It used to be that the sleep medicine community would talk about the great opportunity that would come along should regulations be adopted for screening commercial drivers for sleep apnea. If regulations were passed, sleep medicine professionals could participate in securing safer roads across the country and have a new stream of patients who would need to be screened for sleep apnea. Now that it seems like these regulations are starting to finally come to fruition, the excitement appears to have fizzled. Is there still opportunity within the transportation industry for sleep professionals?
On April 20, 2012, Proposed Recommendations on Obstructive Sleep Apnea were published in the Federal Register. One week later, however, the Federal Motor Carrier Safety Administration (FMCSA) withdrew the proposal stating, “The Agency is still in the process of carefully reviewing the recommendations submitted by the Motor Carrier Safety Advisory Committee and Medical Review Board. The initial publication was a clerical error.”
The publication, then withdrawal, of the proposed recommendations is just another event in the long wait for screening rules to be implemented.
In the meantime, the body of evidence illustrating the number of drivers with OSA is growing. Among 517 commercial motor vehicle (CMV) drivers, Australian researchers “identified a high rate (41%) of previously undiagnosed obstructive sleep apnea indicated by a portable testing device, while only 12% of drivers reported excessive daytime sleepiness. A questionnaire-based prediction tool for OSA did not reliably identify those drivers found likely to have sleep apnea on home testing. These findings suggest that screening instruments dependent on self-report may be unreliable in this population and point to the importance of identifying accurate and acceptable ways to screen CMV drivers for sleep apnea.”
While these findings show the problem, sleep centers have been lacking in terms of providing cost-effective solutions. According to an article by Barbara Phillips, “Unnecessary, expensive testing and delays in management and follow-up have made our specialty the enemy, not the friend, of the commercial driver.” Phillips suggests that sleep centers can become more relevant in diagnosing and treating commercial drivers with sleep apnea by addressing sleep-disordered breathing as a chronic disease and expediting care with emphasis on cost-effective diagnosis.
Companies like Precision Pulmonary Diagnostics, Sleep Service Center, and AeroFlow Industrial Clinics have successfully established themselves as partners with the transportation industry in keeping roads safe by diagnosing drivers with sleep apnea. Your lab should seek such partnerships, too.
It could be the long wait for rules to be passed or the impression that the sleep medicine profession has made on the commercial driving industry that has led to a lack of excitement about the screening of commercial drivers for sleep apnea. However, the opportunity for your lab to participate in the diagnosis and treatment of commercial drivers hasn’t disappeared. The FMCSA states, “We anticipate requesting public comment on the recommendations later this year.” Your sleep lab’s role in diagnosing and treating commercial drivers will depend on your preparation to incorporate new forms of testing and your ability to help manage sleep-disordered breathing among a challenging population.
—Franklin A. Holman