Sleep apnea in truckers
Large truck accidents are potentially serious due to the size, weight, and speed of these commercial vehicles. The Federal Motor Carrier Administration (FCMSA) study of large truck accidents revealed that 50% of such accidents result in fatal or disabling injuries. The truck driver was found to be at fault in 87% of these accidents, and in 7% the driver admitted to falling asleep while driving. Truck accidents result in more than 5,200 deaths a year and more than 125,000 injuries. These figures are likely just the tip of the iceberg regarding the total number of truck accidents due to driver fatigue. Obstructive sleep apnea is a common disorder among commercial vehicle drivers, with a prevalence believed to be between 17% and 28%. Since there are approximately 14 million commercial driver’s license holders in the United States, it is expected that between 2.4 and 3.9 million of these drivers will be affected by OSA.
Unfortunately, OSA is often unrecognized and underreported by professional drivers and their employers, and often underdiagnosed by physicians. OSA has been shown to significantly increase a driver’s danger of drowsy driving. Medical research shows that drivers with undiagnosed OSA have a 2- to 7-fold increased risk of falling asleep at the wheel and increases a person’s chance of developing major health problems such as high blood pressure, stroke, ischemic heart disease, and cardiovascular disorders. Mood. Studies suggest that commercial motor vehicle (CMV) operators have a higher prevalence of OSA than the general population. The likelihood of having sleep apnea depended on two key elements: age and degree of obesity, and the prevalence increased with both. FMCSA population projections indicate that the number 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) should be a high public safety priority.
US federal statute requires commercial motor vehicle drivers to have medical qualification exams at least every 2 years. This section states that the driver must not have “an established medical history or clinical diagnosis of respiratory dysfunction that would interfere with the ability to control and drive a commercial vehicle.” motor vehicle safely.” However, the FMCSA medical examination form only includes a single question about sleep problems, even though there are strong financial incentives for drivers to deny a history or symptoms of a sleep disorder. In fact , the most recent studies have shown that only 15% responded in the affirmative to the single sleep-related question on the driver’s medical assessment form among drivers who were subsequently shown to have substantial OSA.
In order to address these issues, the American College of Chest Physicians, the American College of Occupational and Environmental Medicine, along with the National Sleep Foundation, published a consensus document. These criteria were proposed based on a careful evaluation of the literature to help medical examiners identify individuals who may have OSA and therefore require a sleep study, both to protect the long-term health of the driver and to ensure public safety on the road. roads Suggestions consist of:
1) definition of sleep apnea;
2) current regulations, recommendations and guidelines;
3) identification of patients at risk of 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 a recent report of the medical literature, of 134 results of sleep studies performed based on consensus criteria, 94.8% of people had OSA. This investigator also reviewed 10 large truck crashes resulting in the driver losing control of the motor vehicle for which the carrier is being sued for at least $1 million. Of those 10, their review of CDME medical exams prior to the accident suggests that at least 4 of the 10 would have been required to be tested for OSA based on consensus criteria.
These recommendations suggest certifying a driver with lower risk of sleep apnea for a maximum of three months, pending medical evaluation (in-service evaluations), while drivers with more significant risk factors or a motor vehicle accident likely related to sleep disorders should be prohibited. from the time they return to work until they receive a medical evaluation (off-duty evaluations). In addition, the task force suggests expanding the screening process to include a much more extensive medical history, noting risk factors such as body mass index, neck circumference, history of OSA, and history of comorbidities. For those diagnosed with sleep apnea, experts strongly recommend using positive airway pressure for no less than four hours within a 24-hour period via a machine that can time the pressure. Current guidelines do not specify the minimum use of positive airway pressure.
Not only will the driver and the general public benefit from these recommendations, but recent large-scale clinical research has already shown substantial employer rewards in lowering medical costs, reducing absenteeism, improving productivity, and reducing accidents.
