Drivers with untreated sleep apnea at greater risk to crash

A new study published Monday, March 21 says truck drivers who have sleep apnea but who do not use the medical device prescribed for them have a rate of serious, preventable crashes five times higher than drivers who use the device or do not have sleep apnea.

Furthermore, the authors of the study, which appeared on the website “Sleep” Monday, say sleep apnea screening ought to be part of drivers’ required medical exams and that companies should institute screening and treatment programs for their drivers.

The study results come about two weeks after the Federal Motor Carrier Safety Administration issued an Advance Notice of Proposed Rulemaking, which is the first step in the process to consider whether to propose specific requirements for screening, evaluating and treating commercial motor vehicle drivers for obstructive sleep apnea.

“The most surprising result of our study is the strength and robustness of the increase in the crash risk for drivers with sleep apnea who fail to adhere to mandated treatment with positive airway pressure (PAP) therapy,” said lead author Stephen V. Burks, PhD, professor of economics and management and principal investigator of the Truckers & Turnover Project at the University of Minnesota, Morris. “The results of our study support the establishment of obstructive sleep apnea screening standards for all drivers through the commercial driver’s medical exam.”

Researchers tracked 1,613 truck drivers with obstructive sleep apnea and an equal number of control drivers who were matched by job experience and tenure with the trucking firm. Drivers who were diagnosed with sleep apnea were prescribed positive airway pressure (PAP) therapy and were given a machine that could be used both at home and in the truck sleeper berth while on the road. Data were downloaded from the PAP machine’s memory chip.

“This study emphasizes that untreated obstructive sleep apnea is a pervasive threat to transportation safety,” said American Academy of Sleep Medicine President Dr. Nathaniel Watson, who was not involved in the study. “It is critical for transportation companies to implement comprehensive sleep apnea screening and treatment programs to ensure that truck drivers stay awake at the wheel.”

Study data were gathered from the obstructive sleep apnea screening, diagnosis and treatment program implemented in 2006 by the Schneider trucking company. Treatment was covered at no cost to drivers under Schneider’s employee health insurance.

A health care team provided ongoing assistance, education, troubleshooting and monitoring to help drivers with sleep apnea continue their treatment. Drivers with sleep apnea who did not use the PAP therapy eventually were terminated after a process of remediation failed.

According to the authors, panels of medical experts previously convened by the Federal Motor Carrier Safety Administration (FMCSA) have recommended comprehensive sleep apnea screening for commercial drivers. However, rather than instituting mandatory screening, current federal regulations rely on drivers to self-report sleep apnea symptoms during required medical exams every two years.

“We found that truck drivers with untreated obstructive sleep apnea are at dramatically greater risk of serious, preventable truck crashes, consistent with the greatly increased risk of motor vehicle crashes among automobile drivers with untreated obstructive sleep apnea,” said study co-author Charles A. Czeisler, PhD, MD. “Given that the risk of heart disease, cancer, diabetes, dementia and premature death are similarly increased in people with untreated obstructive sleep apnea, regulatory agencies worldwide owe it to truck drivers and to the motorists who share the road with them to require objective screening, diagnostic testing, and treatment adherence monitoring for all commercial drivers.”

According to the American Academy of Sleep Medicine, obstructive sleep apnea afflicts at least 25 million adults in the U.S.