Factors Associated With Obstructive Sleep Apnea Among Commercial Motor Vehicle Drivers

Abstract

Medical examiners' use of objectively measurable risk factors, such as obesity, history of hypertension, and/or diabetes, rather than symptoms, may be more effective in identifying undiagnosed OSA in commercial drivers during the commercial driver medical examinations.

Management of Obstructive Sleep Apnea in Commercial Motor Vehicle Operators: Recommendations of the AASM Sleep and Transportation Safety Awareness Task Force

“…Although CMVOs can be penalized for making false or misleading statements about disqualifying conditions during an examination by a member of the National Registry of Certified Medical Examiners, false reporting and underreporting have been documented (see Section 7.0). [51][52][53]55 Nonetheless, the lack of symptom disclosure could also lead to denial of insurance coverage for recommended testing.…”

“…[51][52][53]55 By using guidelines provided by the Joint Task Force (which rely on the same BMI threshold of ≥ 35 kg/m 2 , which was recommended by the Medical Review Board of the Motor Carrier Safety Advisory Committee), only 10% to 13% of commercial truck drivers screen positive, [51][52][53]55 despite the fact that the estimated prevalence of OSA in this group is much higher (see Section 2.2). Furthermore, none of those identified as high-risk then marked "yes" to the question about sleep disorders on the CDME form 53 ; of those identified as high risk who completed the recommended PSG testing, 79% to 100% had confirmed OSA [51][52][53]55 ; only one individual returned and showed adherence with PAP therapy 52 ; and 34% to 81% did not return to the medical examiner for follow-up evaluation. [51][52][53]55 No trials have explored the reasons for PAP non-adherence in this group, or ways to address it.…”

“…Furthermore, none of those identified as high-risk then marked "yes" to the question about sleep disorders on the CDME form 53 ; of those identified as high risk who completed the recommended PSG testing, 79% to 100% had confirmed OSA [51][52][53]55 ; only one individual returned and showed adherence with PAP therapy 52 ; and 34% to 81% did not return to the medical examiner for follow-up evaluation. [51][52][53]55 No trials have explored the reasons for PAP non-adherence in this group, or ways to address it. Programs that mandate treatment, 6,16 however, such as the one by Schneider, have shown that adherence improves crash rates.…”

Risk factors, health behaviors, and injury among adults employed in the transportation, warehousing, and utilities super sector

“…A review of a U.S. health insurer's medical claims data reports that local and interurban passenger transit workers have an elevated prevalence for hypertension, depression, cardiovascular disease, and diabetes compared to other occupational groups [Bushnell et al, 2011]. Two recent studies report that driver's selfassessed obesity, hypertension and diabetes contribute to their obstructive sleep apnea [Smith and Phillips, 2011;Xie et al, 2011]. A naturalistic (on-road) study of professional truck drivers indicates a link between obesity and fatigue, a major safety issue surrounding commercial motor vehicle operations given the long hours drivers spend on the road [Wiegand et al, 2009].…”

Commercial Motor Vehicle Driver Positive Airway Pressure Therapy Adherence in a Sleep Center

“…[9][10][11] Protocols employing more broad OSA risk factor assessment have been shown to increase detection of undiagnosed and previously diagnosed OSA in occupational settings compared to current federal requirements. [12][13][14][15][16][17] OSA treatment recommendations, including minimum adherence standards for positive airway pressure (PAP) therapy utilization, are also provided within expert panel publications. [9][10][11] A detailed overview of these recommendations is available in a separate article.…”