In two days of meetings, the Federal Motor Carrier Safety Administration’s Medical Review Board recommended guidelines for when a driver should be tested for obstructive sleep apnea, the minimum amount of treatment for compliance, and when a driver should be retested.
The recommendations came during the Medical 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. Information was sought about a possible sleep apnea testing regulation for truck drivers and railroad workers.
Jay Grimes, manager of federal affairs for the Owner-Operator Independent Drivers Association, represented OOIDA at the meetings.
The decisions made by the Medical Review Board are just recommendations. The FMCSA and FRA are expected to consider the recommendations when and if they decide to move forward with the rulemaking process. In October 2013, President Barack Obama signed a law that required the FMCSA to go through its regulatory process before making any sleep apnea testing requirements.
“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.”
Among the board’s recommendations was a set of 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
- Micrognathia or retrognathia
Grimes said the three physical attributes on the list – age, sex and neck size – shouldn’t be enough to require a sleep test.
“Everyone in the room kind of agreed that if you have a BMI of 33, the chances are that you’re going to have a neck size of 17,” he said. “The truck driving industry is about 95 percent male, so that’s going to be pretty automatic. The age 42 and older is going to be mostly in line with that as well.”
Grimes contended that since a majority of drivers will have three of those physical attributes, the ceiling for BMI becomes 33. The 2012 guidelines called for anyone with a BMI of 35 or more to be tested.
The board also discussed establishing guidelines for when a driver who tested for mild or negative obstructive sleep apnea would have to be retested. The Medical Review Board decided a second sleep study would be required if the driver had one more additional risk factor beyond those that required the original testing or a 10 percent increase in weight.
On Tuesday afternoon, the board recommended that a driver who was diagnosed with moderate-to-severe obstructive sleep apnea could be recertified for a year if the driver was using a CPAP for a minimum of four hours per night, as well as other factors.
Grimes said he didn’t believe the review board placed enough emphasis on the practical implications that a mandate would have.
“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. Most drivers aren’t covered for sleep apnea screenings. 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.”
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