FMCSA Medical Review Board, MCSAC suggests strict apnea rules

By Charlie Morasch, Land Line staff writer | Wednesday, February 08, 2012

A joint panel of two Federal Motor Carrier Safety Administration advisory boards has recommended a series of new medical hoops for truck drivers to jump through – all in the name of improving safety by screening for sleep apnea.

The FMCSA Medical Review Board and the FMCSA Motor Carrier Safety Advisory Committee are meeting jointly this week in the Washington DC-area. The joint panel was slated to discuss recommendations for sleep apnea and electronic on-board recorders.

Because both boards are advisory in nature, the joint recommendations may be proposed for a rule, ignored, or amended and later presented.

If this week’s recommendations are later adopted, however, many truckers should prepare to spend money on sleep labs, CPAP machines and doctor visits.

Among 10 recommendations in total, the proposals would require:

  • Commercial drivers diagnosed with apnea may not be unconditionally certified medically to receive their CDL, and must instead use a CPAP at least four hours nightly for 70 percent of nights. Any driver who reports excessive sleepiness during “the major wake period,” or experiences a crash associated with falling asleep, or has been found to be non-compliant in using a CPAP should be disqualified or immediately denied certification;
  • Drivers with a BMI of 35 or greater to be certified for 60 days pending sleep study and treatment, followed by a 90-day certification if they’re compliant during first 60 days, followed by a one-year certification;
  • Clinicians may cite any combination of possible factors to require or recommend sleep labs. For example, drivers who are male and postmenopausal females with a BMI of 28 or greater, who have experienced a single-vehicle crash or have a 17-inch neck (male) or 15.5-inch neck (female) should be prepared to prove they don’t have sleep apnea. Other factors include being 42 or older, family history, and having a small jaw or airway.

As an example, a 5-foot-10-inch-tall male weighing 195 pounds has a BMI of 28.

The panel recommends sleep data gathering through in-lab or at-home polysomnography, but left the door wide open for clinicians who “believe the level of apnea is greater than the level reported by the in-home study” to require an in-lab sleep exam.

Drivers diagnosed with apnea can be conditionally certified medically for their CDL if they demonstrate four hours of CPAP use during 70 percent of nights and don’t report excessive sleepiness while awake.

The MRB and MCSAC ignored other treatments for sleep apnea, including dental appliances and simple weight loss. The panel deemed surgical treatment as “acceptable.”

OOIDA Executive Vice President Todd Spencer, a member of MCSAC, has repeatedly pointed out conflicts of interest posed by physicians who serve on the MRB and who have a financial interest in requiring sleep tests and CPAP sales.

A previous Medical Review Board chairman faced criticism for her investment in sleep labs and involvement with CPAP manufacturers. The current MRB chairman works for General Electric, which makes and sells CPAP machines.

During a joint-meeting between the MRB and MCSAC in December, MRB members appeared to ignore advice from sleep professionals and trucking industry experts. The sleep professionals and trucking industry representatives said the proposed recommendations were too focused on obstructive sleep apnea and would likely drive many experienced drivers out of trucking.

The OOIDA Foundation researched cost of sleep labs and calculated that 49 percent of the 3.5 million commercial truck drivers have a BMI of 30 or greater. If that number of drivers is required to undergo sleep lab exams, such a rule would cost truckers $5.25 billion.

A survey of OOIDA members showed 72 percent of respondents do not have medical policies that cover sleep apnea expense. 29 percent of respondents said they had no medical insurance coverage at all.

Copyright © OOIDA

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