The FMCSA’s Medical Review Board recently met to review studies on sleep apnea and diabetes as they affect a CDL driver’s fitness. The Board also reconsidered its recommendations to the FMCSA regarding the medical qualification of drivers who have been diagnosed with sleep apnea or diabetes.
Studies conducted in the United States indicated a significantly greater crash risk for drivers who are insulin-dependent. The Board recommended that the FMCSA streamline the medical exemption process to make the exemption due to diabetes available to more drivers.
The reports also identified sleep apnea as the largest safety concern of any area in which the FMCSA regulates drivers. There is a significant prevalence of sleep apnea in the driver population. Methods to screen for, diagnose, and treat sleep apnea remain controversial.
The Board discussed the use of Body Mass Index (BMI) as a marker for screening drivers for sleep apnea; the Medical Review Board had previously recommended using a BMI of 30 or greater to refer a driver for a sleep study diagnosis. The FMCSA’s Medical Expert Panel, however, had previously recommended using a BMI of 33 or higher for sleep study screening. One commenter suggested using a BMI of 33 or higher plus a neck size of 17 inches or more (for males) and other factors to refer drivers for a sleep study.
It was noted that portable diagnostic systems for sleep apnea were an effective alternative to a sleep study, but a concern exists whether the use of these systems would create more false positive or negative results.
Regarding sleep apnea treatment, the studies reflect that CPAP is the only treatment shown to be effective at this time in reducing crash risk. The studies indicated a reduction in crash risk of 72% following use of a CPAP device for one year, but noted that the studies are inconclusive on whether drivers using CPAP therapy return to a “normal” rate of risk or some "still-elevated" risk level.
The Board considered recommending that the FMCSA develop a step level of screening, diagnostic and treatment protocols. But the Board also noted that it would meet in conjunction with the FMCSA’s Motor Carrier Safety Advisory Committee on August 29, 2011 in Alexandria, Virginia to discuss sleep apnea issues, and deferred making any new recommendations on guidance until after that meeting.
To further inform the transportation industry about the concerns of sleep apnea, the FMCSA has created a special sleep apnea page on their website.
With the controversy about how to screen for, diagnose, and treat sleep apnea continuing to grow among the CDL driver community, I encourage you to share your thoughts on the subject by commenting on this article.
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