Organizations offer new screening, treatment recommendations for sleep apnea

| Wednesday, September 13, 2006

Three organizations are making recommendations for changes to the screening and management of sleep apnea for commercial motor vehicle operators.

The recommendations – which were published jointly by the American College of Chest Physicians, the American College of Occupationaland Environmental Medicine, and the National Sleep Foundation as a supplement to the September issue of theJournal of Occupational and Environmental Medicine – include a revisedscreening and evaluation process, modified criteria for returning to work after treatment and recommendations for how truckers could recertify.

“Sleepiness and inattention contribute to a significant number of CMV crashes each year and (sleep apnea)has been shown to significantly increase a driver’s risk of driving drowsy. Yet, current CMV screeningand treatment procedures … are ambiguous,” said Nancy Collop, a spokeswoman for the American Collegeof Chest Physicians, in a press release.

Federal Motor Carrier Safety Administration guidelines for the diagnosis and treatment of sleep apnea are based on a 1991 report sponsored by the Federal Highway Administration.

Current FMCSA guidance for certification cites that drivers must have “no established medical history or clinical diagnosis of respiratory dysfunction likely to interfere with the ability to control and drive a commercial motor vehicle.”

According to a National Sleep Foundation press release, the recommendations:

  • Provide an updated definition of sleep apnea;
  • Suggest a screening process that bases driver certification on the severity of the sleep apnea; and
  • Suggest expanding the screening process to include a more extensive medical and physical history, flagging such risk factors as body mass index, neck circumference and family history.

Although the task force recommends more thorough screening, their recommendations suggest a shorter return-to-work time.

Under current FMCSA guidelines, commercial vehicle operators who are being treated for sleep apnea can return to work a minimum of one month after initiation of treatment. The task force’s recommendations include reducing return-to-work time to two weeks after the start of treatment in many situations. Reevaluation after four weeks to ensure compliance with therapy and improvement in symptoms is also recommended.

A study sponsored by FMCSA and the American Trucking Association estimated that nearly one in three commercial truck drivers suffers from mild to severe sleep apnea.

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