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Federal Update
FMCSA lets cat out of the bag on apnea

By Land Line staff

Truckers have been hearing about recommendations the Medical Review Board is pressing on the Federal Motor Carrier Safety Administration concerning obstructive sleep apnea – and truckers will have their chance to comment later this year.

The agency actually published the recommended guidance in the Federal Register on April 20. However, the agency sent out an alert to industry media later that day, saying the recommendations were published as a result of a “clerical error.” The statement also noted that the agency anticipates seeking comments “later this year.”

The initial publication tipped the agency’s hand about what the recommendations could look like, causing OOIDA to be skeptical of the real motivation behind the move.

The recommendations stem from a joint decision of the Motor Carrier Safety Advisory Committee and the Medical Review Board. The recommendations include criteria for certification, conditional certification and disqualification of drivers with obstructive sleep apnea.

Some of the recommendations included in the notice for comment are:

  • Drivers with a BMI of 35 or greater to be certified for 60 days pending sleep study and treatment, followed by a 90-day certification if they’re compliant during first 60 days, followed by a one-year certification.
  • Clinicians may cite any combination of possible factors to require or recommend sleep labs. For example, drivers who are male and postmenopausal females with a BMI of 28 or greater, who have experienced a single-vehicle crash or have a 17-inch neck (male) or 15.5-inch neck (female) should be prepared to prove they don’t have sleep apnea. Other factors include being 42 or older, family history, and having a small jaw or airway.
  • Commercial drivers diagnosed with apnea may not be unconditionally certified medically to receive their CDL, and must instead use a CPAP at least four hours a day for 70 percent of days.
  • Any driver who reports excessive sleepiness during “the major wake period,” or experiences a crash associated with falling asleep, or has been found to be non-compliant in using a CPAP should be disqualified or immediately denied certification.

OOIDA Executive Vice President Todd Spencer, who serves on MCSAC, has spoken out against the recommendations on behalf of members.

“While there is plenty to indicate some commercial truck drivers have sleep apnea, we find virtually nothing to indicate that that is a factor in increased likelihood of crashes,” Spencer said following the most recent MCSAC meeting.

“That’s what motor carrier safety needs to be all about. It needs to be focusing on crashes. But, nevertheless, if there is an opportunity to make some money and there are some people recognizing that opportunity – they’re going to seize the moment.

In addition to setting criteria for granting qualification to drivers with sleep apnea, and who should be tested, the recommendations also state that the preferred treatment is positive airway pressure (PAP).

“All individuals with OSA (obstructive sleep apnea) should be referred to a clinician with relevant experience,” the recommendation up for comment states.

It also goes on to state “PAP is the preferred OSA therapy.”

Given the wide variety of treatments available and the costs associated with the testing to diagnose sleep apnea, OOIDA is skeptical of the real motivation.

“It’s kind of an issue that’s looking for a place where it can receive gobs of money is certainly what it looks like to me,” Spencer said.

The OOIDA Foundation researched cost of sleep labs and calculated that 49 percent of the 3.5 million commercial truck drivers have a BMI of 30 or greater. If that number of drivers is required to undergo sleep lab exams, such a rule would cost truckers $5.25 billion.

“That is a tremendous economic price for our industry to have to absorb,” Spencer said. “Of course, in this instance we’re primarily talking about individual drivers paying this.” LL