By Melinda Carstensen, ,
Published June 16, 2016
Soon, the federal government may require all commercial truckers, bus drivers and railroad workers to undergo screening for obstructive sleep apnea (OSA), a disease that can lead to drowsy driving and increase the risk of crashes. The Department of Transportation’s (DOT) Federal Railroad Administration (FRA) and Federal Motor Carrier Safety Administration (FMCSA) are taking the first step toward that potential rule, which could also mandate treatment for those diagnosed, by gathering public comments until July 8.
“It is imperative for everyone’s safety that commercial motor vehicle drivers and train operators be fully focused and immediately responsive at all times,” U.S. Transportation Secretary Anthony Foxx said in a statement in March, when the DOT announced the proposal. “DOT strongly encourages comment from the public on how to best respond to this national health and transportation safety issue.”
While sleep experts say the rules would promote public safety as well as commercial operators’ wellbeing, some associations have criticized the idea, questioning the validity of reported OSA and fatigue statistics, and arguing current medical examinations that rely on self-reporting are sufficient.
“There is insufficient data linking OSA and higher crash rates,” Norita Taylor, spokeswoman for the Owner-Operator Independent Drivers Association (OOIDA), told FoxNews.com in an email. “OSA testing can also be quite costly to drivers, both in terms of dollars and time, and if required by a Certified Medical Examiner, is rarely covered by standard medical insurance.”
It’s unclear whether such a mandate would apply only to current drivers, and what the consequence of a diagnosis would mean for their jobs. It also is unknown whether the rule would be used as a screening tool to determine future drivers’ job acceptance. Duane DeBruyne, a spokesman for the FMCSA, said the agencies could not comment on the proposal during the public commenting period.
The FMCSA has already recommended that commercial drivers undergo screening for OSA. In 2013, the trucking lobby prompted Congress to require a formal process before such rules are implemented. However, data suggests sleep apnea may be a large contributing factor to fatigue-related crashes.
A November 2014 report by the AAA Foundation for Traffic Safety estimated drowsy driving causes 328,000 crashes, 109,000 injuries, and 6,400 deaths each year. Commercial drivers are more likely to drive drowsy, according to the Centers for Disease Control and Prevention (CDC).
Pilots are already screened regularly for OSA, but there’s no formal screening for the disease in place among truckers and railroad workers. The National Transportation Safety Board (NTSB) has found sleep apnea to repeatedly be a culprit in commercial driver crashes. Investigators found an undiagnosed case of sleep apnea led to the Dec. 1, 2013 Metro-North train derailment in the Bronx that killed four people and injured 60. The engineer had fallen asleep while operating the train.
A study conducted by the University of Pennsylvania and sponsored by the FMCSA and the American Transportation Research Institute (ATRI) of the American Trucking Associations found that about one-third of commercial truck drivers have mild to severe sleep apnea. The Cleveland Clinic estimates as many as 80 percent of OSA cases nationwide go undiagnosed.
“What we know is that for commercial drivers with obstructive sleep apnea who are treated with CPAP, we see a 73 percent reduction in preventable driving accidents,” Dr. Nathaniel Watson, immediate past president of the American Academy of Sleep Medicine, and a board certified neurologist and sleep specialist, told FoxNews.com.
CPAP, or continuous positive airway pressure, is the most common treatment for OSA, and requires bedtime use of a quiet machine, mask and tube that pushes room air into the nose and mouth. OSA is marked by a blockage of the airway, which results in pauses or shallow breathing during sleep, preventing sufficient air from reaching the lungs. These blockages, which prompt the person to wake up, can last 10 seconds or more each, and occur up to 400 times a night. CPAP acts as an internal splint that prevents the airway from collapsing, thus helping individuals get a good night’s rest.
“One of the biggest problems of [OSA] is excessive fatigue,” Watson said, “and so clearly for anybody working in a safety-sensitive position where alertness is crucial to public safety, this is the type of illness that would be a major public health concern if it were not addressed.”
Lamont Byrd, director of the safety and health department for the Teamsters, one of the largest labor unions for truckers in the United States, said the organization’s members already undergo medical evaluations at least every two years. He said medical examiners are sensitive about screening for at-risk individuals, who are middle-age, have large necks, or a body mass index (BMI) of 35 or higher, which indicates obesity.
“I don’t anticipate that it would be significantly different if the rules moved forward,” Byrd told FoxNews.com, but he added the group would “follow the science.”
Sleep experts like Watson and Stuart Quan, the clinical director of the Division of Sleep and Circadian Disorders at Brigham and Women’s Hospital, argue those evaluations are often inaccurate because they rely on patients to self-report their symptoms. This method often leads to underreporting, Quan said.
“If you’re an independent trucker, your livelihood is based on driving your truck as much as possible,” Quan, also the Gerald E. McGinnis Professor of Sleep Medicine at Harvard Medical School, told FoxNews.com. “If you get a questionnaire to ask, ‘Do you stop breathing when you snore loudly?’ Are you going to tell the truth— realizing that if you tell the truth, a medical examiner may send you for an examination, and he will take you off the road until you’re treated adequately?”
Critics of the proposed rules, including independent truckers and their representatives, argue screening can lead to lost work opportunities for truckers and cost them big, especially without health insurance.
The FMCSA’s Medical Review Board has proposed a polysomnogram (PSG), the most common sleep study for diagnosing OSA, as a screening method. Taylor, of the OOIDA, said the average national price of a PSG is $2,625, and according to a member survey, 72 percent of health insurance policies do not cover sleep apnea expenses.
An ATRI survey of 800 commercial drivers found that 41 percent of participants screened for OSA had to take anywhere from one to 30 days off work.
“I think that’s a valid argument— it is expensive,” said Byrd, the safety expert from the Teamsters. “But then it’s also got to be weighed against if you can reduce crashes and loss of life and injuries.”
Megan Bush, manager of safety policy for the American Trucking Associations (ATA), which represents over 34,000 motor carrier members, agreed that more data needs to be gathered before mandatory screening is implemented.
“Right now there’s not a lot of solid data, and considering that it could impose some significant costs on not just industry, but drivers and eventually down the supply chain to consumers, we think it’s very important they have a real understanding not only of the problem, but whether the benefits will outweigh the costs,” Bush told FoxNews.com.
Watson referenced a recent report by the market research firm Frost & Sullivan that analyzed the cost of undiagnosed versus diagnosed OSA. Data suggested the economic cost of an individual having OSA would be $6,300 on average without a diagnosis, but $2,501 if he or she is diagnosed. The analysis accounted for health care utilization, increased insurance premiums, workplace absences and decreased productivity.
He pointed out that sleep apnea not only is linked to daytime drowsiness, but also to an increased risk of cardiovascular disease, diabetes, mental illness, obesity and high blood pressure.
“The disease is costing people money whether they treat it or not,” Watson said. “They can pay more, and be dangerous and have a lower quality of life, or they can pay less, and be safer on the roadways and have a higher quality of life in the long run.”