OOIDA: Proven link between sleep apnea, crashes doesn't exist

By Mark Schremmer, staff writer

There is insufficient data to show a relationship between moderate-to-severe obstructive sleep apnea and increased crash risk according to the Owner-Operator Independent Drivers Association.

OOIDA points to the lack of a link between the condition and crashes as the first and foremost argument against the creation of any rulemaking regarding obstructive sleep apnea (OSA).

The statement is in response to an advanced notice of proposed rulemaking by the Federal Motor Carrier Safety Administration and Federal Railroad Administration that sought information regarding the evaluation of safety sensitive personnel for moderate-to-severe obstructive sleep apnea. OOIDA submitted its formal comments regarding the notice on Friday, July 8.

“OOIDA opposes any regulations requiring OSA screening until FMCSA identifies OSA as the cause of a not-insignificant number of truck crashes,” OOIDA wrote in its comments signed by President Jim Johnston.

A 2004 FMCSA study concluded “no link between the severity of sleep apnea and traffic crashes was established in these analyses.”

“FMCSA should not jump to the immediate conclusion that OSA is the primary cause of fatigue and fatigue is the primary cause of crashes,” OOIDA wrote.

According to information from “Large Truck and Bus Crash Facts,” fatigue has contributed to only a small percentage of fatality crashes involving large trucks. Using statistics from 2011-14, the percentage of large truck fatality crashes that involved a driver being asleep or fatigued was no more than 1.8 percent.

As part of the advanced notice, the FMCSA and FRA asked 20 questions regarding a possible sleep apnea regulation. In its 24 pages of comments, OOIDA addresses each of the questions.

In the response, OOIDA tackles the lack of a link between OSA and crashes, the cost of testing, and the mistreatment of drivers within the current system.

OOIDA noted that the agencies cited only four crashes that were said to involve obstructive sleep apnea. Out of those four, only one involved a truck driver, and there were several other factors involved in the crash.

“The NTSB can only make the assumption that the driver’s sleep apnea contributed to the crash as FMCSA’s own data demonstrates that there is no relationship between drivers with OSA and crashes,” OOIDA wrote.

OOIDA questioned the current OSA screening process, which often uses body mass index as the single determining factor.

“According to FMCSA’s ‘Sleep Apnea Crash Risk Study,’ 30 percent of those who were diagnosed with OSA had a body mass index or BMI less than 30, while almost 40 percent of those without OSA had a BMI greater than 30,” OOIDA wrote. “Additionally, a study released by UCLA in 2016 concluded that BMI mislabels approximately 54 million Americans as overweight or obese.”

OOIDA said that it has documented instances of drivers who have had a letter from their family physician stating that the driver has never exhibited any signs of OSA, but the certified medical examiner has demanded the driver be tested. In these situations, OOIDA said the medical examiner usually demands that the driver visit a specific testing facility.

“At a minimum, these situations have raised the suspicions of OOIDA regarding the motives of those (medical examiners),” OOIDA wrote.

“When a driver presents a valid notice from their family physician attesting to the fact that the driver has been examined by the physician and has not demonstrated any signs of OSA, this must be recognized by the (medical examiner). It must not be summarily dismissed. In such a circumstance, the (medical examiner) should be required to document evidence based on examination that comorbidities are present which indicate the individual may have OSA.”

Mandatory testing would come at a significant cost to owner-operators, OOIDA noted.

“For owner-operators, all the costs associated with screening, evaluation and treatment of OSA will be passed on directly to them, many of whom do not have a health insurance plan that would pay these costs, nor are (they) covered under the Affordable Care Act,” OOIDA wrote. “Overall, 29 percent of owner-operators do not have medical coverage and for those who do, 61 percent have medical policies which do not cover sleep apnea expenses.”

According to surveys by the American Transportation Research Institute and the OOIDA Foundation, some drivers have reported out-of-pocket costs as much as $6,000 or $7,000. Testing and studies cost drivers even more money for time off the road. CPAP machines can cost as much as $5,000, and the maintenance of the machine costs additional money, OOIDA said.

Another point of contention with the current system is that many medical examiners are requiring drivers to use a CPAP despite being diagnosed with only mild sleep apnea. Many of those drivers with mild sleep apnea have reported reduced sleep and an inability to dream while using the machine.

“Drivers with mild sleep apnea are frequently prescribed a CPAP machine even though research has documented that treatment in such cases can create negative effects,” OOIDA wrote.

The Association contends that drivers diagnosed with severe sleep apnea shouldn’t be isolated to a CPAP as the only source of treatment.

OOIDA concludes its comments by saying that a sleep apnea testing mandate is not the best way to improve highway safety.

“A proposal to screen drivers for OSA when there is no valid or reliable evidence which shows that sleep apnea is the cause behind CMV crashes is not an effective effort to improve highway safety. Instead, it is an effort propelled by special interest groups who already profit at the expense of drivers due to the currently flawed (National Registry of Certified Medical Examiners) program.

“Instead of focusing on a proposed OSA rulemaking, FMCSA would witness a greater and immediate impact on driver safety by simply promulgating flexibility within the hours-of-service regulations. In so doing, any tired or fatigued driver, regardless of reason, would be able to stop their truck and rest when needed without the concern of running against the 14-hour clock.”

July 8 was the final day to submit comments regarding the advanced notice.