One of the big issues that is used as a justification for the fatigue checklist and other efforts is the presence of sleep apnea.
Even the FMCSA’s medical review board is obsessing on this topic, proposing that up to half of all truckers be compelled to pull thousands of dollars out of their own pockets for apnea testing, even absent any prior statement by a doctor that those individuals might have the illness.
Far too many people have bought into the sleep apnea argument without thinking, without questioning, without evidence.
And why is that. Well, you want to find out what’s really driving something, you follow the money. That’s what trucker Warren Riley suggested when he called recently, and as far as I’m concerned, he hit it on the head when he mentioned the money trail.
First, Land Line Magazine staff writer Charlie Morasch has documented connections between
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Two advisory committees agreed Wednesday to approve recommendations that could pull millions of truck drivers from the road and require billions of dollars to be spent on sleep medicine industry products and services.
In a meeting conducted jointly between the FMCSA’s Medical Review Board and Motor Carrier Safety Advisory Committee, both groups agreed to recommend that drivers with a body mass index of 35 or greater be required to “be evaluated for obstructive sleep apnea,” and that other drivers with potential sleep problems be immediately disqualified from driving.
Wednesday’s meeting, however, appeared to include little exchange of information between experts on both panels.
Instead, medical doctors on the Medical Review Board appeared to ignore points of concern brought by commercial vehicle experts, MCSAC members, and even medical experts seated in the audience.
Medical Review Board members used a mixture of anecdotal truck crash descriptions and presentations from researchers before moving forward with the BMI recommendation. MRB members appeared to rarely acknowledge dissenting opinion.
OOIDA Executive Vice President Todd Spencer led a chorus of trucking industry and health professionals who questioned the rampant speed with which some MRB members were pushing for an immediate recommendation.
“I think the cart is way ahead of the horse on this issue,” Spencer said. “Everyone we have heard from has had an economic interest in expanding what they characterize as an epidemic.”
Spencer pointed out that examiners aren’t given guidance to look at other sleep disorders, or a simple lack of sleep because of myriad factors U.S. truckers face on a daily basis.
“Unquestionably, apnea is fairly common in society,” Spencer added later. “Does apnea result in very many crashes? Real accident analysis suggests it doesn’t. It’s going to be far more likely that somebody just didn’t have the opportunity to get restorative sleep because that’s not an easy thing for truck drivers to do.
“Every day those who are on the road – their struggle is to find someplace where they can stop and sleep. And where they won’t get bothered, rousted and run out. Those things people need to do to maintain alertness we’re discouraged from. Drivers don’t set their own schedules; they work around everyone else’s.”
Others agreed.
“I take issue with a lot of the data presented this morning,” said Rob Abbott, vice president for safety policy at American Trucking Associations. “I think it’s inaccurate and misleading.”
Others questioned the need to approve a recommendation the very day it was presented.
“I do have a problem rushing this,” said MCSAC member Calvin Sturdivant. “This is too important to rush. I don’t understand why you need to put out guidance now, when you have an agency that’s willing to do this and do it the right way. ‘We need to do it before we leave the room?’ I don’t get it.”
Aside from the timing, an FMCSA regulation that could require millions to be tested might have unintended consequences. ATA’s Abbott said removing drivers who may possibly be at risk for apnea also will severely shrink the truck driver pool.
“We have to approach this very cautiously,” Abbott said. “30 percent of the 6 million (CDL holders) would be affected? I submit that that may be a concern. … This industry is 98 percent small business, and you don’t have the same sort of health benefits for drivers. What you’re doing is pushing them out of the industry. When we push them out of the industry, we’re inviting others in.”
One presenter, Andrew Mouton of Associates in Sleep Medicine, told the group he treats truck drivers for apnea.
Mouton appeared to question why apnea was the sole focus of the two committees.
“It’s not just apnea in truck drivers,” Mouton said. “Sleep is probably a larger issue. … Apnea is probably not the single greatest cause of sleepiness in this population. We need to be screening for sleep disorders.”
Edward Grandi, executive director of the American Sleep Apnea Association cautioned members of both committees about the ramifications of their recommendations. Grandi pointed out that apnea carries a stigma that can both hurt a driver and motivate CDL holders to keep personal health concerns underground.
Diagnosing or red-flagging an individual for sleep concerns is “putting someone on a long journey – a journey that will probably be with them for the rest of their lives,” he said.
“You have to keep in mind there are going to be drivers who will struggle with being compliant,” Grandi said. “Make it a safe place both for drivers to disclose that they have problems and to show they’re compliant.”
Ben Hoffman, chief medical officer for General Electric Healthcare and chairman of the MRB, signaled that he wasn’t interested in dialogue about whether apnea causes truck crashes.
“The train is out of the station, folks,” Hoffman said. “It’s a matter of trying to make this final regulation something that’s palatable to a large number of parties.”
Later, as MRB members quibbled over the required number of nightly hours drivers with apnea would need to demonstrate compliance, Hoffman noted how arbitrary it was to define a specific number.
“But then,” Hoffman said, “all of this is arbitrary in a sense.”
Under the recommended guidance, medical examiners won’t be required to send drivers with a BMI of 35 to sleep labs, but the guidance would serve as a strong hint.
In addition to the guidance, the committees agreed to approve a recommendation that drivers would be immediately disqualified from driving if they admit to falling asleep behind the wheel; have a fatigue-related crash; have an apnea-hypopnea index greater than 20 until they’re treated by CPAP; have undergone apnea surgery, until post-surgical evaluation; and don’t comply with CPAP treatment.
The FMCSA Medical Review Board is advisory in nature, and cannot approve its suggestions. The MRB’s recommendations are forwarded to FMCSA, which can choose to adopt, amend or ignore the recommendations.
A 5-foot-9-inch person weighing 237 pounds has a BMI of 35. The average U.S. female height is 5-foot-4-inches. A 204-pound person at that height has a BMI of 35 and would be subject to the recommended sleep apnea exam.
Larry Minor, FMCSA Designated Federal Official, clarified the power of guidance by saying medical examiners would be told: “If you encounter this situation, you should consider deferring the granting of a medical card.”
“At least you should delay granting a medical card to this individual,” Minor said. “Let’s defer issuing this person’s medical card until he sees someone to get a proper diagnosis.”
Sleep Apnea- A Smoke Screen for Many Truck Driver Fatigue Issues
Written by Allen Smith
by Allen Smith
Driver Fatigue and Sleep Apnea
Driver Fatigue is no stranger to the trucking industry. The FMCSA has performed studies in the past in order to better understand what causes driver fatigue and how to reduce it by correcting the major contributing sources.
Back in 1996, a 7 year study, The Commercial Motor Vehicle Driver Fatigue and Alertness Study (DFAS), was published by the FMCSA evaluating driver fatigue. At the time, Hours of Service was under review and many contributors to driver fatigue were considered. The cost of this study was 4.45 million dollars. This is the Introductions written by the FMSCA concerning this study.
“The Driver Fatigue and Alertness Study (DFAS) was the largest and most comprehensive over-the-road study ever conducted on driver fatigue and alertness in North America. It provides extensive information on the alertness, driving performance, and physiological and subjective states of commercial motor vehicle (CMV) drivers as they perform real-life, revenue-generating trips. This Executive Summary overviews the objectives, methods, principal findings, and safety implications of this landmark 7-year study.”
During this comprehensive study this is what was concluded in regards to the concerns of Sleep Apnea:
“Although this study was not designed to determine a population prevalence, analysis of subject sleep revealed that two of the 80 drivers (2.5%) had clinically-diagnosable apnea, a sleep disorder characterized by breathing cessations. The driving performance of these two individuals was not statistically different from that of other comparable drivers in the study.”
The Study concludes with:
ASSESSMENT OF RESULTS FOR FATIGUE MANAGEMENT:
“There is no quick fix and no single solution to the fatigue problem. Sleep is the principal countermeasure to fatigue…. Partnerships among government, industry, drivers, safety groups, the scientific community, and shippers are needed for effective solutions to the commercial motor vehicle driver fatigue problem.”
In an article by Misty Bell of eTrucker , Mary Gunnels, director of the Federal Motor Carrier Safety Administration Medical Programs made the statement “We know that fatigue is a problem,” she said, “and we know that sleep apnea is a major contributor to fatigue.”
Do we really know that sleep apnea is the major contributor? Where is the data?
In that same article, Martin R. Walker, chief, FMCSA Research Division, pointed to the prevalence of sleep apnea in commercial truck drivers, noting that a study published in 2002 found that almost a third of CMV drivers have mild to severe obstructive sleep apnea. This study, along with a later study, found that older age and higher body mass index are two factors commonly linked with sleep apnea. 30% of drivers have mild to severe sleep apnea? How could that be? The 7 year study performed by the FMCSA didn’t come close to those figures?
I decided to look at the research, and this is what I came up with:
It appears that these figures and statements made during the Sleep Apnea & Trucking Conference of May 12, 2010 were possibly based on this study. At least this is the only study I could find actual data on.
The study was conducted by the University of Pennsylvania Sleep Apnea Study. The research was conducted during 1996 to1998. Sleep apnea is a condition in which a narrowing or closure of the upper airway during sleep causes repeated sleep disturbances, and possible complete awakenings, leading to poor sleep quality and excessive daytime sleepiness. This study was completed to assess the risks of commercial motor vehicle (CMV) crashes due to the presence of sleep apnea among truck drivers.
Basically, this study involved 1391 drivers. The drivers were asked a series of questions, including their height and weight, sleep patterns, medical history, snoring, etc. This was used as a screening process to determine which drivers were most likely to have sleep apnea. Out of the 1391 drivers, 406 were selected as a result of their questionnaire, to proceed with the overnight laboratory study in order to determine how many of them were accurately predicted to have sleep apnea.
The results were as follows:
64% or 260 of the 406 flagged for most likely to have sleep apnea had no sleep apnea. 21.2% or 86 of the 406 flagged for most likely to have sleep apnea had mild sleep apnea. 7.9% or32of the 406 flagged for most likely to have sleep apnea had moderated sleep apnea. 6.9% or 28 of the 406 flagged for most likely to have sleep apnea had severe sleep apnea.
Now, the above percentages and figures are for the 406 flagged drivers. When you perform the calculations based on the group study of ALL 1391 Drivers, here are the results ( the calculation required to accurately represent and determine % of ALL drivers):
2.0% or 28 of total 1391 drivers had severe sleep apnea ( matches the 1st study by FMCSA- DFAS) 2.3% or 32 of total 1391 drivers had moderate sleep apnea 6.2% or 86 of total 1391 drivers had mild sleep apnea.
This would mean that only 4.3% of drivers have moderate to severe sleep apnea. If you include mild sleep apnea, the % jumps to 10.5%
The following statement in the report however is the most revealing of all:
“The results of the study showed that the prevalence rates of sleep apnea among commercial truckdrivers are similar to sleep apnea rates found in other general populations.” The study also revealed that the prevalence of sleep apnea depends on the relationship between two major factors – age and degree of obesity as measured by body mass index (BMI) – with the prevalence of sleep apnea increasing with increasing age and BMI. Another meaningful study finding showed that the prevalence of sleep apnea depends on the average duration of sleep over consecutive nights at home. Short sleep duration, six hours or less per night, results in an increase in the prevalence of sleep apnea.”
Here’s that last statement again which has not been mentioned by the authorities and experts as a major source of sleep apnea,” Short sleep duration, six hours or less per night, results in an increase in the prevalence of sleep apnea.”
When you consider that the average OTR truck driver gets 5.2 hours sleep/night, then you have to wonder if it is the trucking industry lifestyle, behavior, and rules which are major causes for driver fatigue and also for creating/inducing “driver sleep apnea.”
The original hypothesis tested was the following: “A driver diagnosed with sleep apnea is more likely to be involved in a motor vehicle crash than a driver with no history or symptoms of sleep apnea, after controlling for differences in the other predictor variables included in the model.“
Finally, the study concluded to say, “No association was found between sleep apnea presence or severity and multiple crashes. This suggests that the commercial drivers in this study who were diagnosed with sleep apnea were not at increased risk for having more than one crash over the 14 year period prior to and following diagnosis…. Furthermore, there was no evidence from the data used in this study to suggest that crash risk is impacted before and after drivers are diagnosed with sleep apnea.”
There are many reasons for Driver Fatigue, and despite what many would like you to believe, lack of available sleep is the major cause. Sleep Apnea appears to represent a much smaller percentage than what is being stated. The data strongly suggests this.
Although sleep apnea is a real condition, it represents a much smaller percent of the driver population than the FMCSA and the ATA are suggesting. To screen a driver by height and weight (BMI), and neck size ( 17 or greater) is not only discriminatory, but is ludicrous. To force drivers to pay for the testing based on such information is simply wrong and unjust. A serious look at other reasons for driver fatigue should be investigated.
On the other side of that coin, if you do believe you may have sleep apnea, then you should by all means be tested and start the treatment.
The FMCSA needs to create laws, ensuring that drivers are not sleep deprived rather that associate driver fatigue on the hype of sleep apnea. It appears this is just a way to take the attention off of the real and valid reasons that drivers are fatigued, thus relieving the responsibility from carriers, shippers, and receivers who are all a part of depriving drivers from the rest they need. It’s also a way to deviate attention from the present HOS rules which need to be modified in order to aid in better and more rest for drivers.
Creating a sleep apnea testing program will be a BIG money maker for many as well as one more excuse to eliminate “undesirable” drivers from the industry.
Sleep Apnea
