Nonadherence with Employer-Mandated Sleep Apnea Treatment and Increased Risk of Serious Truck Crashes

Abstract

A commentary on this article appears in this issue on page 961.

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

“…PAP is established, effective, and the most studied mode of treatment. Treatment with PAP reduces crash risk, 15,16,79 improves health, and decreases mortality, as discussed previously.…”

“…[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. 16 Therefore, a recommendation for PSG using existing guidelines yields high rates of positive diagnoses, suggesting that the BMI threshold of ≥ 35 kg/m 2 leaves high numbers of atrisk drivers untested.…”

“…Programs that mandate treatment, 6,16 however, such as the one by Schneider, have shown that adherence improves crash rates. 16 Therefore, a recommendation for PSG using existing guidelines yields high rates of positive diagnoses, suggesting that the BMI threshold of ≥ 35 kg/m 2 leaves high numbers of atrisk drivers untested. The failure of individuals with confirmed OSA to accept PAP therapy or return for follow-up evaluation suggests that doctor shopping was an issue.…”

“…Those who did not meet the PAP adherence criterion had a crash rate that was five-fold higher I Gurubhagavatula, S Sullivan, A Meoli, et al Management of OSA in Commercial Motor Vehicle Operators than that of drivers in the matched control group; drivers with OSA who met the PAP adherence criterion had crash rates statistically equivalent to the matched control group. 16 A follow-up study at Schneider 17 found that, of 255 CMVOs with a diagnosis of OSA and treated with CPAP, 75% had a preventable crash during the study period (pre-or post-CPAP). Among the drivers with crashes, 93% experienced their crash before treatment for OSA, whereas 25% were involved in a crash after CPAP treatment (a 73% reduction in total crashes).…”

Screening for obstructive sleep apnea in the transportation industry—the time is now

“…Over a ten year span from 2004 to 2013, it has been estimated that 3,133 to 8,952 deaths and 77,000 and 220,000 serious injuries have resulted from sleepy operators of commercial motor vehicles, many of whom most likely had undiagnosed and untreated OSA. (6) Given the severe consequences of unrecognized OSA on public safety and the high prevalence of unrecognized OSA among operators of trains, buses and commercial trucks, the imperative to screen and treat these persons for OSA is high. The advisory boards to the Federal Motor Carrier Safety Administration (FMCSA)have recommended that commercial truck drivers be screened for OSA if their body mass index is > 40 kg/m 2 , or >33 kg/m 2 and have 3 or more conditions or findings associated with OSA, but adoption of these recommendations has not occurred.…”