The Apnea Hurdle
Coming regulations would force reckoning with a condition common to truckers. And that’s not all that could make passing the medical exam even harder.
Pending regulatory initiatives could make it much more difficult for truckers, especially those with obstructive sleep apnea, to obtain or renew a medical certificate.
One apnea proposal would tie a Body Mass Index threshold to mandatory testing. Another would disqualify drivers on certain apnea-related scenarios, such as refusing treatment.
The creation of a National Registry of Certified Medical Examiners also promises to be a major regulatory move. A final rule on it was expected to be announced by the end of January.
Such certification would considerably reduce doctor shopping by truckers in poor health because only certified examiners, who would be trained and tested, could issue a CDL medical certificate.
The registry will also bear on sleep apnea because drivers can expect more unified testing of the disorder once the registry goes into effect, along with precise guidelines for obstructive sleep apnea screening.
Regulators “are trying to get standard guidelines out there so that the examiners in the National Registry will share a common guideline,” says industry analyst Tom Bray at J.J. Keller & Associates. Some doctors screen aggressively for the disorder, currently grouped with respiratory function under the Federal Motor Carrier Safety Regulations. Others “aren’t screening for it at all,” Bray says. “Some examiners aren’t even aware of it.”
Two recommendations drafted as guidance to an eventual final rule regulating obstructive sleep apnea were formed in December by the Federal Motor Carrier Safety Administration’s Medical Review Board and Motor Carrier Safety Advisory Committee. The panels said that a driver with a BMI of 35 or higher must be screened for the disorder. The second guidance disqualifies drivers who refuse treatment, report excessive daytime sleepiness, have had an accident after falling asleep, have apnea-hypopnea index scores of 20 or higher, or await evaluation after corrective apnea surgery.
A subcommittee of the panels was expected to submit to FMCSA a rule proposal relative to the condition as early as February. Though it could take years for a proposed rule to culminate in a final rule on screening, testing, treating and monitoring for the sleep disorder, truckers should expect a version of the guidance recommendations to become standard guidelines much sooner, observers say.
Adoption of the proposed guidances has been compared to the pilot program exemption for drivers with insulin-treated diabetes. Though no formal rule exists, that program has been in effect since 2005.
“The issuance is going to have some teeth,” says John McElligott, physician and longtime medical examiner at Occupational Health Services in Knoxville, Tenn., of standard guidelines. His clinic has stocked extra equipment for treating the sleep disorder in anticipation of tougher standards, he says.
Sound sleep is difficult for those with sleep apnea, which deprives the body of oxygen and causes fatigue. An estimated 30 percent of truckers have the disorder, which has figured in some fatigue-related accidents. In December, a settlement in a case against Celadon Group said that sleep apnea was related to a highway death. A jury awarded a Texas family more than $3 million. The driver who crashed had been diagnosed with the condition yet remained untreated for it.