NTSB Urges Tougher Measures to Fight Drivers’ Sleep Apnea

This story appears in the Oct. 26 print edition of Transport Topics.

The Federal Motor Carrier Safety Administration should identify commercial truck and bus drivers who are at high risk for obstructive sleep apnea, and require drivers diagnosed with the condition to prove they are being treated, the National Transportation Safety Board recommended last week.

There is compelling and growing evidence that drivers who are obese and have high blood pressure have an increased risk for sleep apnea, a disorder that often causes sufferers to experience extreme daytime sleepiness or to fall asleep within minutes in a “quiet or monotonous environment,” NTSB stated in an Oct. 20 letter.

The board — which is charged with investigating common carrier accidents — said that people with sleep apnea have a “clearly” higher risk of being involved in an accident, and that “FMCSA’s own research suggests a prevalence of more than 10% of at least moderate OSA in commercial drivers.”

“In spite of limited guidance regarding drivers who are excessively sleepy or already diagnosed with OSA, the FMCSA currently provides no guidance regarding how to identify commercial drivers at risk for OSA,” the letter said.

The NTSB said that FMCSA has not yet acted on a January 2008 recommendation by its medical review board that the agency require screening for sleep apnea in drivers with a body-mass index of more than 30. A 5-foot-11-inch person who weighs 215 pounds has a BMI of 30.

In a written response, FMCSA said sleep apnea is a “safety issue we take seriously” and stated it is “already considering a rule to tighten its standards for medical certification of commercial drivers.”

Some fleet executives and medical firms praised the call for action.

Don Osterberg, Schneider National Inc.’s senior vice president of safety and driver training, said that the NTSB’s recommendation is “one more nudge to get FMCSA to act on the medical review board recommendation.”

Schneider National has had an aggressive apnea testing and treatment program since 2003 and spends from $2,500 to $3,500 to identify and treat each driver with sleep apnea, Osterberg said.

“I certainly am supportive of the NTSB’s position,” Osterberg added. “The current DOT standards haven’t been updated since 1991. I think everyone agrees now it’s time to address the issue.”

He said studies indicated that up to 28% of truck drivers have some level of sleep disorder, but of that number only about 15% have been diagnosed with the condition.

Osterberg said that statistically, the truck-driving population has more of a problem with obesity than the general public. One university study estimated that there were as many as 1.8 million commercial drivers afflicted with sleep apnea, he said.

NTSB said it has found a correlation between drivers at risk for sleep apnea and those involved in some of the accidents it has investigated.

In one of those accidents, where a 2000 tractor-trailer collision killed a Tennessee state highway patrolman, NTSB determined that the probable cause of the accident was a 358-pound truck driver’s incapacitation due to sleep apnea and represented a “failure of the medical certification process to detect and remove a medically unfit driver from service.”

In other investigations, however, NTSB said it identified drivers at risk for sleep apnea where the disease could not be clearly linked to the accident.

One FMCSA study found that 17.6% of drivers had mild apnea, 5.8% had moderate OSA and 4.7% had a severe condition, NTSB said.

Sleep apnea long has been on the trucking industry’s radar screen and was singled out as a topic of concern during a panel discussion at American Trucking Associations’ Management Conference and Exhibition in Las Vegas earlier this month.

“ATA has expressed general support for improved medical standards consistent with current medical science, including sleep apnea, but will obviously have to wait to see what specific proposals FMCSA makes before taking firm positions,” said Clayton Boyce, a spokesman for ATA.

Boyce said FMCSA already deals with apnea screening as part of its driver qualification standards during physical examinations of drivers.

Dana Voien, president of SleepSafe Drivers, a consulting firm based in California that tests and treats truck drivers for sleep apnea, said subjective tests or questions given to drivers don’t always elicit honest answers, since the drivers fear they could lose their jobs if they had the disorder.

He said that FMCSA should require that truck drivers with a neck size of 17 or larger, high blood pressure and a body-mass index of 33 or higher be further screened before they are certified as fit to drive.

Voien said that sleep apnea is a problem because when a person’s breathing is obstructed, the individual fails to get restful sleep.

“It punishes the body,” he said. “It’s literally like getting waterboarded all night.” The common treatment, a continuous positive airway pressure device, is simple and effective — but some find it uncomfortable and stop using it after a few weeks.