Daily Archives: September 7, 2016

The Latest On The FMCSA Sleep Apnea Review Board Recommendations

As anybody who sits for a prolonged period of time for their work will tell you, sleep apnea can be a real concern. Now, the Federal Motor Carrier Safety Administration (FMCSA) is taking the topic head on.

They have now convened a group of top medical advisers to take a close look at sleep apnea and make a list of guidelines in regards to the condition, with a decision already upon us.

What to Expect

It is likely that truck drivers will be required to undergo diagnostic sleep tests if they are showing a body mass index of 40 or higher. They may also target those who have experienced excessive fatigue or have been in a sleep-related accident.

The medical review board, after some deliberation, issued a specific set of recommendations during a two-day session on August 22nd and 23rd. Their goal was to help the FMCSA come up with clear guidelines that medical examiners can use to handle cases of severe cases of sleep apnea.

The board also suggested that any truck driver at risk for sleep apnea could receive a conditional 90-day medical certification. The validity of this certification would be pending the sleep study treatment and potential diagnosis.

Fortunately, there’s still time for the industry to digest the full report, as the FMCSA has reported the new rule would not come until sometime next year, after the new administration takes office.

What Are the Factors?

The review board also pinpointed specific factors in determining if a truck driver should be required to undergo a sleep study. The target body mass index range is 33 to 40.

Here is what they are looking at:

  • Hypertension
  • Type 2 diabetes
  • Male neck size > 27 inches
  • Female neck size > 15.5 inches
  • History of stroke
  • History of coronary artery disease
  • History of arrhythmias
  • Excessively loud snoring
  • Small or recessed jaw
  • Visible apnea symptoms
  • Hypothyroidism
  • Over 42 years of age
  • A male
  • Post-menopausal female
  • A small airway

The board went on to recommend that any truck driver diagnosed with sleep apnea after testing should not be given a medical certification lasting more than a year.

One of the advisory board members. Brian Morris of Quadrant Health Strategies Inc., tried to get the board to require four risk factors instead of three, but he was overruled. He was worried that in only going with three risk factors, a large number of drivers might be sent for screening for no reason.

Consider that some of the factors, such as gender or age, are somewhat automatic. For example, truck drivers are usually over 42 years old and male, so those are two risk factors already counting against the individual – things that are outside their control.

On the other side of the argument, other board members believe these recommendations will help to clarify uniform standards concerns regarding medical examinations and when a sleep apnea determination is made.

Some Nagging Concerns

The American Transportation Research Institute did a survey of 800 truck drivers and found that the overall average for the cost of a sleep study is around $1,200. This includes both out-of-pocket costs and any time missed from work.

Another item of concern among those receiving the recommendations is that medical examiners could have something to gain financially by sending drivers to sleep labs.

As far as how to treat the condition, the board recommended a preferred method of treatment called PAP, or positive airway pressure. To this day, PAP remains the most effective treatment for sleep apnea.

Although the board did say it would allow oral devices for apnea treatment, some members pointed out that many of these alternate treatments have not been medically proven to work.

In the end, the board updated a list of recommendations from 2012. Their methodology included up to 77 written statements from physicians and industry stakeholders.

So what will the final word be on sleep apnea and costly sleep studies? For that, and as to how the these recommendations will be implemented, only time will tell.