A new study in the Journal of Occupational and Environmental Medicine reiterates previous findings that tests to evaluate truck drivers for obstructive sleep apnea (OSA) based on obesity are effective and should be utilized. The authors of this study go a step further by suggesting the implementation of federally mandated OSA screenings for the trucking industry.
“OSA screenings of truck drivers will be ineffective unless they are federally mandated or required by employers,” says senior author Stefanos N. Kales, MD, MPH, medical director of employee and industrial medicine at Cambridge Health Alliance.
During the 15-month study, 456 commercial drivers were examined, with 17% meeting the screening criteria for suspect OSA. The 17% who met the criteria were older, were more obese, and had higher average blood pressures. This statistic, coupled with the authors’ belief that truck drivers with undiagnosed OSA frequently minimize or underreport symptoms (snoring, daytime sleepiness) to their primary physicians, supports the argument for regulated OSA screenings in the industry.
“In our study, the majority of truck drivers did not follow through on physician recommendations for sleep studies and sleep apnea treatment,” says lead author Philip Parks, MD, MPH, medical director of Lifespan’s employee health and occupational services. “As a result, it is possible that many of the 14 million truck drivers on American roads have undiagnosed or untreated sleep apnea.”
Of the 53 drivers referred for sleep studies, 33 did not comply and were lost to follow-up. The remaining 20 were all confirmed to have OSA, but only one of those people complied with treatment recommendations.
“It is very likely that most of the drivers who did not comply with sleep studies or sleep apnea treatment sought medical certification from examiners who do not screen for sleep apnea and are driving with untreated or inadequately treated sleep apnea,” says Kales.
The results of this study fuel debate over whether the Federal Motor Carrier Safety Administration should require OSA screening for all obese drivers based on body mass index (BMI). As it stands now, the Administration requires medical recertification of licensed commercial drivers at least every 2 years, which could present an opportunity for detecting OSA. Additionally, the study authors express the necessity to prohibit “doctor shopping”—the process of seeking doctors who might be more lenient medical examiners.
Do you think federally mandated screenings of truck drivers is the solution to the problem of truck drivers with undiagnosed OSA? How would federally mandated OSA screenings for truck drivers impact your lab? Join the discussion at Sleep Review’s Facebook page.