Marian Benjamin

In last year’s June issue, the editor’s message discussed the prevalence of sleep disorders and the risk of automobile accidents related to these disorders. Something that frightened me about the statistics was that many of the drowsy drivers are commercial motor vehicle (CMV) operators—the folks barreling down the highway in the 18-wheelers. Although the Federal Motor Carrier Safety Administration (FMCSA) had guidelines for the diagnosis and treatment of sleep apnea in these individuals, they were based on a 1991 report sponsored by the Federal Highway Administration.1

In the years since 1991, our knowledge about the prevalence of sleep-disordered breathing has grown: we know that 35 million Americans have sleep disorders and 95% of these are undiagnosed.2 Further, 200,000 auto accidents each year are sleep-related. Commercial vehicle operators have a higher prevalence of OSA (AHI between 5 and 15 events per hour, 17.6%; AHI between 15 and 30 events per hour, 5.8%; AHI greater than 30 events per hour, 4.7%).3 Additionally, CMV operators must be held to a higher standard than other drivers because they operate larger vehicles that may contain hazardous chemicals or large numbers of passengers. There is also a much higher fatality risk for occupants of the vehicles they hit. Finally, CMV operators often have economic incentives to drive extremely long distances or in unsafe conditions.

These facts caught the attention of members of the American College of Chest Physicians, the American College of Occupational and Environmental Medicine, and the National Sleep Foundation, who formed a task force to investigate and update the FMCSA guidelines. The task force reviewed the existing literature, medical regulations/guidelines/standards from international organizations, and reports and recommendations from the National Transportation Safety Board and FMCSA. The result of their investigation is not an evidence-based guideline, but a consensus-type document based on the literature.4 However, the executive summary does discuss what treatments should be recommended, when it is felt that a CMV operator can return to work after treatment, and what type of follow-up is required.5

Nancy Collop, MD, FCCP, Johns Hopkins University, and colleagues, state that this is important to respiratory care professionals because an estimate 40% of outpatient visits to pulmonologists are for sleep-disordered breathing. Pulmonologists, therefore, will often be the individuals screening these patients and overseeing their care. Now that we have CPAP devices that can measure usage, physicians can better monitor adherence to therapy. Collop et al write, “This is an important issue to everyone driving on our highways and is especially important to those of us caring for patients who may be CMV operators.”

For our readers involved in sleep medicine, this is a huge responsibility, but thanks to advances in technology and our increasing knowledge of sleep disorders, they can make a huge contribution to safety on our highways—not only as it pertains to CMV operators, but also to the drivers who must share the roads with them.

Marian Benjamin
[email protected]

References

  1. Report targets driver sleep apnea. Bulk Transporter. September 18, 2006. Available at bulktransporter.com/news/drivers8181/. Accessed May 21, 2007.
  2. The sleep crisis in America. Available at [removed]www.sleeptest.com/america_pf.html[/removed]. Accessaed May 21, 2007.
  3. Collop N, Hartenbaum N, Rosen I, Phillips B. Paying attention to at-risk commercial vehicle operators. Chest. 2006;130:637-9.
  4. Hartenbaum N, Collop N, Rosen I, et al. Sleep apnea and commercaial 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. J Occup Environ Med. 2006;48(9 suppl):s4-37.
  5. Hartenbaum N, Collop N, Rosen M, et al. 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. Chest. 2006;130:902-3.