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The following article was published in our article directory on September 19, 2010.
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Sleepy Truck Drivers

Article Category: Business Management

Author Name: Lawrence Earl, MD

Large truck crashes are a serious public health hazard, with half leading to death or debilitating injury, according to the Federal Motor Carrier Administration's (FMCSA) Large Truck Crash Study. The truck driver was deemed to be at fault in 87% of these crashes, and in 7% the driver admitted to having fallen asleep while driving. Truck accidents result in over 5200 fatalities on an annual basis and more than 125,000 injuries. These statistics are likely only a small portion of the actual number of truck crashes due to driver fatigue. Obstructive sleep apnea is a common disorder among commercial drivers, with a prevalence believed to be between 17% to 28%. Considering that presently there are roughly 14 million commercial drivers license holders in the Country, somewhere between 2.4 and 3.9 million of these drivers are likely to be affected by OSA.

Unfortunately, OSA typically remains unrecognized or unreported by professional drivers and their employers, as well as undiagnosed by physicians. OSA can drastically raise a driver's danger of driving drowsy. Medical research demonstrates that drivers with undiagnosed OSA have an increased risk (2 to 7 times) for falling asleep at the wheel and increases the possibility of an individual developing important health problems including 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. The prevalence of sleep apnea is considerably higher in older and more obese drivers. Population projections by FMCSA indicate the amount of older drivers will increase by 50% over the next twenty years. Therefore, determining which truck drivers are most prone to excessive daytime sleepiness (EDS) needs to be a significant public safety priority.

U.S. federal statute requires commercial motor vehicle drivers to undergo medical qualification examinations no less than every 2 years—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." Nonetheless, the FMCSA medical examination form only includes a single question on sleep disorders, while strong economic incentives exist for drivers to deny a history or symptoms of a sleep disorder. In fact, current studies have demonstrated that only 15% answered yes on the single sleep-related question on the driver medical evaluation form amongst individuals subsequently proven to have substantial OSA.

To be able to address these problems, a consensus document was published by the American College of Chest Physicians, the American College of Occupational and Environmental Medicine, as well as the National Sleep Foundation. These criteria were proposed based on a thorough literature evaluation to assist medical examiners in detecting drivers who might have OSA, and thus who may possibly need a sleep study, both to protect the long-term well being of the driver and to ensure public safety on the highways. The recommendations contain:

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;
8) additional analysis questions.

In one recent medical literature report, out of 134 sleep study results obtained because of the consensus criteria, 94.8% of the individuals had OSA. This researcher also reviewed ten large truck crashes resulting from driver loss of vehicle control for which the carrier is being sued for at least 1 million dollars. Of those 10, their review of the CDME medical examinations prior to the crash suggests that no less than 4 out of the 10 would have been required to be tested for OSA by the consensus standards.

These recommendations suggest certifying a driver at lower chance for sleep apnea for a maximum of 3 months, pending a medical evaluation (in-service evaluations), while drivers with more serious risk factors or a motor vehicle crash likely related to sleep disturbances needs to be prohibited from returning to work until they receive a medical evaluation (out-of-service evaluations) Furthermore, the task force suggests expanding the screening procedure to contain a more extensive medical history, flagging such risk factors as bmi, neck circumference, family history of OSA, and history of comorbidities. For those diagnosed with sleep apnea, experts strongly recommend using positive airway pressure for no less than 4 hours inside a 24-hour period via a machine that has the capacity to measure time on pressure. Current guidelines don't specify minimum use of positive airway pressure.

A large recent study has already shown that the use of these guidelines will not only protect drivers and the general public, but will also result in lower costs to the employer by virtue of fewer accidents, reduced medical costs, reduced absenteeism, and improved productivity.

Keywords: sleep apnea solution, truck accidents, truck drivers

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