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Tired Truck Drivers and Sleep Disorders
Nearly 2 million drivers have crashed or had near misses due to drowsiness in the last year, according to The National Sleep Foundation's 2009 Sleep in America poll.1 Truck crashes are a significant public health hazard causing thousands of deaths and injuries each year. Commercial truck drivers may be even more at risk of driving drowsy than the general population, due to their high road mileage and the likelihood that they have OSA, or obstructive sleep apnea.
OSA is characterized by breathing cessations during sleep, resulting in daytime sleepiness and an increase in the risk of motor vehicle accidents. OSA is a highly under-diagnosed condition that is also associated with obesity, high blood pressure, diabetes, and heart disease. Between 2.4 and 3.9 million licensed truck drivers in the US are thought to have OSA.2 In a recent study of over 450 truck drivers published in the Journal of Occupational and Environmental Medicine, 17% met the screening criteria for OSA. Obese truck drivers were more likely to have OSA, and screening for the condition could reduce the risk of truck crashes and improve the quality of life for these drivers. Unfortunately, although effective treatment is available for OSA, the study found that most drivers that were referred for a sleep study to confirm the diagnosis of OSA did not follow through with the referral to get tested. "Truck drivers with sleep apnea are much more likely to fall asleep at the wheel, and the condition is increasingly common as Americans become more obese," said the study's senior author, Stefanos N. Kales, MD, MPH, Medical Director of Employee and Industrial Medicine at Cambridge Health Alliance, where the study was conducted. "Additionally, we found that drivers who suffer from obstructive sleep apnea frequently underreport symptoms and diagnoses and often do not follow through with sleep study referrals and sleep apnea treatment." It is clear that OSA screenings of truck drivers will not be effective unless they are required by law or by employers. If they were required, drivers diagnosed with a serious disorder could be prohibited from driving until they seek treatment. The Federal Motor Carrier Safety Administration (FMCSA) is debating recommendations to require sleep apnea screening for all obese drivers based on their body mass index or BMI. Currently drivers are required to seek medical certification every two years to maintain their license, but examiners are not required to screen for OSA. Since lack of awareness among health professionals is a major reason for under-diagnosis of the condition, many truck drivers may be getting their certification from doctors who aren’t familiar with the prevalence and dangers associated with OSA. Implementing the screening recommendations by the FMCSA offers an excellent opportunity to detect OSA as part of standard driver safety examinations. The result will not only help the truck drivers, it will make our roads safer for all drivers. 1 http://www.sleepfoundation.org/sites/default/files/2009%20POLL%20HIGHLIGHTS.pdf 2 Cambridge Health Alliance. http://www.cha.harvard.edu/news/press_releases_09/090310_kales_sleep_apnea_study.shtml
