FMCSA Medical Review Board to Offer Recommendations for Sleep Apnea Rule
The Federal Motor Carrier Safety Administration’s top medical advisers on Aug. 22 began a two-day review of obstructive sleep apnea diagnosis and treatment issues to offer their final recommendations for apnea regulatory requirements.
The agency’s Medical Review Board, made up of several physicians and certified medical examiners, began discussions on a “matrix” of the 77 written comments from physicians and trucking and railroad industry stakeholders regarding the cost, diagnosis, screening and treatment of moderate to severe sleep apnea.
The comments were offered in response to a joint FMCSA/Federal Railroad Administration advance notice of proposed rulemaking on March 8. Neither agency is certain whether an apnea rule will be ultimately adopted, but each is exploring the possibility.
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The ANPRM requested comment on 20 questions related to the problem of OSA, cost and benefits, screening procedures and diagnostics, medical personnel qualifications and restrictions and treatment effectiveness, Mark Patterson, executive officer for safety operations for the Federal Railroad Association, said in a briefing to the board.
Some of the more hot-button issues related to an apnea regulation center on how a medical examiner should determine whether a driver is at risk and when to refer a driver to a costly sleep lab test.
A large number of drivers have objected to being referred to sleep lab tests based solely on neck size and/or body-mass index numbers.
Patterson said that drivers and crash victims who spoke at three FRA/FMCSA listening sessions were passionate in their comments, both favorable and negative.
Rebecca Brewster, president of the American Transportation Research Institute, told the board that the results of a survey of 800 truck drivers showed that the average cost of a sleep lab study for high-risk drivers is $1,220.
The survey also showed that drivers want to see more evidence on the relationship of sleep apnea and crash risk and had concerns that they were being referred to sleep labs by a medical examiner with a financial interest in the lab.
Christine Cisneros, review board member and medical director of two USHealthworks clinics in Indiana, said the board needs to work on “mitigation of driver animosity.”
Mary Pat McKay, chief medical officer for the National Transportation Safety Board, said her agency has since 2009 been urging that FRA and FMCSA to both implement a sleep apnea rule to save lives caused by drivers falling asleep at the wheel.
Several medical researchers commenting at the meeting said there is a great need for drivers and motor carriers to be better understand the serious long-term health risks associated with sleep apnea.
