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Apnea suggestions ignore real safety risks

Recommendations made last week by two FMCSA advisory panels appear to be geared toward making profits but ignore safety risks they’re intending to address, OOIDA Executive Vice President Todd Spencer says.

The FMCSA Medical Review Board and the FMCSA Motor Carrier Safety Advisory Committee met jointly last week in the Washington DC-area. The joint panel was slated to discuss recommendations for sleep apnea and electronic on-board recorders.

Because both boards are advisory in nature, the joint recommendations may be proposed for a rule, ignored, or amended and later presented.

Spencer, a member of MCSAC, told Land Line Now the sleep lab industry and CPAP makers appear to have found an investment target in CDL-holders.

“It’s kind of an issue that’s looking for a place where it can receive gobs of money is certainly what it looks like to me,” Spencer told Land Line Now’s Reed Black.

“While there is plenty to indicate some commercial truck drivers have sleep apnea, we find virtually nothing to indicate that that is a factor in increased likelihood of crashes,” Spencer said. “That’s what motor carrier safety needs to be all about. It needs to be focusing on crashes. But nevertheless, if there is an opportunity to make some money and there are some people recognizing that opportunity – they’re going to seize the moment

After returning from last week’s MCSAC-MRB meetings, Spencer said the MRB appears to be ignoring potentially deadly consequences of aggressive apnea testing.

“This is supposed to be about safety,” Spencer said. “When you throw out experienced drivers and you replace them with new ones, well, then safety becomes a real issue. “I mean, new guys are going to be far more likely to crash. They’re going to be far more likely to be involved in injury and fatality crashes. One of the things I’m trying to point out to the committee is this ain’t make believe; this is gonna happen.”

The OOIDA Foundation researched cost of sleep labs and calculated that 49 percent of the 3.5 million commercial truck drivers have a BMI of 30 or greater. If that number of drivers is required to undergo sleep lab exams, such a rule would cost truckers $5.25 billion.

“That is a tremendous economic price for our industry to have to absorb,” Spencer said. “Of course, in this instance we’re primarily talking about individual drivers paying this.”

A survey of OOIDA members showed 72 percent of respondents do not have medical policies that cover sleep apnea expense. Indeed, 29 percent of respondents said they had no medical insurance coverage at all.

Among 10 recommendations in total, the proposals would require:
Commercial drivers diagnosed with apnea may not be unconditionally certified medically to receive their CDL, and must instead use a CPAP at least four hours nightly for 70 percent of nights. Any driver who reports excessive sleepiness during “the major wake period,” or experiences a crash associated with falling asleep, or has been found to be non-compliant in using a CPAP should be disqualified or immediately denied certification; Drivers with a BMI of 35 or greater to be certified for 60 days pending sleep study and treatment, followed by a 90-day certification if they’re compliant during first 60 days, followed by a one-year certification; Clinicians may cite any combination of possible factors to require or recommend sleep labs. For example, drivers who are male and postmenopausal females with a BMI of 28 or greater, who have experienced a single-vehicle crash or have a 17-inch neck (male) or 15.5-inch neck (female) should be prepared to prove they don’t have sleep apnea. Other factors include being 42 or older, family history, and having a small jaw or airway.
As an example, a 5-foot-10-inch-tall male weighing 195 pounds has a BMI of 28.

The panel recommends sleep data gathering through in-lab or at-home polysomnography, but left the door wide open for clinicians who “believe the level of apnea is greater than the level reported by the in-home study” to require an in-lab sleep exam.

Drivers diagnosed with apnea can be conditionally certified medically for their CDL if they demonstrate four hours of CPAP use during 70 percent of nights and don’t report excessive sleepiness while awake.

The MRB and MCSAC ignored other treatments for sleep apnea, including dental appliances and simple weight loss. The panel deemed surgical treatment as “acceptable.”

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