Body Mass Index is an effective measure for occupational screening of employees at high risk for moderate to severe obstructive sleep apnea: implications for DOT commercial driver medical examinations

Details

• Personal Author:
  Barger L ; Czeisler, Charles A. ; Epstein LJ ; Lockley SW ; O'Brien C ; Qadri S ; Rajaratnam S ; Shea SA ; White D
• Description:
  Introduction: In 2007, an FMCSA Medical Expert Panel recommended that commercial motor vehicle drivers with a BMI greater than 33 kg/m2 be denied medical certification without objective testing, and where indicated, effective treatment for OSA. In 2008, the Medical Review Board of the FMCSA recommended a BMI threshold of 30. In 2011. the FMCSA Medical Review Board and the Motor Carrier Safety Advisory Committee jointly recommended that the FMCSA immediately issue a Guidance with a BMI threshold 35, pending final ruling. We examined the association between BMI and objectively diagnosed OSA. Methods: State troopers (n=605) completed the Berlin questionnaire and provided self-reported BMI. Polysomnographic studies were performed on 114 participants; 60 screened positive on the Berlin and 54 screened negative. OSA severity was classified by a sleep specialist using both RDI and Sa02. Those with RDI > 10/hour or RDI>5/hour with Sa02<85%. were classified as Mild-to-Moderate, Moderate-to-Severe. or Severe-OSA (MMS-OSA): those with RDI >25/hour were classified as Moderate-to-Severe. or Severe-OSA (MS-OSA). Results: We found that BMI >25 had a positive predictive value (PPV) of67% for MMS-OSA. PPV 01'31% for MS-OSA: BMI >30 had PPV of 80% for MMS-OSA. PPV of 36% for MS-OSA: BMI >33 had PPV of 81% for MMS-OSA. and PPV of 52% for MS-OSA: BMI >35 had a PPV of 92% lor MMS-OSA. PPV of 75% tor MS-OSA among state troopers. We found that BMI >25 had negative predictive value (NPV) of 67% for MMS-OSA. NPY of 87% to r MS-OSA: BMI >30 had NPV of48% lor MMS-OSA. NPY 01'76% for MS-OSA: BMI >33 or >35 had NPV of41% for MMS-OSA, NPV of77% tor MS-OSA. Conclusion: Elevated BMI conveys a very high risk of moderate-to severe/ severe-OSA. These results can be used to inform public policy regarding occupational screening of commercial vehicle drivers and others in safety sensitive occupations. [Description provided by NIOSH]
• Subjects:
  Automobiles Body Weight Circadian Rhythm Occupational Health Safety
• Keywords:
  Body Weight Circadian Rhythms Medical Examinations Motor Vehicles Sleep Apnea
• ISSN:
  0161-8105
• Document Type:
  Text
• Funding:
  Grant
• Genre:
  Abstract or Summary
• Place as Subject:
  Massachusetts ; OSHA Region 1
• CIO:
  National Institute for Occupational Safety and Health (NIOSH)
• Topic:
  Workplace Safety & Health
• Location:
  North America
• Volume:
  35
• NIOSHTIC Number:
  nn:20045615
• Citation:
  Sleep 2012 Jun; 35(Abstract Suppl):A138
• Federal Fiscal Year:
  2012
• Performing Organization:
  Brigham and Women's Hospital - Boston, Massachusetts
• Peer Reviewed:
  False
• Start Date:
  20040930
• Source Full Name:
  Sleep
• Supplement:
  Abstract Supplement
• End Date:
  20070929
• Collection(s):
  National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:58afa55fece371788f15cc360fef760344d8f051932a65a022b931a7371e9ebffc140fe39719e37c4b8037bc23978263e0168c298e58b89174ca8780d463628f
• Download URL:
  https://stacks.cdc.gov/view/cdc/200968/cdc_200968_DS1.pdf
• File Type:
  [PDF - 1.20 MB ]