conditions), as well as at-home sleep testing that ensures a chain of custody.
ALL sleep studies must be interpreted by a board-certified sleep specialist and the driver should be tested while on their usual medications.
Based on evidence based literature, CPAP (continuous positive airway pressure) is the preferred treatment for OSA.
Alternative forms of treatment may be possible based on a drivers special circumstances.
WHAT CAN A COMPANY DO
Recognize that drivers need to be alert when they report for duty.
Ensure that scheduling and dispatching practices do not compromise the opportunity for drivers to gain restorative sleep.