Sleep Apnea Screening for Commercial Drivers: A Retrospective Comparison of the 2016 FMCSA MRB Recommendations and the 2006 Joint Task Force Consensus Guidelines

Enhancing Workplace Wellness: A Comprehensive Approach to Sleep Apnea Screening in Onsite Health

BACKGROUND

This quality improvement project aimed to increase the screening rate for OSA in individuals aged 18 and above with obesity (body mass index [BMI] ≥30).

METHODS

This quality improvement study occurred from March 2023 to August 2023 using a two-independent pre-implementation post-implementation design. The STOP-Bang Questionnaire (SBQ) was implemented during annual exams, chronic disease management visits, and Department of Transportation (DOT) physicals.

FINDINGS

There were 946 patients involved in the study, including 471 in the pre-implementation group and 475 in the post-implementation group. OSA screening increased from 14.1% to 71.6% after implementing the screening protocol in the general population and 26.7% to 90.4% in the commercial driver's license (CDL) holder population. Of the CDL holders screened in the pre-intervention group, 15 (65.2%) were at intermediate to high risk for OSA (SBQ ≥3), and in the post-intervention group, 33 (50%) had an SBQ score of ≥3.

CONCLUSIONS/APPLICATION TO PRACTICE

Standardized OSA screening is crucial because it is common but underdiagnosed. Screening for OSA during DOT exams promotes community safety. Earlier identification of at-risk patients leads to earlier diagnosis and treatment of OSA to prevent long-term complications, reduce healthcare costs, improve patient outcomes, and improve community safety.

Insights into the Use of Point-of-Care Ultrasound for Diagnosing Obstructive Sleep Apnea

Obstructive sleep apnea (OSA) is a sleeping disorder caused by complete or partial disturbance of breathing during the night. Existing screening methods include questionnaire-based evaluations which are time-consuming, vary in specificity, and are not globally adopted. Point-of-care ultrasound (PoCUS), on the other hand, is a painless, inexpensive, portable, and useful tool that has already been introduced for the evaluation of upper airways by anesthetists. PoCUS could also serve as a potential screening tool for the diagnosis of OSA by measuring different airway parameters, including retropalatal pharynx transverse diameter, tongue base thickness, distance between lingual arteries, lateral parapharyngeal wall thickness, palatine tonsil volume, and some non-airway parameters like carotid intima-media thickness, mesenteric fat thickness, and diaphragm characteristics. This study reviewed previously reported studies to highlight the importance of PoCUS as a potential screening tool for OSA.

Obstructive sleep apnea screening, diagnosis, and treatment in the transportation industry

Obstructive sleep apnea (OSA) is a common, identifiable, and treatable disorder with serious health, safety, and financial implications-including sleepiness- related crashes and incidents-in workers who perform safety-sensitive functions in the transportation industry. Up to one-third of crashes of large trucks are attributable to sleepiness, and large truck crashes result in more than 4,000 deaths annually. For each occupant of a truck who is killed, 6 to 7 occupants of other vehicles are killed. Treatment of OSA is cost-effective, lowers crash rates, and improves health and well-being. A large body of scientific evidence and expert consensus supports the identification and treatment of OSA in transportation operators. An Advanced Notice of Proposed Rulemaking regarding the diagnosis and treatment of OSA in commercial truck and rail operators was issued by the Federal Motor Carrier Safety Administration and Federal Railroad Administration, but it was later withdrawn. This reversal of the agencies' position has caused confusion among some, who have questioned whether efforts to identify and treat the disorder are warranted. In response, we urge key stakeholders, including employers, operators, legislators, payers, clinicians, and patients, to engage in a collaborative, patient-centered approach to address the disorder. At a minimum, stakeholders should follow the guidelines issued by a medical review board commissioned by the Federal Motor Carrier Safety Administration in 2016 alone, or in combination with the 2006 criteria, "Sleep Apnea and Commercial Motor Vehicle Operators," a Statement from the Joint Task Force of the American College of Chest Physicians, the American College of Occupational and Environmental Medicine, and the National Sleep Foundation developed by a joint task force. As research in this area continues to evolve, waiting is no longer an option, and the current standard of care demands action to mitigate the burden of serious health and safety risks due to this common, treatable disorder.

CITATION

Das AM, Chang JL, Berneking M, Hartenbaum NP, Rosekind M, Gurubhagavatula I. Obstructive sleep apnea screening, diagnosis, and treatment in the transportation industry. J Clin Sleep Med. 2022;18(10):2471-2479.

Enhancing public health and safety by diagnosing and treating obstructive sleep apnea in the transportation industry: an American Academy of Sleep Medicine position statement

Obstructive sleep apnea (OSA) may lead to serious health, safety, and financial implications-including sleepiness-related crashes and incidents-in workers who perform safety-sensitive functions in the transportation industry. Evidence and expert consensus support its identification and treatment in high-risk commercial operators. An Advanced Notice of Proposed Rulemaking regarding the diagnosis and treatment of OSA in commercial truck and rail operators was issued by the Federal Motor Carrier Safety Administration and Federal Railroad Administration, but it was later withdrawn. This reversal has led to questions about whether efforts to identify and treat OSA are warranted. In the absence of clear directives, we urge key stakeholders, including clinicians and patients, to engage in a collaborative approach to address OSA by following, at a minimum, the 2016 guidelines issued by a Medical Review Board of the Federal Motor Carrier Safety Administration, alone or in combination with 2006 guidance by a joint task force. The current standard of care demands action to mitigate the serious health and safety risks of OSA.

CITATION

Das AM, Chang JL, Berneking M, et al. Enhancing public health and safety by diagnosing and treating obstructive sleep apnea in the transportation industry: an American Academy of Sleep Medicine position statement. J Clin Sleep Med. 2022;18(10):2467-2470.

Fatigue in NTSB-investigations 2013-2019: evidence of accidents and injuries

ABSTRACTThis study updates the prevalence of operator fatigue as a causative factor in accidents investigated by the National Transportation Safety Board (NTSB) and the associated injury severity in fatigue-related accidents. 394 investigations were analyzed and 12% of them were identified fatigue. The prevalence of fatigue varied among the transportation modes, ranging from 28% of aviation to 7% of marine. Most fatigue-related accidents (48%) occurred during late night or morning. Compared to non-fatigued operators, fatigued operators were more involved in severe or fatal injuries (odds ratio (OR)  =  2.30; 95% confidence interval (CI) [1.66, 2.95]) and to injure non-operators (OR = 3.32; 95% CI [2.70, 3.95]). Obstructive sleep apnea (OSA) was identified as a probable cause, contributing cause, or finding in 15% of fatigued-related accidents, and 85.7% of these accidents, the operator met OSA screening criteria. Thus, opportunities remain for preventing fatigue-related accidents, including through more systematic operator screening for OSA.

Risk of obstructive sleep apnea among taxi-motorbike drivers in Parakou city in West Africa and associated factors with road traffic accidents

OBJECTIVES

Obstructive sleep apnea (OSA) is an underdiagnosed chronic respiratory disease, causing excessive daytime sleepiness (EDS) and road traffic accidents (RTA). This study aimed to determine the risk of OSA among taxi-motorbike drivers (TMD) and factors associated with RTA in Parakou, Benin.

METHODS

A cross-sectional comparative study was carried out between July and September 2020, including 225 TMD and 450 motorbike drivers other than TMD (non-TMD). A multiple logistic regression was then performed to determine factors associated with RTA.

RESULTS

The mean age of participants was 38.2 ± 10.2 and 36.6 ±10.9 years, respectively, for TMD and non-TMD (p = .048). The average daily working time was 10.7 ± 2.3H and 9.1±3.5H, respectively, for TMD and non-TMD (p < .001). Average sleeping time was comparable in both groups (7.5±1.4H vs 7.4±1.4H; p = .415). TMD significantly more complained of non-restorative sleep (38.7% vs 18.4%; p < .001) but less of EDS (20.0% vs 28.7%; p = .015). Abdominal obesity predominated in TMD (13.8% vs 4.4%; p < .001). An increased risk of OSA (NoSAS score ≥8) was diagnosed in 25.8% TMD and 26.7% non-TMD (p = .805). Overall, 25.8% of TMD and 18.4% of non-TMD (p = .027) reported at least one RTA in the last 12 months. After adjusted analysis, the unique factor associated with RTA was a daily sleeping pills consumption (aOR=2.2; 95%CI = 1.2-3.8; p = .006).

CONCLUSION

There is need to improve systematic screening and diagnosis of OSA in both TMD and non-TMD and reinforce the regulation and consumption of sleeping pills.