Obstructive sleep apnea screening during commercial driver medical examinations: A survey of ACOEM members
To survey American College of Occupational and Environmental Medicine (ACOEM) members regarding recent consensus guidelines for screening commercial drivers for Obstructive Sleep Apnea (OSA).
A brief survey instrument was distributed electronically by the American College of Occupational and Environmental Medicine to its members during February 2008 to April 2008.
Most (92%) of the 552 examiners opined that screening commercial drivers for OSA was important. Nevertheless, only 42% reported screening using consensus guidelines or another specific protocol. Common reasons for not applying the guidelines included unaware (36%), too complicated (12%), client retention (10%), and driver inconvenience (10%). Most would consider using the guidelines going forward but 39% wanted additional evidence and another 21% only if they became the "community standard."
More education regarding OSA and drivers is needed. A Federal mandate and eliminating "doctor shopping" would likely increase examiners' compliance with screening.
Available from: James Talmage
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ABSTRACT: Identify factors associated with obstructive sleep apnea (OSA) risk during commercial driver medical examinations.
A case-control study was conducted at an occupational health clinic by reviewing the commercial driver medical examinations medical records performed from January 2007 to December 2008. The magnitude of association with OSA was estimated with logistic regression.
Among 1890 commercial motor vehicle drivers, 51 were confirmed positive for OSA by polysomnography after initial screening by Joint Task Force guidelines, yielding estimated positive predictive values of 78.5% for the screening criteria. Multivariable logistic regression showed that body mass index ≥ 30 (odds ratio: 26.86), hypertension (odds ratio: 2.57), and diabetes (odds ratio: 2.03) were independently associated with OSA.
Medical examiners' use of objectively measurable risk factors, such as obesity, history of hypertension, and/or diabetes, rather than symptoms, may be more effective in identifying undiagnosed OSA in commercial drivers during the commercial driver medical examinations.
Journal of occupational and environmental medicine / American College of Occupational and Environmental Medicine 02/2011; 53(2):169-73. DOI:10.1097/JOM.0b013e3182068ceb · 1.63 Impact Factor
Available from: zapto.org
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ABSTRACT: Commercial motor vehicle drivers are at an increased risk for obstructive sleep apnea (OSA). The Federal Motor Carrier Safety Administration (FMCSA) Medical Review Board has recommended that commercial motor vehicle drivers undergo testing for OSA if they have a positive Berlin Questionnaire or a BMI ≥ 30 kg/m(2). We developed an online screening tool based on the Berlin Questionnaire for anonymous use by commercial drivers to assess their risk of OSA prior to their required FMCSA physicals.
We based the survey on the Berlin Sleep Questionnaire. The survey was hosted on the Truckers for a Cause Chapter of Alert Well and Keeping Energetic of the American Sleep Apnea Association (TFAC-AWAKE) organization website, and was promoted through the TFAC's XM radio, word of mouth, and trucking industry press contacts.
A total of 595 individuals completed the survey. Of these, 55.9% were positive on the Berlin, 78.3% had either hypertension or obesity, 69.6% were obese, 47.6% had a BMI > 33 kg/m(2), and 20.5% reported falling asleep at stoplights.
Some commercial drivers willingly assess their OSA risk anonymously online, and a majority of those who do so are obese, have positive Berlin screening questionnaires, and would be required to undergo polysomnography if recommendations made to the FMCSA became regulation. In contrast to reported behavior during actual Commercial Driver Medical Examinations physicals, some commercial drivers will report OSA symptoms if it is "safe" to do so. Sleep health professionals need expedient, non-punitive methods to keep commercial motor vehicle drivers healthy and driving and to raise drivers' awareness of the dangers of drowsy driving and unhealthy lifestyles.
Journal of clinical sleep medicine: JCSM: official publication of the American Academy of Sleep Medicine 06/2011; 7(3):241-5. DOI:10.5664/JCSM.1060 · 3.05 Impact Factor
Available from: Vilma Leyton
06/2011; 90(2):78. DOI:10.11606/issn.1679-9836.v90i2p78-88
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