Debatable accuracy of hard-fast sleep-apnea screening protocol

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Updated Nov 15, 2016

When news of FMCSA’s Medical Review Board’s preliminary recommendations on apnea screening broke, a commenter at raised the issue of how hard-fast apnea screening protocols produce too many false positive and false negative screening situations. He said that a one-size-fits-all screening process, like those protocols that have been recommended over many years, is far less than a perfect substitute for one-on-one medical consultations.

Overdrive research suggests that false-positive and -negative screening for apnea has been the case for more than a third of readers who’ve experienced the screening. Twenty-one percent reported false-positive situations, where testing was recommended but came back negative. Another 16 percent reported the opposite – false-negative situations.

Drivers’ experience with apnea testing results

The latter such is illustrated by the commenter, identified only by a logon:

Quite frankly, having a [CPAP] machine saved my life. I got checked out when I was having trouble staying awake during the day and dozing while driving. I was not driving a truck when diagnosed. My latest doctor told me being overweight has no bearing on sleep apnea. It doesn’t help, but is not a causality. My doctor even uses a machine, and he’s not overweight in the least. Unfortunately, what the government is doing is generalizing the condition. [Recent preliminary recommended screening] criteria is flawed. Will they find a lot of people with it? Most likely. A simple question checklist, answered honestly, will find more true cases than anything else. But then, who’s going to be “honest” and put their job on the line. … Bottom line, others’ lives are at risk by having true sleep apnea and not being treated.

Other readers were equally concerned about recommended sleep apnea screening criteria becoming regulation, partly because of the high incidence of false-positive screens that required testing for no good reason. “This is just a cash cow for doctors and manufacturers” of medical equipment, wrote reader Yote Anders.

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More importantly, perhaps, the commenter’s situation also underscores the value of having a good relationship with a doctor outside of the medical certification process and taking early initiative regarding irregularities with sleep or other aspects of your health. Given the time that testing and follow-up visits can take, getting any real apnea problem taken care of before your DOT physical is up – outside of the medical certification process and without your livelihood hanging in the balance – has been recommended by many who’ve been through the process.