Washington Insider
Help is on the horizon in apnea diagnosis

By Dr. Eliot J. Alpher, D.D.S., D.A.C.P.

When a truck driver or certified medical examiner suspects a driver may suffer from obstructive sleep apnea, the current process involves a lot of guesswork and potentially lost work and wages. For example, many drivers report that being sent for a traditional sleep study requires travel to the sleep center, lost wages, and time away from work or home. The cost can be in the thousands of dollars.

Increasingly, testing and successful treatment for sleep apnea are tied to the driver’s commercial license. Therefore, the certified medical examiner may require a provisional license that allows the driver to continue working for a limited time, but that also means the driver will have to be recertified and that’s another expense.

The sleep test, plus the time off work to go for the sleep study and testing, can range anywhere from one day to a month before a driver is cleared to return to full work. Typically, a driver is without income during this time. Estimates by OOIDA put the costs between $5,000 and $7,000. Treatment using a continuous positive airway pressure machine (CPAP) is also expensive, estimated at upwards of $4,000 a year.

These expenses must be paid by the driver or insurance. However, according to an OOIDA survey, 29 percent of the 6 million drivers on the road today have either no insurance or coverage that does not include diagnosis and treatment for sleep apnea. Finally, to make matters worse, there are no guarantees that the treatment with a CPAP will succeed because some users cannot tolerate the device and stop using it.

But there is a better way on the horizon, one developed by a consortium of dental sleep medicine, medical experts and sleep technology pioneers. The goal is to create an integrated, definitive diagnostic and treatment procedure when apnea is suspected. It would eliminate all the guesswork for both the certified medical examiners and the drivers. In addition, it will allow drivers to keep working while undergoing sleep testing and treatment. It relies upon precise 3-D scanning and printing of an oral appliance custom-designed for that user. Trials for patients are currently being designed.

Imagine that with one instrument, the medical examiner can precisely determine whether a driver is suffering from obstructive sleep apnea. The driver undergoes a sleep study from the comfort of familiar surroundings, say the sleeping quarters on his truck. The results are emailed to a lab, and within a week the driver is wearing an oral sleep appliance made precisely for him, which replaces the CPAP machine. Compliance can be monitored through a tiny computer chip in the oral appliance.

The goal of this research is to gain precise, individual information on patients so they can be treated – without lost work hours, without the possibility of losing their drivers’ license, and with a higher compliance success rate.

Using mobile technology will bring more efficient, cost-effective and successful diagnosis and treatment options. This is unlike the current process, which allows for too much subjectivity for an apnea disorder.

The current guidelines provide only the broadest criteria for diagnosing obstructive sleep apnea. In contrast, the American Academy of Sleep and Breathing requires more extensive diagnostic measurements. However, under FMCSA guidelines, a diagnosis of sleep apnea can be made on the following four factors:

  • Body Mass Index (BMI) of 35
  • 17-inch or greater neck size
  • Male
  • Whether the driver reports daytime sleepiness

The FMCSA says its goal is safety because drivers who are overweight or male have a higher probability of suffering from obstructive sleep apnea. Further, those with obstructive sleep apnea may be less alert and at higher risk for an accident. Yet a 2012 report titled “Large Truck and Bus Crash Facts” indicated that only 1.7 percent of the truck driver-related crashes were the result of drowsiness, fatigue, or falling asleep at the wheel.

Once the research and testing are concluded, there will be no more guesswork in diagnosis and treatment for obstructive sleep apnea. LL

Editor’s note: We know apnea is important to a lot of our readers. We invited Dr. Alpher to write a guest edition of Washington Insider to let you hear from others who are battling for the rights of those who suffer from sleep apnea. LL