Proposal to tie likelihood of sleep apnea to body mass index

The first lawsuit against a trucking company acknowledging that sleep apnea played a role in a highway death reached a settlement last week. A Texas family was awarded over $3 million dollars after a driver rear-ended John Lindsay's vehicle on a Texas interstate in May of 2010. Evidence showed that the driver had refused to treat his previously diagnosed sleep apnea and the company did not ensure follow up care was provided.

As part of the agreement, the trucking company has promised to educate its drivers regarding the dangers related to sleep apnea and truck driving. The fact that a driver can be treated for sleep apnea and not lose his commercial driver's license is a key piece of information that has yet to be reinforced within the industry. Although at this time the Federal Motor Carrier Safety Administration (FMCSA) has not mandated that drivers be tested, drivers' perceptions remain rooted that even being tested for sleep apnea will lead to job loss. Until transportation companies are given accurate information regarding the screening, testing and treatment process, misconceptions will continue to surround the topic of sleep apnea and the public will remain at risk.

The FMCSA website estimates that almost one-third of commercial drivers suffer from sleep apnea. "Companies need to put an effective sleep program in place with support and mandates from management that gets the at-risk drivers the treatment they need while keeping the freight moving," comments Paul Valentine, president and chief executive officer of Sleep HealthCenters (SHC).  

Sleep HealthCenters' National Services Group guides transportation companies through policy development, sleep apnea program education and sleep disorders management to avoid this type of tragedy. They offer sleep medicine services to regional and national health providers, employers and insurance carriers.

Each year, more and more companies are implementing sleep health assessment, diagnosis and treatment programs to improve the health, performance and safety of their employees. Effective sleep health programs are proven to lower healthcare costs and fatigue-related accidents, which improve employee performance and retention. SHC can also provide centralized care coordination, status tracking and follow-up communication between drivers, their medical examiners and local accredited sleep physicians.

"Healthy sleep is vital to employee wellness and safety, but for trucking companies, it can be difficult to implement a program for employees who live in different places, are constantly moving around the country, have different primary care physicians and maybe even different health insurance coverage," says Dr. Lawrence Epstein, Chief Medical Officer at Sleep HealthCenters, based in Brighton, Massachusetts.

Recently Sleep HealthCenters became the first multi-state provider of Out of Center Sleep Testing (OCST) to receive accreditation from the American Academy of Sleep Medicine (AASM). Sleep HealthCenters can provide OCST and treatment in almost every state by working with a network of accredited sleep centers, currently numbering over 200.

On Wednesday, December 7, 2011, the Medical Review Board and Motor Carrier Safety Advisory Committee of the FMCSA held a joint meeting to discuss sleep apnea and the effect it has on driver safety. As a result, the committees issued a proposal that would tie the likelihood of sleep apnea with body mass index (BMI). Under Recommendation #1, the medical examiner would refer any interstate commercial driver with a BMI of 35 or higher for sleep apnea evaluation. Recommendation #2 listed five criteria that would result in a driver being immediately disqualified from driving. Both of these recommendations are short-term guidances that are intended as stop-gaps until more permanent regulations can be adopted by the FMCSA. A draft of the permanent regulations is expected before the end of the first quarter of 2012.