Two FMCSA advisory committees this week stamped their approval on recommendations to the agency regarding which truck operators should be screened for obstructive sleep apnea before being cleared to drive.
The final version of the recommendations retains the conditional criteria to refer truckers for sleep apnea testing, based mostly around their BMI and other factors that could indicate obstructive sleep apnea. FMCSA’s Medical Review Board and its Motor Carrier Safety Advisory Committee voted to approve the recommendations Tuesday, Oct. 25.
Truck operators with a Body Mass Index of 40 or higher would be flagged for sleep apnea screening if the recommendations are made law. Those truckers would receive a 90-day medical certification, during which time they must have an in-lab or at-home sleep study. If diagnosed with obstructive sleep apnea, they would need to begin treatment within the 90-day period.
Truckers with a BMI of 33 or higher would also be subject to screening if they meet three other qualifiers, a list that includes being male and being older than 42 — a large demographic in the trucking industry. Such truckers would receive the same 90-day certification aforementioned and must receive a sleep study during that time.
Male or postmenopausal female truckers age 42 and older who have a BMI of 33 or greater would be flagged for an in-lab or at-home sleep test if they also have high blood pressure, have diabetes, have history of heart disease, snore loudly, have witnessed apneas or have a neck size greater than 17 inches (15.5 inches for women), among other qualifiers.
Truckers diagnosed with moderate to severe obstructive sleep apnea could receive a medical certification from their examiner that lasts no longer than a year, rather than the standard two-year certification.
The Oct. 25-finalized recommendations are simply recommendations and bear no legal weight. However, FMCSA may lean on the criteria when developing a sleep apnea screening rule.
Overdrive‘s recent analysis, based on a survey with heavy reader participation, showed that between 25 and close to 40 percent of owner-operators would be screened for required testing if such criteria were in place. Those percentages exclude the 1 in 10 total survey respondents who reported currently being treated for the condition.
Former corporate jet captain and longtime truck owner-operator Dan Boyce says he believes the FMCSA ought to consider the experience of the Federal Aviation Administration before adopting the BMI-related recommendations. “The FAA prohibits BMI use [alone] when issuing flight medical cards,” Boyce noted, referencing a policy reversal within the FAA, which sought to do just what the Medical Review Board has recommended for truckers — require all pilots with 40 or higher BMI to be tested for apnea.
According to policy statements on the FAA’s website, “Key aviation industry stakeholders, as well as members of Congress, expressed concern about this enhanced screening,” after which FAA adopted guidance that stressed more holistic approaches to apnea screening to refer pilots for testing.
Who were those “key stakeholders?” Pilots, says Boyce, who spoke out against the BMI criteria in large numbers. Boyce sees a “double standard” in this for truckers, should the 40 BMI cutoff be adopted. “FMCSA needs to seek legal advice before proceeding full bore ahead on this one.”
Boyce agrees with previous commenters, too, when he notes he sees no small amount of profiteering by medical professionals around the apnea issue. “Hopefully we can divert this federal overreach locomotive to a side track before it arrives at the station!” he said.
Reader Steve Pieri, commenting under this analysis of the screening criteria published last week, emphasized the cost of testing as of paramount concern. “The big question is who should pay the driver and the doctors?” he asked. “Who is going to pay the bill? And if have to take two-three weeks off work and pay thousands of dollars to do so.”
The question of just what “requiring $3,000 in medical expenses does when an industry hasn’t had a substantial pay raise in over a decade at least” was on the mind of Brian Loysen, too, commenting under the same story. And “if truck drivers have affordable care, thanks to the President they are paying everything out of pocket.” Average out-of-pocket costs associated with testing were recently estimated by the American Transportation Research Institute at $1,200.
The hard-fast BMI cut-off recommended by the Medical Review Board, combined with what Overdrive uncovered in the case of trucker William Stewart — told by his doctor that if he weren’t a truck driver his apnea case was mild enough to go essentially untreated with a CPAP machine with a focus on weight loss — led reader Yote Anders to a stark conclusion: “We are a targeted, discriminated-[against] class of people.”
Notable changes to the final recommendations
The Oct. 25-made recommendations saw significant changes to immediate-disqualification criteria. Truckers who meet the following would be immediately disqualified from driving by their medical examiner and would be referred for a sleep test:
- Report excessive sleepiness while driving
- Experience a crash associated with falling asleep
- Have been observed sleeping behind the wheel while operating the vehicle
- Have been found non-compliant with proper treatment of existing obstructive sleep apnea
The recommendations would also give medical examiners the discretion to “disqualify any driver who appears to be extremely high risk,” according to the document.
Truckers sidelined by the immediate disqualifications would remain out of service until they begin treatment for apnea. Per the recommendations, truckers would need to be treated for two weeks to requalify to drive. They would then receive a 90-day certification.
Treatment options included in the committee recommendations include the use of a continuous positive airway pressure machine and various surgeries intended to treat the condition. –Todd Dills contributed to this report.