Sleep apnea guidelines are ‘only recommendations’ for now

By Mark Schremmer, staff writer

The Federal Motor Carrier Safety Administration's Medical Review Board has recommended guidelines for when a driver should be tested for obstructive sleep apnea, but at this point they are only recommendations, says Jay Grimes, manager of federal affairs for OOIDA.

The recommendations came during the review board's meetings on Aug. 22-23 in Washington, D.C., regarding an advanced notice of proposed rulemaking by the FMCSA and Federal Railroad Administration that sought information about a possible sleep apnea testing regulation.

Grimes represented OOIDA at the meetings.

"We still have a long way to go on this," Grimes said. "This is only the Medical Review Board's recommendation. They don't technically have any regulatory power."

The FMCSA and FRA are expected to consider the recommendations when and if they decide to move forward with the rulemaking process.

Among the board's recommendations were guidelines for when a truck driver should be required to have a sleep test. The board suggested mandatory screening for any truck driver with a body mass index 40 or above, with admitted fatigue or sleeping during wakeful periods, or for any drivers who have been involved in a sleep-related motor vehicle accident. Screening could also be mandatory for drivers who possess a BMI of 33 and have at least three of the following risk factors:

  • Untreated hypertension
  • Type 2 diabetes
  • Loud snoring
  • Witness apneas
  • Small airway/Mallampati score
  • A neck size of 17 inches or more for
  • males and 15.5 or more for females
  • Age 42 or older male or
  • post-menopausal female
  • Untreated hypothyroidism
  • Stroke, coronary or artery disease

Grimes said the physical attributes on the list - age, sex and neck size - shouldn't be enough to require a sleep test. He contended that since a majority of drivers will have three of those physical attributes, the ceiling for BMI becomes 33.

"I told them we'd like to see more evidence of a relationship between sleep apnea and crash risk before we see any rulemaking on this," Grimes said. "The cost for drivers is also an issue. … It seems like there are a lot of people making money off these screenings, and it's all coming from the pockets of the drivers." LL