Language of MCSAC / Medical Review Board recommended apnea guidelines — more from D.C.
Contrasting viewpoints coming together — or not — made for an interesting day today at the first of four days’ worth of meetings of the FMCSA’s Motor Carrier Safety Advisory Committee. Today’s agenda was dedicated to drafting language toward formal recommendation to the agency of potential guidance to adopt in future rulemaking relating to sleep apnea and drivers’ medical qualifications. For a roundup of what’s in the recommendations as issued and some of the debate that went on today between industry participants, medical reps and law enforcement, check out the news brief now live at OverdriveOnline.com.
Below you’ll find the language of the 10 recommendations, and I thought I’d also share here some statistics that the Owner-Operator Independent Drivers Association has put together relative to the potential total cost of treatment of drivers under the 35 BMI testing mandate proposed. These costs are estimated at a $180 million total annual cost to the industry. That’s the testing alone. Granted, it assumes an average $2,500-$3,000 figure for an in-lab sleep test, which sleep specialists note has fallen somewhat in recent years. (However, in public comment near the end of the meeting yesterday, former small fleet owner — and current school bus fleet owner — Donald Fowler, of Richmond, Mo., referenced an October sleep study he himself had that was billed, all told, at just shy of $2,000.)
Furthermore, in a member survey OOIDA conducted, 72 percent of operators said their medical policies would not cover sleep apnea expenses. An argument OOIDA’s Todd Spencer and others made today, too, demonstrated something of a safety net loss if a large number of experienced operators are in fact forced out of the industry by the regulation (the OOIDA stats estimate 12 percent of the 3.5 million or more CDL drivers have BMI above or equal to 35) and are replaced by a less-experienced group, naturally more prone to making on-highway mistakes.
That’s all of course not counting the time and miles lost to downtime during testing, which for some operators could be significant if their apnea problems turn out to be significant themselves — some operators concluded to have apnea would be disqualified until treated. See below for specifics.
Another interesting part of the proceedings was the fact the final recommendations from the subcommittee on acceptable areas of treatment put the most confidence in continuous positive airway pressure (CPAP) machines, not least due to the ease of monitoring that is in place in current devices. This came in spite of dental practices in existence today that specialize in sleep medicine, as some of you I know are already well aware of. Midwest Dental Sleep Center’s Scott Craig, of Woodridge, Ill., characterized the exclusion of dental treatment of apnea in the recommendations as a mistake that is the result of the lack of a dental specialist on the FMCSA’s Medical Review Board. “Currently there are commercially available products to monitor compliance,” he said, showing me the Smart Retainer device by Scientific Compliance as an example.
The manufacturer inserts electronic temperature sensors into dental retainers in order to allow doctors to scan the device to retrieve information about use and other data.
MRB members effectively dismissed much of the literature on studies relating to dental appliances as non-objective, borderline “commercials,” one said.
MCSAC member and Texas-based Clark Freight Lines’ Danny Schnautz put in his objection to the exclusion of the devices. Schnautz could well see such devices’ potential attraction to drivers who might otherwise need to idle their trucks to ensure power to a CPAP machine and truck starting power overnight. “I think we might be shutting the door tighter than we should have,” he said, making reference to language in the MCSAC recommendations that state dental devices’ “long-term efficacy” cannot “be demonstrated currently, so these technologies are unapproved alternatives at this time.”
Full language of the recommendations as I best followed their drafting/revision follows. (Note: there may be further revision as yet before they are sent formally to FMCSA, though their intention as outlined here should largely remain. Italics represent committee annotations about intentions.)
Recommendation 1 — General
- Obstructive sleep apnea (OSA) diagnosis precludes unconditional certification.
- A driver with OSA diagnosis can be certified if:
- The driver has untreated OSA with apnea-hypopnea index (AHI) < 20 (i.e., mild-to-moderate OSA) AND
- The driver does not admit to experiencing sleepiness during the major wake period OR
- OSA is being effectively treated.
A driver with an OSA diagnosis may be recertified annually, based on demonstrating compliance with therapy.
- Minimally acceptable compliance with PAP means at least 4 hours/day of use 70 percent of days.
- § Drivers should be encouraged that more hours of PAP use is preferable.
- § Optimal treatment efficacy occurs with 7 hours or more of daily use during sleep.