December 07, 2011
Trucking moved a small step closer to a sleep apnea regulation yesterday, when advisors to the Federal Motor Carrier Safety Administration recommended that the agency toughen up its approach to the disorder.Two advisory panels, one from the medical community and one representing industry, enforcement, labor and safety advocacy interests, said the agency should tell medical examiners that drivers with a body mass index of 35 or more must be evaluated for sleep apnea.If the agency takes this advice, it would lead to guidance to examiners, rather than a rule. The guidance would include conditions for immediate disqualification of a driver, such as falling asleep while driving or having a fatigue-related crash. It also would allow the driver to get a 60-day conditional card during evaluation and treatment for the condition. The two panels are the Motor Carrier Safety Advisory Committee and the Medical Review Board. They have formed a joint subcommittee charged with producing recommendations for an eventual rule that could set standards for sleep apnea screening, evaluation and treatment."Our goal is to very quickly get something done," said David Parker, chairman of the safety committee. The panels see the guidance as an interim step toward a comprehensive rule. Parker said the subcommittee will meet in January, will report to the two committees in February and come up with a joint recommendation to the agency by March. The Medical Review Board for several years has been pushing stricter regulatory standards for sleep apnea. In 2008 the Board recommended that the agency require all drivers to be screened for obstructive sleep apnea, a significant change from the current rules that do not explicitly require testing and treatment.The selection of a body mass index of 35 as a trigger for screening arose from research that shows BMI, a measurement of body fat based on height and weight, is a primary indicator that a person may have sleep apnea. The higher the BMI, the greater the likelihood of sleep apnea. There are other indicators, such as middle age and male gender, but BMI would be an effective tool for medical examiners to make the initial screening."We need a prescriptive number to make it easy for the examiner," said Benjamin Hoffman, chairman of the Medical Review Board. He said it is almost impossible to controvert the evidence that a BMI of 35 is a reliable indicator of sleep apnea.The disorder can lead to chronic fatigue, which in turn causes performance problems such as slowed reaction time, lapses of attention and distractibility, said Charles Czeisler, professor of sleep medicine at Harvard Medical School.The crash risk for a person with sleep apnea is 242% greater than a person without the disorder, Czeisler said.Understanding of the problem is not widespread in the trucking industry, but awareness is growing and a number of carriers have implemented groundbreaking programs to screen drivers for apnea and treat them if they have it.Schneider National, for instance, has put in place a program that produced a 30% reduction in crash rates and a 48% reduction in the median cost of crashes. The kicker, has been a savings of $539 per driver per month in health care costs, according to senior safety VP Don Osterberg at a sleep apnea conference in 2010.Treatment for the disorder is typically handled with a nighttime sleep-aid device that provides continuous positive airway pressure, called CPAP for short.