Undiagnosed sleep apnea puts all motorists at risk

Research has shown that untreated sleep apnea increases the risk of motor vehicle accidents, but those who perform Department of Transportation medical certifications for commercial vehicle drivers are still getting up to speed on how to screen for this disorder. Last month’s deadly Amtrak wreck in Philadelphia underscores the importance of responsible screening, diagnosis and treatment for drivers with sleep apnea.

Every year, tens of thousands of fatalities occur on U.S. highways. Heavy to medium trucks accounted for many of them. As the result of long hours spent on the road, commercial vehicle drivers are at increased risk for motor vehicle accidents. Researchers have studied the effect of sleep apnea and short sleep duration on commercial drivers and found a decrease in neurobehavioral performance particularly when reduced sleep duration and severe sleep apnea are combined.

Among the most important consequences of sleep apnea in the context of occupational health is excessive daytime sleepiness, which is a significant public safety concern for any safety-sensitive occupation, especially commercial driving. Even for those not in safety-sensitive positions, productivity is affected.

Driving a motorized vehicle is a complex task requiring attentive perceptual and motor skills. Driving also requires quick decision-making, which necessitates a sharp mental status. Sleepiness can affect all or some of these skills.

Sleep apnea is a health-related condition characterized by repetitive episodes of airflow impairment during sleep that is often the result upper-airway collapse stemming from obesity.

Manakai o Malama Integrative Clinic has seen so many patients with risk factors for sleep apnea, I decided to build Nio­lo­pua Sleep Lab and Wellness Center in 2012. It is accredited by the American Academy of Sleep Medicine. Since opening the facility, more than 90 percent of those tested were found to have a positive diagnosis. There are numerous treatment strategies once a diagnosis has been made. Commonly, a diagnosis of moderate sleep apnea responds to treatment with a continuous positive airway pressure machine.

Sleep apnea is common among commercial drivers with an estimate of 15 percent to 30 percent of North American drivers having the condition. The No. 1 risk factor for obstructive sleep apnea, which is the most common form of sleep apnea, is obesity.

Roughly 50 percent of truck drivers in the United States are obese. Sleep apnea is underdiagnosed in this at-risk population and undertreated among those who have been diagnosed. It is important to pursue collective efforts among occupational medicine providers, transportation industry leaders and government regulatory agencies to improve screening measures and avoid preventable disasters involving sleep-related vehicle accidents amongst commercial drivers.

Individuals employed by commercial vehicle businesses must be screened by medical providers who are certified to conduct Department of Transportation examinations. Medical examiners may be licensed physicians, physician assistants, nurse practitioners or chiropractors. Manakai o Malama offers this service performed by a certified provider.

The Federal Motor Carrier Safety Administration continues to face criticism over a lack of clearly defined guidelines for medical examiners to follow on the screening for undiagnosed sleep apnea. The current recommendation is that referrals to sleep specialists for further evaluation and testing is based on the judgment of the medical professional and not a result of federal regulation providing specific screening requirements. Many cases are missed.

The Federal Motor Carrier Safety Administration is now determined to increase the proficiency of medical examiners by requiring all of them to be certified by the agency. Until a consensus is reached on how best to screen for sleep apnea, commercial drivers at increased risk for sleep apnea will continue to be on the road.

The use of screening questionnaires is one way to identify drivers at risk, which is a voluntary screening tool utilized at Manakai o Malama by our commercial driver’s license certified providers. The two most common criteria identified are daytime sleepiness and nighttime snoring. Because clearance by a certified medical examiner has far-reaching implications for the driver and the public, it is important that screenings are both standardized and comprehensive and that workers who meet criteria obtain a sleep study and appropriate treatment. This will limit preventable sleep-related accidents and optimize productivity across the board.

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Ira Zunin, M.D., M.P.H., M.B.A., is medical director of Manakai o Malama Integrative Healthcare Group and Rehabilitation Center and CEO of Global Advisory Services Inc. Please submit your questions to info@manakaiomalama.com.