The Medical Review Board of the Federal
Motor Carrier Safety Administration
(FMCSA) outlined its official recommendations to the agency on screening and
disqualification criteria for truck drivers who are suspected of having moderate to severe obstructive sleep
apnea.
The board’s preliminary
recommendations, which have not yet been approved by the board, encourage the
FMCSA to require a trucker to be screened for sleep apnea if:
1.
Has a
body mass index greater than 40, or
2. Has a body mass index greater than 33 and
meets three of the following:
·
Older
than 42
·
Male
·
Postmenopausal
female
·
Type 2
diabetes
·
High
blood pressure
·
History
of stroke, coronary artery disease, or arrhythmias
·
Small or
recessed jaw
·
Loud
snoring
·
Witnessed
pauses in breathing
·
Small
airway
·
Neck
size over 17 inches (male) or 15.5 inches (female)
·
Untreated
hypothyroidism
The
board also recommends that FMCSA allow truckers with a sleep apnea diagnosis to
continue to drive if they are being “treated effectively,” which is defined as
“the resolution of moderated to severs OSA to mild or better, as determined by
a certified sleep specialist.”
These recommendations are not yet final, however, as the board
did not vote to approve them. Also the recommendations are just that —
recommendations. FMCSA has no legal requirement to adopt any of the
recommendations, but will likely lean on them
when developing a sleep apnea rule.
Other Recommendations made
included the following:
1.
A driver
found to be at risk for sleep apnea based on BMI should be certified for 90
days pending a sleep study.
2.
If a
driver already has a negative or mild diagnosis, a new sleep study should be
ordered if any additional risk factors appear or if the driver has a 10 percent
increase in weight. If age is the only added risk factor, then there should be
a three-year wait since the last sleep study.
3.
To diagnose
drivers, an in-lab test is preferred but at-home testing is acceptable if the
results cannot be falsified.
4.
For
treatment, a positive airway pressure (PAP) machine is preferred but oral
devices and surgeries are options. A driver using a PAP machine can be
certified for one year if they use the machine for at least 30 days (fewer if
being recertified), at least 4 hours per night and on 70 percent of nights.
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