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Medical groups denounce transportation agencies’ withdrawal of sleep apnea rulemaking

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Photo: KingWu/iStockphoto

Darien, IL – Three medical professional groups have expressed disapproval over the Federal Motor Carrier Safety Administration’s and the Federal Railroad Administration’s Aug. 4 decision to withdraw a proposed rule on obstructive sleep apnea.

The American Academy of Sleep Medicine, the American College of Occupational and Environmental Medicine, and the American Thoracic Society issued statements after the Aug. 4 withdrawal, asking the agencies to “take alternative steps to improve sleep apnea screening among individuals occupying safety-sensitive positions in highway and rail transportation.”

FMCSA and FRA released their joint advance notice of proposed rulemaking in March 2016 in response to truck and train incidents investigated by the National Transportation Safety Board in which OSA was a factor. The agencies sought to gather information and look at the costs and benefits of any regulations, such as requiring operators with multiple OSA risk factors to undergo evaluation/treatment by a sleep disorders expert.

A recent study from the University of California, San Francisco concluded that 41 percent of commercial motor vehicles drivers could have OSA, which occurs when the airway is blocked and normal breathing is interrupted. One of the results is increased drowsiness that can cause operators to become less alert and reactive.

A March 2016 study from the University of Minnesota, Morris determined that drivers who do not follow their prescribed treatment for OSA are five times more likely to be involved in a crash than drivers without OSA.

“By withdrawing this rule, under the guise of reducing regulatory burdens, our nation’s highways and rail systems are less safe and less reliable for us all,” Dr. David Gozal, former president of the American Thoracic Society and a sleep research expert, said in a statement released Aug. 10. “We strongly urge the administration to reconsider its decision and to move forward with the rulemaking process.”

Sleep apnea affects an estimated 22 million people in the United States, and 80 percent of moderate to severe OSA goes undiagnosed, according to the American Sleep Apnea Association.

“As [ACOEM] noted last year in our comments to the ANPRM, the literature clearly shows that drivers with untreated OSA are at an increased risk of motor vehicle crash, but as there is no agreement on how to best identify these at-risk workers, it is essential that a starting point be identified – we had hoped this rulemaking would fulfill that purpose,” American College of Occupational and Environmental Medicine President Dr. Charles Yarborough said in an Aug. 21 statement.

FRA’s Rail Safety Improvement Act of 2008 requires railroads to institute fatigue management programs. FMCSA stated that it plans to continue endorsing the voluntary North American Fatigue Management Program to CMV drivers and employers.

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Daniel J.
September 1, 2017
As an employee for a nonprofit that works with trucking companies to promote safety we often get calls from drivers who, because they may have a neck size or MBI that statistically may put them at risk, are automatically required to do the sleep apnea testing. Some medical examiners, because a driver may have one of many risk factors require them to be tested. The testing is expensive, I'm told from $1,000.00 - $1,300.00 per test and are not covered by most insurance companies nor do the carriers pick up the costs. Drivers have told me they are requested to submit to a test that costs $100.00 but they always come back inconclusive. Drivers have brought reports from there family physicians explaining they are being monitored for sleep apnea but do not feel testing is necessary but the medical examiners (often a nurse practitioner or PA, no disrespect to these professionals), ignore these explanations because they feel they are obligated by law to require the testing be done which is not correct. In the above article one study suggested 41% of CMV drivers could have OSA, if this were true accident rates would be substantially higher than they are. I'm all for safety, but I also feel medical examiners need more conclusive evidence a driver may be at risk for OSA before automatically sending them for testing. I was also under the impression the studies by FMCSA were not cancelled but put on hold. Please correct me if I'm wrong. Thank you.

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Jack Coxen
September 3, 2017
As a professional in the school bus industry, any threat to children is uppermost in my safety horizon, especially given that our buses are operated by a sole individual without the benefit of a co-pilot as not all our buses benefit from the assignment of our school bus aides.

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Mike Sims
September 28, 2017
Use the best data moving forward. Not data that is skewed for some agenda. IF OSA is enough of an issue bring the scientific proof. I have OSA I use my machine every night without fail. I think it is bogus for me to be required to prove I use my machine. Federal inspectors and, practioners who perform DOT physicals do not even have a way to read the SD card! Slow down and make sense of it as we go!