Truckers With Untreated OSA Have Higher Crash Risk – MedPage Today

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Truck drivers with obstructive sleep apnea (OSA) who were not adequately treated for the condition were five times more likely to be involved in preventable crashes than drivers without the sleep disorder, researchers reported.

Truck drivers who were non-adherent with positive airway pressure treatment had a crash rate for preventable U.S. Department of Transportation-reportable crashes of 0.070/100,000 miles that was nearly five-fold more that the rate of 0.014/100,000 miles for matched controls (without sleep apnea) and fully compliant drivers (incidence rate ratio 4.97, 95% CI, 2.09-10.63, P<0.001),according to Stephen V. Burks, PhD, of the University of Minnesota Morris in Morris, Minn., and colleagues.

Partially adherent drivers had a crash rate of 0.021/100,000 miles, which was not statistically different from control and compliant drivers, they wrote in Sleep.

Findings from this analysis of a large-employer screening and monitoring program for OSA in the trucking industry make a strong case for routinely screening commercial truck drivers for OSA, and requiring close monitoring and treatment of those who have it, the authors stated.

Screening for OSA is currently not mandated for commercial truck drivers, although they are required to undergo biennial examinations to determine their medical fitness to drive.

Earlier investigations suggest that among the estimated 14 million commercial vehicle drivers in the U.S., between 17% and 25% have obstructive sleep apnea.

There had previously been no large-scale studies evaluating crash risk among commercial drivers diagnosed with OSA, co-author Stefanos Kales, MD, MPH, of Harvard TH Chan School of Public Health in Boston, told MedPage Today.

“Screening for sleep apnea has been a hotly contested issue, and there has been a lot of pushback from drivers and the commercial trucking industry,” he said. “Until now, almost all of the data on OSA and accident risk has come from passenger car drivers and not commercial drivers.”

The study findings emphasize the “pervasive threat” of untreated OSA to transportation safety, said Nathaniel Watson, MD, president of the American Academy of Sleep Medicine, in a written press statement.

“It is critical for companies to implement comprehensive sleep apnea screening and treatment programs to ensure that truck drivers stay awake at the wheel,” stated Watson, who was not involved in the study.

Study Details

Burks’ group analyzed the results of a OSA screening, diagnosis, and treatment program implemented by the major North American trucking firm Schneider National in 2006.

The program requires drivers to complete a screening questionnaire to assess their risk for OSA, and undergo polysomnogram (PSG) diagnostic testing if the screening suggests an elevated risk for the sleep disorder. Drivers diagnosed with OSA receive first-line treatment, consisting of an auto-adjusting positive airway pressure (APAP) machine, heated humidifier, and mask interface, which are suitable for use both at home and in their truck sleeper berth.

Early in treatment, and later on, a disease management team helps the drivers learn to use the equipment and remain compliant with therapy. This intervention consists of frequent phone calls and face- to-face contact “to assist with ongoing PAP trouble-shooting, education and adherence monitoring.”

“Drivers with OSA who remained non-adherent as demonstrated by objective APAP adherence monitoring despite this multi-faceted process of remediation were eventually terminated after the process of remediation failed,” the researchers wrote.

“This is a very effective program for identifying and treating sleep apnea,” Burks told MedPage Today. “I don’t know of another carrier that has done this to this extent.”

The study compared 1,613 drivers with a diagnosis of OSA with a control group of 2,016 drivers, whose scores on the assessment questionnaire indicated that they were unlikely to have OSA.

Of the drivers diagnosed with OSA, 682 fully adhered with treatment using the company-provided pressurized air machines; 571 were considered partially compliant; and 360 never used the machines.

Based on the findings, the researchers noted that for a fleet of 1,000 drivers operating for 1 year (about 100,000 miles),“the observed crash rates translate to a difference between 70 preventable DOT-reportable crashes for the non-adherent drivers and 14 such crashes” among the fully and partially compliant groups.

“These findings for commercial drivers operating tractor-trailers are consistent with previous studies of non-commercial drivers showing a markedly increased crash risk for untreated OSA and crash rates approximating those of controls after successful treatment,” they wrote.

They noted that safety selection may be a significant study limitation, given that drivers for the commercial carrier who accumulated unacceptable preventable crash histories were fired or not hired. The primary study limitation was the necessary nonrandom nature of the driver subgroups (compliant, partially compliant, noncompliant).

Mandated Screening?

Despite these limitations, the researchers concluded that the findings have significant implications for public safety.

“In the absence of federally-mandated procedures other than the currently-required self-report during biennial medical examination, drivers who have diagnosed OSA, but are nonadherent with treatment can simply choose to quit working for a motor carrier that knows their diagnosis (as did nearly 60% of those in the present study.) They can instead seek employment — without revealing their OSA diagnosis — with a different firm that does not have (a screening and treatment) program.”

The Department of Transportation’s (DOT) Federal Motor Carrier Safety Administration (FMCSA) and the Federal Railroad Administration (FRA) are currently considering mandating the screening, evaluation, and treatment of rail and commercial motor vehicle drivers for OSA. In a statement published March 8, the agencies announced a 90-day public input period on the impact of such a mandate.

In a statement announcing the 90-day public comment period, Transportation Secretary Anthony Foxx noted that, it is “imperative for everyone’s safety” that commercial motor vehicle drivers and train operators be “fully focused and immediately responsive at all times.”

“DOT strongly encourages comment from the public on how to best respond to this national health and safety issue,” Foxx said.

The study was funded by the Harvard Clinical and Translational Science Center and the National Surface Transportation Safety Center for Excellence.

Burks disclosed no relevant relationships with industry. Kales disclosed serving as a medicolegal consultant and expert witness on cases involving commercial drivers and a relevant relationship with Circadies.

One co-author disclosed royalty payments for the use of the Somni-Sage questionnaire and relevant relationships with Precision Pulmonary Diagnostics. One co-author disclosed relevant relationships with Bose, Boston Red Sox, Cleveland Browns, Institute of Digital Media and Child Development, Merck Sharpe and Dohme, Purdue Pharma, Quest Diagnostics, Samsung Electronics, Teva Pharmaceutical Industries, Koninklijke Philips Electronics, Novartis, Vanda Pharmaceuticals, Somnus Therapeutics, McGraw Hill, Penguin Press/Houghton Mifflin Harcourt, Philips Respironics, the Mary Ann and Stanley Snider through Combined Jewish Philanthropies, National Football League Charities, Optum, ResMed, San Francisco Bar Pilots, Simmons, Schneider, Sysco, Bombardier, Citgo, HG Energy, Michael Jackson’s mother and children, Stric Lan, Valero Celadon, Crete Carrier, Fedex, and UPS.

Truckers With Untreated OSA Have Higher Crash Risk – MedPage Today