Obstructive Sleep Apnea In Commercial Drivers Research Articles

Work-Related Sleep Disorders: Causes and Impacts.

Insufficient sleep syndrome, shift work disorder, and obstructive sleep apnea (OSA) not only significantly impact the health of affected individuals, but also pose a threat to public safety. This article describes the clinical manifestations and impact of these sleep disorders, particularly as they pertain to workers' health and those with safety-sensitive positions. Sleep deprivation, circadian rhythm disruptions, and excessive daytime sleepiness-hallmarks of insufficient sleep, shift work disorder, and OSA, respectively-all lead to a series of cognitive deficits and impaired concentration that affect workers in a wide variety of fields. We describe the health consequences of these disorders along with treatment strategies, with a focus on current regulatory standards and the under-recognition of OSA in commercial drivers. Given its large scale, there is a need for improved guidelines and regulations for the screening, diagnosis, treatment, and long-term follow-up of OSA in commercial motor vehicle drivers. Increased recognition of the ways in which these sleep disorders impact workers will pave the way for significant improvements in occupational health and safety.

Obstructive sleep apnea (OSA) and reaction time in commercial vehicle drivers- an exploratory study

ContextRoad traffic accidents [RTA] are a major cause of morbidity and mortality in India. Obstructive sleep apnea [OSA] has been identified world over as one of the risk factors in vehicle collisions. The estimated death due to RTA attributable to OSA is largely unknown. AimAim of the study was to estimate the risk of OSA in commercial drivers and see the relationship with reaction times. Setting and DesignProspective exploratory study in a metropolitan city. MethodCommercial vehicle drivers with a minimum of 5 years driving experience were administered STOPBANG questionnaire for identification of risk of OSA. Driving history and details related to collisions were elicited using a questionnaire. Anthropometric measures, visual and auditory reaction times were assessed. ResultsBased on the questionnaire, 35% of the drivers were at risk for OSA. Drivers with high risk of OSA showed reduced auditory reaction time. Anthropometric measurements of the drivers with risk of OSA were significantly higher from those without OSA. There was no significant correlation between OSA and collisions. ConclusionPrevalence of risk for OSA is high among commercial vehicle drivers, however it not the single risk factor contributing to collisions. OSA along with reduced reaction time could probably increases the risk of vehicular collisions.

Screening Commercial Vehicle Drivers for Obstructive Sleep Apnea: Tools, Barriers, and Recommendations.

Obstructive sleep apnea (OSA) is a disorder characterized by a cessation of breathing during sleep, leading to poor sleep patterns and daytime somnolence. Daytime somnolence is of particular concern for commercial vehicle drivers, whose crash risk increases 50% with untreated OSA. The process of diagnosing and treating OSA in commercial drivers begins with effective and consistent screening. Therefore, the researchers screened drivers with both the STOP-Bang Questionnaire and the Obstructive Sleep Apnea Evaluation Worksheet (OSAEW) and compared the two tools. Drivers screening positive on the STOP-Bang Questionnaire, OSAEW, and both questionnaires were 28%, 23%, and 13%, respectively. Sleep study referrals were made for 50 drivers; 12 drivers were scheduled for sleep tests within 3 months. Health care provider referral rates for drivers screening at high risk (37%) and commercial driver monitoring rates (24%) were both low. Recommendations to improve OSA screening and testing practices include Federal Motor Carrier Safety Administration-mandated screening and referral guidelines, employee-facilitated sleep testing, and OSA awareness campaigns.

Factors Associated With Obstructive Sleep Apnea Among Commercial Motor Vehicle Drivers

Identify factors associated with obstructive sleep apnea (OSA) risk during commercial driver medical examinations. A case-control study was conducted at an occupational health clinic by reviewing the commercial driver medical examinations medical records performed from January 2007 to December 2008. The magnitude of association with OSA was estimated with logistic regression. Among 1890 commercial motor vehicle drivers, 51 were confirmed positive for OSA by polysomnography after initial screening by Joint Task Force guidelines, yielding estimated positive predictive values of 78.5% for the screening criteria. Multivariable logistic regression showed that body mass index ≥ 30 (odds ratio: 26.86), hypertension (odds ratio: 2.57), and diabetes (odds ratio: 2.03) were independently associated with OSA. Medical examiners' use of objectively measurable risk factors, such as obesity, history of hypertension, and/or diabetes, rather than symptoms, may be more effective in identifying undiagnosed OSA in commercial drivers during the commercial driver medical examinations.

Consensus Criteria for Screening Commercial Drivers for Obstructive Sleep Apnea: Evidence of Efficacy

To validate the recently published consensus criteria for screening commercial drivers for obstructive sleep apnea (OSA). A large, consecutive case series of commercial drivers was screened for OSA at a single occupational medicine clinic and those screening positive were referred for overnight polysomnography. One hundred ninety (13%) of 1443 individuals having commercial motor vehicle driver examinations screened positive for OSA. None of these would have been detected if the only screening were the questions on the current Commercial Driver Medical examination form. One hundred thirty-four underwent polysomnography, and of those 94.8% had OSA, which is the best estimate of the positive predictive value of these consensus criteria in a population of truck drivers. The proposed screening criteria have a high positive predictive value in this population. This study lends support for the requirement to screen for OSA in commercial drivers.

Sleep Apnea and Commercial Motor Vehicle Operators:

Obstructive sleep apnea (OSA) has been demonstrated to significantly increase safety and health risks. Medical research has shown that OSA is a significant cause of motor vehicle crashes (resulting in a two- to sevenfold increased risk) and increases the possibility of an individual developing significant health problems 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. U.S. federal statute requires CMV drivers to undergo medical qualification examinations at least every 2 years—the federal medical standard that deals with OSA is section 49 CFR 391.41(b)(5) of the Federal Motor Carrier Safety Regulations. 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.” Recently, the Federal Motor Carrier Safety Administration (FMCSA) changed the medical examination reporting form to include a question that asks a driver whether he or she has a sleep disorder, pauses in breathing while asleep, daytime sleepiness, or loud snoring. So far, the only guidance available from FMCSA on the diagnosis and treatment of OSA in CMV drivers was issued in 1991, the result of a report from a conference sponsored by the Federal Highway Administration. However, in the past 15 years, there has been a tremendous increase in the scientific and clinical knowledge regarding the diagnosis and treatment of OSA. This new information is not reflected in the current FMCSA guidance and has created challenging and, at times, conflicting approaches to managing OSA in commercial drivers. Because public safety has always been of the highest priority when determining acceptable risk in relation to medical conditions in CMV drivers (this differs significantly from the usual approach in clinical medicine), it is well accepted that when assessing risk of accidents due to a medical condition, CMV drivers are held to a higher medical standard than the general population. Given the public safety risks associated with OSA, its prevalence in the CMV driver population, and the fact that the guidance on OSA diagnosis and management is 15 years old, the American College of Chest Physicians, the American College of Occupational and Environmental Medicine, and the National Sleep Foundation convened a Task Force to address this important safety and medical risk in CMV drivers. The Task Force pursued the following activities: 1) review the existing scientific literature related to the diagnosis and management of OSA; 2) review the medical standards and guidelines related to OSA from U.S. Department of Transportation agencies and equivalent international groups; 3) review other relevant reports and recommendations from the National Transportation Safety Board, FMCSA, and others; 4) draft a preliminary document of findings; 5) develop recommendations related to screening, diagnosis, treatment, return to work, and follow up; and 6) address other relevant topics such as compliance, duration of certification, and research needs. This report of the Task Force provides the detailed findings of the extensive reviews conducted of documents from diverse resources on many relevant topics. The detailed reviews address the following areas: 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; and 8) additional research questions. Findings formed the foundation for consensus recommendations regarding the diagnosis and management of OSA in commercial drivers. The information presented in the eight sections are not summarized here, but rather provided in detail with references in the report. The recommendation categories focus on the following: Screening; Diagnosis; Treatment; Compliance and efficacy; Return to work after treatment for OSA; and Follow up. The tables included in this article provide an overview of these recommendations. However, the Task Force recommends that the commercial driver medical examiner (CDME) evaluate each driver individually and make a judgment about his or her fitness for duty based on specific criteria, including those listed in the tables in this article. These criteria cannot predict every situation faced by the examiner, and the final judgment belongs to the CDME. Additional testing is optional, based on clinical judgment, to document absence of excessive somnolence.Table: Screening Recommendation for Commercial Drivers With Possible or Probable Sleep ApneaTable: Recommendation Regarding the Evaluation for Fitness-for-Duty for Commercial Drivers With Possible or Probable Sleep Apnea