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Todd Dills

Language of the MCSAC/MRB sleep apnea recommendations

| December 08, 2011

You’ve more than likely seen the news, available via Overdrive here, that firm recommendations for guidance on required evaluation and treatment for sleep apnea among truck drivers with a body mass index (BMI) measurement of 35 or higher came down from the FMCSA’s Motor Carrier Safety Advisory Committee in their joint meeting with the Medical Review Board late yesterday. At the 11th hour, too, a second formal recommendation was added to the discussion mix, namely a series of related disqualifying conditions. These come nearly verbatim from prior recommendations to FMCSA from a 2008 medical expert panel on sleep apnea, whose original report you can see here.

Track back through my Twitter feed for various points of view expressed through the daylong affair and/or see my post from yesterday for some of what went on there yesterday. Objections to the  recommendations came from various panel members from Todd Spencer of the Owner-Operator Independent Drivers Association to Rob Abbott of the American Trucking Associations, particularly with respect to the notion that these recommendations could be seen as forcing apnea sufferers out of the industry given the high cost associated with diagnostic testing and CPAP treatment in particular. While MRB chair Benjamin Hoffman noted a cost of $800 in the first year of diagnosis, treatment and monitoring, Southeastern Freight Lines compliance director Bill Bennett, speaking from hard experience instituting an apnea screening program among the fleet’s drivers, noted much higher costs — “It isn’t inexpensive,” he said. They’ve found apnea treatment costs “roughly $3,000-$4,000 per person for the first year of monitoring and testing.”

Other objections were numerous, and included the notion, proffered by OOIDA’s Todd Spencer, that concern over apnea was misplaced given the huge problems faced by drivers in the industry. “Do I think drivers will see [HOS, parking, scheduling problems] as far more important than apnea? They clearly will and they’re clearly right.” He went as far at one point as charging that the majority of panelists presenting at the meeting had a clear financial interest in painting the sleep apnea problem as an “epidemic.”

No others went so far, though ATA’s Abbott made a point of abstaining from the vote on recommendation 1.

I thought I’d share the final language of the recommendations today (find it below). These are intended to be guidances to be formally issued ASAP by the FMCSA (though not without public comment, which should begin fairly soon if the agency chooses to move forward with them) while a joint subcommittee made up of MCSAC and MRB members hashes out a proposed sleep apnea rulemaking, with potential to have draft language as early as February of next year.

Drivers, what do you think?

Recommendation 1
A. FMCSA shall issue new guidance for medical examiners that drivers with a Body Mass Index (BMI) of greater than 35 need to be evaluated for obstructive sleep apnea (OSA) using an objective test
B. The driver may be given a 60 day conditional certification during the evaluation and treatment process
C. A driver diagnosed with OSA may maintain certification with evidence of appropriate treatment (if any) and effective compliance and if the examiner determines that the condition does not affect the driver’s ability to safely operate a commercial motor vehicle (CMV).
1) Subsequent certification should be no longer than one year term
2) Future certification should depend on proof of continued compliance with treatment

Recommendation 2 – Immediate Disqualification (from Medical Expert Panel/Medical Review Board recommendations)
Drivers who should be immediately disqualified:
A. Individuals who report that they have experienced excessive sleepiness while driving
B. Individuals who have experienced a crash associated with falling asleep
C. Individuals with an apnea-hypopnea index (AHI) measurement > 20, until such an individual has been adherent to CPAP. They can be conditionally certified based on the criteria for CPAP compliance.
D. Individuals who have undergone surgery and who are pending the findings of postoperative evaluation
E. Individuals who have been found to be effectively non-compliant with their CPAP treatment

  • james a swenson jr

    is this the move that there making to gt even cheaper labor from mexico, i question there truthfullness that this is entirely about safety.

  • http://overdriveonline.com/channel19 tdills

    Not ostensibly, James. But I suppose one could make the argument that this could result in fewer U.S. drivers being qualified if it makes it. Interesting thought there.

  • james a swenson jr

    fewer drivers, there is a possibility that there could be as much as 30% of cdl class a drivers could be diqualified.read the ooida article for yesterday about this subject.

  • http://overdriveonline.com/channel19 Todd Dills

    I know the estimates for sure, James — I believe they refer to folks who would need testing and certification conditional on treatment, not outright disqualified, though many will think twice about continuing on the profession should it all come to pass. In short, a screening requirement of this type could ultimately force folks presented with cumbersome testing and compliance procedures (and, of course, costs) out of the industry into another. That leaves the industry in need of others, of course.

  • David Carpenter

    James,
    I have to agree with your view that this is not entirely safety driven. It looks like it could be both a way of sourcing cheap labor and for the folks in the position to profit from the Apena business to do just that.

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  • Scott Ward

    I agree that if this goes into affect the will be an overwhelming screening process for many drivers in which the operaters found to meet the disqualifications will have to undergoe testing and prove compliance with therapy to maintain thier operator license. Fair or not regulations will continue throught the years and I do sympathize with everyone affected. however ad a healthcare professional president and ceo of National Sleep Soltions located in Columbus Georgia, I can honestly say that anyone that runs the risk of sleep apnea should consider testing and appropriate therapy. This medical condition is very serious and increases thr risk of hypertension, heart attack, and stroke just to mention a few related medical conditions. Whether you operate a truck or not if you suffer fron signs and symptoms of sleep apnea you should undergoe a simple test and begin aporopriate therapy. Good news is that the testing procedure can be very simple and positive pressure therapy can be initiated immediately following testing and an individual can begin the road to a healthier life style quickly,

    Our company can offer a very quick screening tool and tedting immediately that is very inexpensive. Folowing testing we dan get youbsetup on your cpap device quickly.

    Feel free to login to the kiosk website below to take a quick sleep apnea screening. There is absolutely no obligation and your information is kept confidential. One of our staff members will contact you to discuss your results with you absolutely free of no charge.

    In the event that you wish to go ahead and prrsue testing andvtherapy so that you will meet the guidelines setforth to maintain your certification, we can easily mailout the home testing device to you anywhere in the usa and get you started on your therapy before these regulations are adopted and affect your ability to continue driving.

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    Thank you,

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    National Sleep Solutions Inc.

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  • F. McHenry

    Did u notice that proposition; prove compliance on the sleep apnea! The problem is FMCSA, large motor carriers, and manufacturers of CPAP never proves a direct causation relationship between truck crashes and sleep apnea! They only attempt to show systemic correlations! Sorry but they are going to pull off the biggest public relation scam like the EOBR proposal in the history of trucking!! WOW!

  • http://overdriveonline.com/channel19 Todd Dills

    F., And these are only the first round — check out the more detailed recommendations the joint committee put together later on, in February. Applicable post from me is here: http://www.overdriveonline.com/language-of-mcsac-medical-review-board-recommended-apnea-guidelines-more-from-d-c/

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