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Truckers Drive Their Own Assessment for Obstructive Sleep Apnea: A Collaborative Approach to Online Self-Assessment for Obstructive Sleep Apnea

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B. Smith and B. Phillips, "Truckers Drive Their Own Assessment for Obstructive Sleep Apnea: A Collaborative Approach to Online Self-Assessment for Obstructive Sleep Apnea", Journal of Clinical Sleep Medicine, vol. 7, no. 3, pp. 241-245, 2011.

Abstract

Background. Commercial motor vehicle drivers are at an increased risk for Obstructive Sleep Apnea (OSA). The Federal Motor Carrier Safety Administration (FMCSA) Medical Review Board has recommended that commercial motor vehicle drivers undergo testing for OSA if they have a positive Berlin Questionnaire or a BMI > 30 kg/m2. We developed an online screening tool based on the Berlin Questionnaire for anonymous use by commercial drivers to assess their risk of OSA prior to their required FMCSA physicals.

Methods. We based the survey on the Berlin Sleep Questionnaire. The survey was hosted on the Truckers for a Cause Chapter of Alert Well and Keeping Energetic of the American Sleep Apnea Association (TFAC-AWAKE) organization website, and was promoted through the TFAC’s XM radio, word of mouth and trucking industry press contacts.

Results. 595 individuals completed the survey. Of these, 55.9% were positive on the Berlin, 78.3% had either hypertension or obesity, 69.6% were obese, 47.6% had a BMI > 33 kg/m2, and 20.5% reported falling asleep at stoplights.

Conclusions. Some commercial drivers willingly assess their OSA risk anonymously online, and a majority of those who do so are obese, have positive Berlin screening questionnaires, and would be required to undergo polysomnography if recommendations made to the FMCSA regulation. In contrast to reported behavior during actual Commercial Driver Medical Examinations physicals, some commercial drivers will report OSA symptoms if it is “safe” to do so. Sleep health professionals need expedient, non-punitive methods to keep commercial motor vehicle drivers healthy and driving and to raise drivers’ awareness of the dangers of drowsy driving and unhealthy lifestyles.

Background

Obstructive sleep apnea (OSA) is associated with an increased risk of motor vehicle crash[1-3], and effective treatment with continuous positive airway pressure (CPAP) reduces that risk[4]. Although evaluation of the risk for crash in commercial motor vehicle drivers with OSA has not been extensively evaluated[2]. it is likely that OSA increases the crash risk for those drivers as well. Commercial motor vehicle crashes carry an increased risk because of the size of the vehicles, the number of passengers, and the types of cargo that they may carry. Indeed, the fatality rate per 100 million vehicle miles travelled was higher for large trucks than for all vehicles in 2005[5]. Further, commercial motor vehicle drivers appear to be at increased risk for OSA, with some estimates as high as one in four commercial drivers having OSA[6-8].

The Federal Motor Carrier Safety Administration (FMCSA) of the Department of Transportation’s (DOT) primary mission is to reduce crashes, injuries and fatalities involving large trucks and buses. The process by which regulations and guidelines are developed is well described[9]. As part of this process, the FMCSA commissioned an evidence review and convened a Medical Expert Panel, which made recommendations about identification and management of OSA in commercial drivers[10]. Among the recommendations of the Medical Expert Panel were that certain individuals should be required to undergo evaluation to confirm the diagnosis of and to stratify the severity of OSA, including those categorized as high risk for OSA according to the Berlin Questionnaire[11]; those with a Body Mass Index (BMI) ≥ 33 kg/m2; or those judged to be at risk for OSA based on a clinical evaluation. After further review of the evidence and of the Medical Expert Panel’s recommendations, the Medical Review Board of the FMCSA recommended adopting the Medical Expert Panel’s report and recommendations in toto, with the exception that individuals with a BMI > 30 kg/m2 (rather than 33 kg/m2) should undergo evaluation for OSA[12].

As of this writing, these recommendations to the FMCSA have not yet been acted on by the FMCSA, but they are in the public domain on the DOT website, and have resulted in considerable discussion and anticipatory change. In particular, commercial drivers themselves are understandably concerned about the impact of these guidelines on their careers. As a service to its members, the Truckers for a Cause - Alert Well and Keeping Energetic (TFACAWAKE) organization of truck drivers sought to develop a truck driver sleep apnea selfevaluation web page to be hosted on the TFAC-AWAKE website, based on the proposed FMCSA guidelines for screening for OSA. Individuals from this organization approached us for assistance with screening tools and with website development to help drivers screen themselves for sleep apnea.

The aims of this study (in addition to establishing a tool that truck drivers could use to assess their risk for OSA) were to determine if commercial drivers would actually employ an online tool to assess risk, to collect demographic data from self-selected commercial drivers, and to make correlations between drowsy driving and risk factors for OSA. We hypothesized that some truckers would, indeed, use the online tool, and that a large proportion of those who chose to do so would have a high probability for OSA. We hypothesized that those who reported classic OSA symptoms (snoring, sleepiness) would be more likely to report drowsy driving, but that objective data (BMI, hypertension history) would predict sleepy driving better than would subjective data.

Methods

Results

Discussion

References

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