21 Mar Truck Drivers With Sleep Apnea Who Don’t Use Their CPAP Have More Preventable Crashes
MedicalResearch.com Interview with:
Stefanos N. Kales, MD, MPH, FACP, FACOEM
Associate Professor, Harvard Medical School &
Harvard TH Chan School of Public Health
Director, Occupational Medicine Residency
Division Chief OEM, Cambridge Health Alliance
MedicalResearch: What is the background for this study?
Dr. Kales: Up to 20% of all large truck crashes are due to drowsy or fatigued driving, which would account for almost 9,000 fatalities and up to 220,000 serious injuries. OSA is the most common medical cause of excessive daytime sleepiness or fatigue, and has been linked with negative impacts on attention, working memory, vigilance, and executive functioning. Past studies primarily of passenger car drivers have linked untreated OSA with a several-fold increased risk of motor vehicle accidents. They have also shown that effective treatment with CPAP reduces this risk close to that of unaffected drivers.
Although commercial truck drivers undergo a biennial examination to determine their medical fitness to safely operate a vehicle, there are currently no mandatory standards for OSA screening or diagnosis, in part because there have been no large-scale studies evaluating the crash risk of commercial drivers diagnosed with OSA.
Our study examined the results of the first large-scale employer program to screen, diagnose, and monitor OSA treatment adherence in the U.S. trucking industry
MedicalResearch: What are the main findings?
Dr. Kales: We compared a control group of 2,016 drivers unlikely to have OSA with a group of 1,613 drivers with OSA. Of the latter group, 682 fully adhered with requirements to use company-provided positive airway pressure (PAP) machines, 571 partially adhered to the treatment, and 360 never adhered. For each group, we looked at data on serious preventable crashes in which the driver was found to be at fault.
Drivers with OSA who didn’t adhere to treatment had a rate of preventable crashes five-fold greater than that of the control group which had similar driving experience. We also found that drivers with OSA who were fully compliant with the company-mandated treatment had a crash rate no different than that of the control group. The results were robust across a series of analytic models that adjusted for various additional covariates.
MedicalResearch: What should clinicians and patients take away from your report?
Dr. Kales: Commercial drivers and other professional transportation operators should be screened for OSA and if found to be at high-risk, undergo diagnostic testing. CPAP or APAP should be required along with treatment compliance monitoring in order for those with OSA to continue driving/operating. Given the unreliability of OSA symptoms in the occupational setting, treatment is advised for even “mild” OSA. In our study, the diagnostic criterion and treatment threshold was an AHI >/=5.
MedicalResearch What recommendations do you have for future research as a result of this study?
Dr. Kales: Future research should improve the calibration of criteria and thresholds for OSA treatment
Success. In addition, markers that predict those persons with untreated OSA who are most prone to crash risk need to be developed/identified.
MedicalResearch: Is there anything else you would like to add?
Dr. Kales: Our results strongly support Federal OSA regulations for commercial drivers as well as throughout other modes of public/commercial transportation.
Non-Adherence with Employer-Mandated Sleep Apnea Treatment and Increased Risk of Serious Truck Crashes. Sleep, March 7, 2016, Stephen V. Burks, Jon E. Anderson, Matthew Bombyk, Rebecca Haider, Derek Ganzhorn, Xueyang Jiao, Connor Lewis, Andrew Lexvold, Hong Liu, Jiachen Ning, Alice Toll, Jeffrey S. Hickman, Erin Mabry, Mark Berger, Atul Malhotra, Charles A. Czeisler, and Stefanos N. Kales
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Stefanos N. Kales, MD, MPH, FACP, FACOEM (2016). Truck Drivers With Sleep Apnea Who Don’t Use Their CPAP Have More Preventable Crashes MedicalResearch.com