100,000 fatigue-related crashes occur each year, many of which involve professional drivers in heavy commercial vehicles

A Deadly Combination: Sleep Apnea and Commercial Drivers

An estimated one in 25 adult drivers (aged 18 years or older) report having fallen asleep while driving in the previous 30 days, and a condition called obstructive sleep apnea can make drivers even more susceptible to drowsy driving.

Aug 24, 2016 Chris Zimmer

The National Highway Traffic Safety Administration reports that 100,000 fatigue-related crashes occur each year, many of which involve professional drivers in heavy commercial vehicles.

There’s no question that driver fatigue poses a serious threat to safety on our nation’s roadways. But just how bad is the threat?

The National Highway Traffic Safety Administration (NHTSA) reports that 100,000 fatigue-related crashes occur each year, many of which involve professional drivers in heavy commercial vehicles. That means an average of 1,550 deaths, 71,000 injuries and $12.5 billion in monetary damages each year as a result of fatigue-related accidents.

So what is being done to prevent fatigued commercial drivers – specially licensed, professional operators of 18 wheelers, buses and other large commercial vehicles – from getting behind the wheel while they’re tired or fatigued? Well, as it turns out, not enough.

Driver/Employer Responsibility

According to the Federal Motor Carrier Safety Regulations, specifically § 392.3 on ill or fatigued operators:

"No driver shall operate a commercial motor vehicle, and a motor carrier shall not require or permit a driver to operate a commercial motor vehicle, while the driver’s ability or alertness is so impaired, or so likely to become impaired, through fatigue, illness, or any other cause, as to make it unsafe for him/her to begin or continue to operate the commercial motor vehicle."

That means both drivers and their companies have a legal responsibility to make sure that anyone suspected of obstructive sleep apnea (OSA), or other similar condition, stays off of the road.

Recent developments in the law have witnessed the implementation of a number of “improvements,” including hours of service regulations, intended to help drivers get more rest during the work week. Unfortunately, according to the Insurance Institute for Highway Safety, the new rules have done nothing to improve safety as they provide no means to effectively monitor hours spent driving.

Commercial Drivers More Likely to Fall Asleep

According to the NHTSA, because commercial drivers generally are required to drive long distances for long periods of time, often at night, they are more susceptible to falling asleep behind the wheel than non-commercial drivers. Disturbingly, research from the National Transportation Safety Board has confirmed that fatigue was the most frequently cited cause of heavy truck accidents, accounting for 30-40 percent of them, and was also the cause of 31 percent of the 182 fatal-to-the-truck-driver accidents studied.

Due to sedentary lifestyles and a tendency toward a high body mass index (BMI), commercial drivers are at greater risk than non-commercial drivers of developing dangerous sleep disorders. While commercial truck drivers are required by the Federal Motor Carrier Safety Administration to undergo regular medical exams to spot dangerous medical conditions like these, many sleep disorders still go undiagnosed, or worse, ignored.

OSA, the most common form of sleep apnea, is a condition in which the upper respiratory system intermittently constricts to block the flow of oxygen into the lungs. This constriction forces the body to work hard in order to breathe and, consequently, causes the body to shift from deep, restful sleep to light sleep in order to bring air in. This lack of sleep tends to accumulate until individuals start to operate with a significant sleep deficit.

While individuals of all ages can develop sleep apnea, common sleep apnea risk factors include:

• Obesity/high BMI;
• Heavy snoring;
• Large neck circumference;
• High blood pressure;
• Diabetes;
• Male;
• Middle to older age;
• Smoking;
• Alcohol or sedative use;
• Difficulty breathing through the nose.

Sleep Deprivation and the Human Body

When the human body is deprived of sleep, cognitive performance begins to suffer almost immediately. Sleep deprivation problems can include a decrease in alertness and an inability to perform; cognitive as well as memory difficulties; and an increased risk of involvement in a motor vehicle or workplace accident.
On Sept. 14, 2013, a Greyhound bus driver fell asleep at the wheel while traveling northbound on Interstate 70 just north of Cincinnati. The bus, loaded with 51 passengers, drove off the highway and rolled over into a cornfield, severely injuring several of the bus passengers onboard.

Greyhound denied responsibility for the crash, claiming that the driver had lost consciousness from choking on a cup of coffee that he was drinking while driving the bus.

Attorneys Ryan Zehl and Kevin Haynes filed a lawsuit against Greyhound and its parent company, FirstGroup, on behalf of five of the injured bus passengers. After taking depositions of Greyhound’s CEO and head of safety, they learned that just one month prior to the crash, the same driver was suspected of having OSA.

The Department of Transportation physician who suspected that the driver had OSA notified Greyhound, recommended that they send the driver in for a polysomnography (an overnight sleep study), and issued a limited three-month medical certificate (rather than the ordinary one- or two-year certification).
Despite these serious red flags, Greyhound failed to have the sleep study done and instead, allowed the bus driver to continue driving passengers.

After taking the deposition of the Greyhound bus driver, Zehl and Haynes were able to convince the trial court and court of appeals to require the driver to undergo an overnight sleep study. The court ordered sleep test confirmed that the bus driver had moderate-to-severe OSA and, as a result, should not have been driving the bus.

This appears to be the first time in history that a forensics firm like Metropolitan Forensics has been able to convince both a trial court and court of appeals to issue an order requiring a Greyhound Bus driver to undergo an overnight sleep study.

Several weeks before trial, Zehl and Hayes negotiated a $6 million settlement on behalf of the injured bus riders.

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Recommendations would force at-risk truckers into sleep apnea screening/treatment

health James Jaillet | August 23, 2016
 



Under the proposal, male truckers 42 and older with a BMI greater than or equal to 33 would need to meet only one of the other criterion to automatically qualify for screening.

The Medical Review Board of the Federal Motor Carrier Safety Administration outlined this week 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 FMCSA to require a trucker to be screened for sleep apnea if he or she:

(1) has a body mass index greater than or equal to 40, or

(2) has a body mass index greater than or equal to 33 and meets at least three of the following criteria:
**Is 42 or older
**Is male
**Is a postmenopausal female
**Has diabetes
**Has high blood pressure
**Has a neck size greater than 17 inches (males) or 15.5 inches (females)
**Has a history of heart disease
**Snores loudly
**Has had witnessed apneas
**Has a small airway to the lungs
**Has untreated hypothyroidism
**Has micrognathia (undersized jaw) or retrognathia (clinical terminology for a kind of overbite)

Male truck operators 42 and older and who have a BMI of 33 or greater would need to meet only one of the other criterion to automatically qualify for screening.

The board also would recommend that FMCSA allow truckers with a sleep apnea diagnosis to continue to operate if they’re being “treated effectively,” which is defined as “the resolution of moderate to severe OSA to mild or better, as determined by a certified sleep specialist,” according to the board’s preliminary discussion report.

Another board meeting will be needed to finalize and approve the recommendations. No meeting date is yet set. FMCSA is not required to adopt board suggestions, but it is likely lean on them when developing a sleep apnea rule, if it chooses.


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The board based its recommendations in part on public meetings held this year, in which board members heard testimony from truckers and industry advocacy groups, along with expert testimony from doctors. The board also relied on formal public comments made on its “pre-rule” questionnaire to the industry about apnea’s prevalence, screening and treatment, costs and more.

The meetings and the formal questionnaire were not only initiated to determine what a sleep apnea rule may look like, but to determine if a rule was needed at all. Some commenters in the meetings and in the pre-rule comments nipped the agency for not seeking data on sleep apnea’s correlation to crashes.

There are also industry-wide concerns about the costs associated with a sleep apnea rule, particular to truckers, as screening and treatment can expensive, even for those who are insured.

Among other preliminary recommendations outlined by the board this week is a provision to limit truckers who’ve received a sleep apnea diagnosis to a yearly medical certification, even if the diagnosis was for mild apnea.


This means truckers with any type of apnea diagnosis would need to be recertified at least annually, if not more often, rather than the standard every-other-year certification. The annual certification is already common for CDL holders treated for sleep apnea.

The board also spelled out screening and treatment requirements and a conditional certification measure. Medical examiners under the board’s recommendations would be able to issue 90-day conditional medical certifications to truckers who’ve been referred for sleep screening based on the aforementioned factors (BMI, etc.). Such truck operators would be required to be tested and, if found to have apnea, begin treatment within the allotted 90 days.

A full year’s certification could be issued afterward.

Discussed treatment options in the board’s preliminary report include (1) use of PAP machine or other oral appliance, (2) bariatric surgery, (3) oropharyngeal surgery or facial bone surgery and (4) tracheostomy.