Continuous Positive Airway Pressure machine

On February 6, 2012 the FMCSA came one step closer to developing sleep apnea regulations when a joint committee of the agency’s Motor Carrier Safety Advisory Committee and Medical Review Board adopted 11 recommendations that would, among other things, require all drivers with a body mass index (BMI) measurement of 35 or higher to be tested for sleep apnea.

In a January meeting 11 new recommendations were made based on seven key questions regarding sleep apnea, how to treat it, monitor it and it’s relationship with highway safety. Certainly the question on everyone’s mind is whether or not people with obstructive sleep apnea pose an increased risk in motor vehicle crashes compared with drivers who don’t.

Should sleep apnea be regulated outside of commercial drivers based on data used?

The OSA subcommittee linked crash risk with sleep apnea largely by extrapolating data from studies on noncommercial drivers (and one that involved commercial drivers) that showed a range of increased risk. “How many crashes actually occur because of this?” he asked. “The causal relationship has not been studied.” In addition based on this study should only commercial drivers be regulated or should all drivers of all motor vehicles be equally regulated? Based on the data it would be reasonable to conclude sleep apnea might be a risk for all drivers, not just commercial.

Sleep Apnea compared with alcohol use

Dr. Indira Gurubhagavatula of the Veteran’s Administration’s medical center, states sleep apnea is “an extremely treatable disorder and extremely prevalent among commercial drivers.” She cited obesity statistics that suggested well more than half of male adult commercial drivers were obese, a well-known apnea risk factor. She added that a study found that “people with severe apnea were impaired similar to the effect of an alcohol level of 0.05.”

English: The Cycle of Obstructive Sleep Apnea ...

The recommendations issued by the  Feb. 6th meeting see at risk drivers, rather drivers over a 35 BMI, screened for sleep apnea and be given a 60 day conditional medical certificate to allow time for testing. Medical professionals would also be allowed discretion on requiring testing and  issuing conditional medicals for persons under a BMI of 35.

Diagnoses and treatment

If the driver was diagnosed with sleep apnea they would have to complete a one week’s worth of treatment and be successful in it’s completion before being issued a 90 day certificate for further follow ups and evaluation of treatment compliance. Drivers then could be issued annual or one year medical certificates.

Testing methods would include at-home polysomnography tests with verifiable chain of custody (to keep testers from faking the test) and an in-lab overnight polysomnographytest, designated as the most comprehensive and accurate.

Finally the use of CPAP or Continuous Positive Airway Pressure machines would be the accepted method of treatment.

Accidents where sleepiness was reported

A second group of drivers – those with an apnea-hypopnea index (AHI) measurement greater than 20, who have reported experiencing excessive sleepiness during their major work period, day or night, or who have experienced a crash “associated with” falling asleep – would be denied the conditional certification.

Any rulemaking or guidance based on the recommendations would be put up for public comment, and a rulemaking would take years to develop, noted Minor. He said drivers could expect the interim recommended guidance issued by the joint committee last December to come up for a 30-day comment period this spring.

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