Study Urges U.S. to Mandate Testing of All Truck Drivers for Sleep Apnea

This story appears in the April 13 print edition of Transport Topics.

A new study linking obesity and obstructive sleep apnea found that truck drivers are so resistant to testing and treatment that the federal government should mandate screening because the disorder plays a larger role in accidents than officially reported.

Published in the latest issue of the Journal of Occupational and Environmental Medicine, the study says apnea, which causes excessive daytime sleepiness, increases accident risk twofold to sevenfold.

The study also said that apnea could affect as many as 3.9 million of the nation’s 14 million commercial drivers and that obesity is a strong predictor of which drivers suffer from the sleep disorder.

“The relative risk of [apnea] has been shown to be greater than [tenfold] in persons with a [body mass index greater than 29],” the study says.

BMI, as the index is known, uses height and weight to measure relative obesity. People with sleep apnea suffer airway constriction that causes sleep interruption at night and subsequent fatigue during the day.

The study, funded in part by the Federal Motor Carrier Safety Administration, involved 456 commercial drivers from more than 50 companies. The study was written by a team that included researchers from the Harvard School of Public Health, the Boston University School of Medicine and the Cambridge Health Alliance.

Last year, FMCSA’s medical review board recommended mandating obstructive sleep apnea screening for commercial drivers with a 30-plus body mass index.

In the future, the agency may consider the recommendation as part of comprehensive medical rulemaking, “but nothing is scheduled at this time,” said FMCSA spokesman Duane DeBruyne.

The medical study also found federally mandated screening of commercial drivers will be ineffective if “doctor shopping” is not prohibited. Research shows, the study said, drivers could seek out doctors who won’t report medical conditions.

Within the trucking industry, though, some carriers already have taken steps to combat sleep apnea.

Truckload carrier Swift Transportation, Phoenix, recently launched a voluntary pilot program on obstructive sleep apnea prescreening that will involve about a third of its 15,000 drivers.Schneider National, Green Bay, Wis., which started screening programs in 2004, now screens all of its 16,000 drivers for sleep apnea and, in conjunction with a private medical vendor, provides treatment for drivers found to have the disorder.

Safety experts at the two trucking companies agreed that, as the authors of the medical journal study found, there is a stark correlation between obesity and sleep apnea.

“We know it’s an issue,” said Scott Barker, safety and compliance director for Swift. “It’s an issue, not just because of sleep apnea but because of other health-related factors.”

In addition to its sleep apnea pilot program in which drivers are prescreened via a questionnaire, Swift has weight management campaigns for drivers, Barker said.

Don Osterberg, Schneider’s senior vice president for safety and training, said his firm’s own studies found “a near-perfect correlation between body mass index and safety performance.

“So, we have to take this on because it’s very clear that high-BMI drivers are problematic on a number of fronts,” Osterberg said.

Schneider found itself pioneering sleep apnea screening, he said, after conducting an intensive analysis of its own severe driver accidents.

The firm found that fatigue figured in a far higher percentage of the accidents than officially reported. That may be true, Osterberg said, because law enforcement officers rarely report a crash as fatigue-related, unless the driver says he or she fell asleep at the wheel.

The new study made similar findings. According to the study, officially reported fatigue figures are likely to be only the “tip of the iceberg” in crashes caused by “driver somnolence.”

Sleep apnea screening is fraught with scientific issues that have to be addressed. For instance, when Schneider began prescreening drivers with a questionnaire, Osterberg said, it found that, if it relied just on prescreening without further testing, it could miss as many as 18% of those drivers who ultimately tested positive for obstructive sleep apnea.

Moreover, the link between sleep apnea and obesity raises a host of issues ranging from civil liberties to lifestyle and definitions of wellness.

“These are thorny issues, there’s no doubt,” said Dave Osiecki, vice president, safety, security and operations for American Trucking Associations.

“Not only is the industry trying to get their hands around the thorny questions, so is the government,” Osiecki said, “and that’s one of the reasons they haven’t moved with regulating [sleep apnea] because they’re still trying to figure out how to do that and do it appropriately and legally.”

ATA has not taken a position on mandatory screening for truck drivers, Osiecki said, but is trying to raise awareness through its safety committees about the disorder and the dangers it poses if untreated.