Sleep Apnea in Truck Drivers

Large truck accidents are potentially serious because of the size, weight and speed of these commercial vehicles. The Federal Motor Carrier Administration’s (FCMSA) Large Truck Crash Study revealed that 50 % of such accidents result in fatal or incapacitating injuries. The truck driver was judged to be at fault in 87% of these crashes, and in 7% the driver admitted to having fallen asleep while driving. Truck accidents result in over 5200 deaths annually and more than 125,000 injuries. These figures are likely only the tip of the iceberg regarding the total number of truck crashes due to driver fatigue. Obstructive sleep apnea is a common disorder among commercial vehicle drivers, with a prevalence believed to be between 17% to 28%. Given that there are roughly 14 million commercial drivers license holders in the United states, somewhere between 2.4 and 3.9 million of these drivers are expected to be affected by OSA.

Unfortunately, OSA often remains unrecognized or unreported by professional drivers and their employers, as well as undiagnosed by physicians. OSA has been shown to significantly enhance a driver’s danger of driving drowsy. Medical research demonstrates that drivers with undiagnosed OSA have an increased risk (2 to 7 times) for falling asleep at the wheel and increases the possibility of an individual developing important health issues such as hypertension, stroke, ischemic heart disease, and mood disorders. Studies suggest that commercial motor vehicle (CMV) operators have a higher prevalence of OSA than the general population. The chance of having sleep apnea depended on two key elements – age and degree of obesity – with prevalence increasing with both. Population projections by FMCSA indicate the amount of older drivers will increase by 50% over the next twenty years. Therefore, determining which truck drivers are most prone to excessive daytime sleepiness (EDS) must be a major public safety priority.

U.S. federal statute requires commercial motor vehicle drivers to undergo medical qualification examinations at least every 2 years-This section states that the driver must have “no established medical history or clinical diagnosis of respiratory dysfunction likely to interfere with the ability to control and drive a commercial motor vehicle safely.” Nonetheless, the FMCSA medical examination form only includes a single question on sleep problems, though strong economic incentives exist for drivers to deny a history or symptoms of a sleep disorder. In fact, latest studies have demonstrated that only 15% answered yes on the single sleep-related question on the driver medical evaluation form among drivers subsequently proven to have substantial OSA.

To be able to address these problems, a consensus document was published by the American College of Chest Physicians, the American College of Occupational and Environmental Medicine, along with the National Sleep Foundation. These criteria were proposed based on a thorough literature evaluation to assist medical examiners in detecting individuals who may possibly have OSA, and thus who may require a sleep study, both to protect the long-term health of the driver and to ensure public safety on the highways. The suggestions consist of:

1) definition of sleep apnea;

2) current regulations, recommendations, and guidelines;

3) identification of patients at risk for sleep apnea and diagnosis;

4) objective assessment of sleepiness and performance;

5) identification of CMV drivers with sleep apnea who are at high risk for crashes;

6) management of sleep apnea in the CMV driver;

7) practical considerations;

8) additional research questions.

In one recent medical literature report, out of 134 sleep study results performed because of the consensus criteria, 94.8% of the individuals had OSA. This researcher also reviewed 10 large truck crashes resulting from driver loss of motor vehicle control for which the carrier is being sued for at least 1 million dollars. Of those ten, their review of the CDME medical examinations prior to the crash suggests that at the very least 4 out of the 10 would have been required to be tested for OSA by the consensus criteria.

These recommendations suggest certifying a driver at lower risk for sleep apnea for a maximum of three months, pending a medical evaluation (in-service evaluations), while drivers with more significant risk factors or a motor vehicle crash likely related to sleep disturbances must be prohibited from returning to work until they receive a medical evaluation (out-of-service evaluations) Furthermore, the task force suggests expanding the screening process to involve a far more extensive medical history, flagging such risk factors as body mass index, neck circumference, family background of OSA, and history of comorbidities. For those diagnosed with sleep apnea, experts strongly recommend utilizing positive airway pressure for no less than four hours within a 24-hour period via a machine that is able to measure time on pressure. Current guidelines do not specify minimum use of positive airway pressure.

Not only will the driver and the public at large benefit from these recommendations, but a large scale recent clinical investigation has already proven substantial rewards to the employer by lowering medical costs, reducing absenteeism, improving productivity, and fewer accidents.