New guidelines urged for sleep apnea in truckers

NEW YORK (Reuters Health) - An expert panel has recommended new guidelines to more consistently screen and treat commercial truck drivers for sleep apnea, a breathing disorder that can disrupt sleep and cause daytime drowsiness.

A more uniform and updated approach to catching sleep apnea could make roads safer for truckers and the general public, according to a joint task force of the American College of Chest Physicians (ACCP) and other groups.

Obstructive sleep apnea, or OSA, is a disorder in which a person's breathing repeatedly stops and starts during the night, often leading to poor sleep and symptoms such as loud snoring and daytime sleepiness.

Drowsiness is a major factor in collisions involving commercial drivers, and experts believe that unrecognized OSA contributes to the problem. A recent study of more than 400 truck drivers found that 28 percent had at least mild symptoms of OSA, while 5 percent showed severe symptoms.

The new recommendations, published in the Journal of Occupational and Environmental Medicine, call on the government to update its guidelines for diagnosing and treating OSA in commercial drivers.

The current guides from the Federal Motor Carrier Safety Administration were issued in 1991. So they do not reflect advancements that have been made in the last 15 years in diagnosing and managing sleep apnea, according to the task force.

"Current (commercial motor vehicle) screening and treatment procedures for OSA are ambiguous and not reflective of the latest advancements in the diagnosis and management of OSA," the ACCP's Dr. Nancy Collop, a member of the panel, said in a statement.

In the new recommendations, the ACCP, along with the National Sleep Foundation and the American College of Occupational and Environmental Medicine, call for expanding screening to include a more extensive physical and medical history.

Drivers with potential symptoms of, or risk factors for, sleep apnea would be given a conditional three-month certification until they had a formal evaluation for sleep apnea.

This would include drivers who score in the suspicious range on sleep apnea screening tests, as well as those with symptoms such as snoring or excessive daytime sleepiness. Drivers with more than one risk factor for sleep apnea -- including obesity, a large neck circumference or uncontrolled high blood pressure -- would also fall into this category.

Some drivers would be immediately taken off the road until they had a full evaluation for sleep apnea. This would include, among others, drivers who'd already had an accident thought to be related to sleep deprivation.

For those diagnosed with sleep apnea, the task force recommends continuous positive airway pressure, or CPAP, as the first-line therapy. This treatment involves wearing a facemask through which a CPAP device delivers pressurized air to keep the airways open during sleep.

Though the recommendations do call for more thorough screening, they also allow for a shorter return-to-work time for drivers who've begun treatment. The panel says drivers can be re-evaluated by a sleep specialist after two weeks of treatment rather than the minimum of one month under the current guidelines.

The change, according to the task force, reflects more recent findings on the effectiveness of sleep apnea therapy.

SOURCE: Journal of Occupational and Environmental Medicine, Supplement, September 2006.