Sleep Apnea and Commercial Motor Vehicle Operators: Statement from the Joint Task Force of the American College of Chest Physicians, American College of Occupational and Environmental Medicine, and the National Sleep Foundation

Details

• Personal Author:
  Collop N ; Freedman N ; George CFP ; Gurubhagavatula I ; Hartenbaum N ; Leaman HM ; Moffitt GL ; Phillips B ; Rosekind MR ; Rosen IM ; Rowley JA ; Strohl K ; Weaver TE
• Description:
  Medical research supports the finding that obstructive sleep apnea (OSA) is a significant cause of motor vehicle crashes (MVCs) resulting in two- to sevenfold increased risk. Recent reports indicate OSA is present in a greater prevalence in operators of commercial motor vehicle (CMV) operators than in the general population. Although U.S. commercial drivers are required by federal statute to undergo medical qualification examinations at least every 2 years, the most recent OSA recommendations for medical examiners were prepared during a 1991 conference sponsored by the Federal Highway Administration (FHWA). Since then, the clinical diagnosis, evaluation, treatment, and follow-up criteria have changed significantly. Lacking current recommendations from the U.S. Department of Transportation (DOT), commercial driver medical examiners (CDMEs) must rely on outdated guidance and are thus forced to fill in the many existing gaps when evaluating CMV operators for this safety-sensitive type of work. In addition to causing difficulties for the medical examiner, the current guidelines, or lack thereof, foster an environment in which drivers who possibly have OSA are afraid to be evaluated because it might result in their removal from work. This set of circumstances may lead to the underrecognition of this condition and an increase in MVCs. OSA is a risk factor for sudden or subtle performance impairment leading to accidents. This impairment goes beyond simply falling asleep. The driver must be able to survey the surrounding environment, stay in his or her driving lane, and make adjustments in speed and position-a divided-attention task. Like with alcohol use or hypoglycemia, the driver tends to underestimate his or her degree of impairment. Healthcare providers are also imperfect at assessing impairment or adequately identifying those who should be evaluated for OSA. The situation is further complicated by the fact that not all patients with OSA are prone to accidents or performance decrements and some commercial drivers with OSA are known to have long, safe driving records despite having "severe" OSA. When a medical examiner qualifies a CMV operator, he or she is required to determine whether that driver meets U.S. federal medical standards and can perform driving and nondriving tasks. Examiners cannot place work restrictions on the driver such as limiting hours, travel, or type of vehicle operated. Once a driver is medically certified, he or she can use that medical certificate to perform any task that may be required of a commercial driver for any company. The CDME must be aware that although OSA itself can affect safety, it also plays a key role in other medical conditions that may affect medical certification; these conditions include hypertension, heart failure, diabetes, and other cardiovascular and cerebrovascular diseases. [Description provided by NIOSH]
• Subjects:
  Automobiles Occupational Health Safety Transportation
• Keywords:
  Drivers Equipment Operators Medical Examinations Medical Screening Sleep Apnea Transportation Workers Vehicle Safety
• ISSN:
  1076-2752
• Document Type:
  Text
• Funding:
  Grant
• Genre:
  Journal Article
• Place as Subject:
  Arkansas ; California ; Kentucky ; Maryland ; Michigan ; Ohio ; OSHA Region 3 ; OSHA Region 4 ; OSHA Region 5 ; OSHA Region 6 ; OSHA Region 8 ; OSHA Region 9 ; Pennsylvania ; Utah
• CIO:
  National Institute for Occupational Safety and Health (NIOSH)
• Topic:
  Workplace Safety & Health
• Location:
  North America
• Volume:
  48
• Issue:
  9
• NIOSHTIC Number:
  nn:20053541
• Citation:
  J Occup Environ Med 2006 Sep; 48(9)(Suppl):S4-S37
• Contact Point Address:
  Natalie Hartenbaum, MD, MPH, FACOEM, President and Chief Medical Officer, OccuMedix, Inc., P.O. Box 197, Dresher, PA 19025
• Email:
  occumedix@comcast.net
• Federal Fiscal Year:
  2006
• Performing Organization:
  University of Pennsylvania, Philadelphia
• Peer Reviewed:
  True
• Start Date:
  20050701
• Source Full Name:
  Journal of Occupational and Environmental Medicine
• Supplement:
  Suppl
• End Date:
  20290630
• Collection(s):
  National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:164d111f61a57d4252395992a7d3ccb1b3ed06cd340eb94821724edfeafa162bd8fabbff1660afb11ffe194866230af7fb9b7703492f20b75a9cbf3c231f8862
• Download URL:
  https://stacks.cdc.gov/view/cdc/216273/cdc_216273_DS1.pdf
• File Type:
  [PDF - 673.27 KB ]