New recommendations released today by a joint task force of the American College of Chest Physicians (ACCP), American College of Occupational and Environmental Medicine (ACOEM), and the National Sleep Foundation (NSF) offer an updated and consistent approach to the screening and management of obstructive sleep apnea (OSA) among commercial motor vehicle (CMV) operators. Published as a supplement to the September issue of the Journal of Occupational and Environmental Medicine, these recommendations include a more thorough screening and evaluation process, modified criteria for returning to work after treatment, and provide follow-up and recertification recommendations.
Guidelines for the diagnosis and treatment of sleep apnea from the Federal Motor Carrier Safety Administration (FMCSA) are based on a 1991 report sponsored by the Federal Highway Administration. Current FMCSA guidance for certification cites that drivers 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."
New recommendations are based on an extensive review of the latest sleep apnea research and existing medical guidelines related to OSA from the US Department of Transportation agencies. Recommendations provide an updated description of sleep apnea, based on how sleep apnea is currently defined by professional organizations and other federal agencies. Patients with sleep apnea include those with repetitive partial or complete obstruction of upper airway tissues during sleep, resulting in sleep disruption, gas exchange abnormalities, and cardiovascular changes. In addition, sleep experts advise that the diagnosis and severity of sleep apnea be established using the apnea-hypopnea index.