DOT Seeking Sleep Apnea Input
March 8, 2016
The Federal Motor Carrier Safety Administration and the Federal Railroad Administration jointly announced on March 8 that the agencies are seeking public comment during the next 90 days on the impacts of screening, evaluating, and treating CMV drivers and rail workers for obstructive sleep apnea.
FRA and FMCSA will host three public listening sessions to gather input on OSA in Washington, DC, Chicago, and Los Angeles.
The agencies said their Advance Notice of Proposed Rulemaking, a.k.a. a “pre-rule,” is “the first step” in considering whether to propose specific requirements around OSA.
The pre-rule (RIN 2126-AB88 and 2130-AC52), titled “Evaluation of Safety Sensitive Personnel for OSA,” specifically seeks “data and information concerning the prevalence of moderate-to-severe obstructive sleep apnea among individuals occupying safety sensitive positions in rail and highway transportation.”
The agencies are also requesting information about the potential economic impact and safety benefits associated with “regulatory actions that would result in transportation workers in these positions, who exhibit multiple risk factors for OSA, undergoing evaluation by a healthcare professional with expertise in sleep disorders, and subsequent treatment.”
Regulatory action around OSA has long been in the works. FMCSA’s Medical Review Board began issuing recommendations back in 2000 on the screening, diagnosis, treatment and monitoring of truckers afflicted with sleep apnea.
The current pre-rule activity is in line with legislation passed by Congress in 2013 that instructs FMCSA on the regulatory approach it must take regarding OSA.
That law does not require the agency to issue any sleep-apnea policy or regulation. Rather, the bill states that no policy can be issued without the agency first conducting a thorough analysis of the prevalence of OSA among commercial drivers; the range of possible actions to address the problem; and the costs and benefits that may result.
In their latest announcement, the two agencies noted that the National Transportation Safety Board had recommended that the U.S. DOT “take action to address OSA screening and treatment for transportation workers.”
Sleep apnea is often viewed as a safety concern because it can cause general fatigue and result in drowsy driving.
FMCSA currently recommends that medical examiners refer any CMV drivers who are detected to have a respiratory dysfunction, such as OSA, for further evaluation and therapy.
The agency issued a bulletin in January, 2015, to remind healthcare professionals on the agency’s National Registry of Certified Medical Examiners of the current physical qualifications standard and advisory criteria concerning the respiratory system, including specifically how the requirements apply to drivers who may have obstructive sleep apnea.
To read the joint ANPRM on OSA and provide comments, click here.
According to the National Institutes of Health, sleep apnea is a common disorder, usually chronic, in which a person has one or more pauses in breathing or takes shallow breaths while asleep. The breathing pauses can last from a few seconds to minutes and may occur 30 times or more an hour. Typically, normal breathing then starts again, sometimes with a loud snort or choking sound.
The condition disrupts sleep in such a way that the sufferer will move out of deep and light sleep. That results in poor-quality sleep, which makes for daytime fatigue and excessive daytime sleepiness.
The most common type is OSA, which is distinguished by the airway collapsing or becoming blocked during sleep. “When you try to breathe, any air that squeezes past the blockage can cause loud snoring,” states NIH. “Obstructive sleep apnea is more common in people who are overweight, but it can affect anyone.”
Per NIH, besides increasing the chance of having a driving or work-related accident, untreated sleep apnea can:
- Increase the risk of high blood pressure, stroke, diabetes and obesity
- Increase or worsen the risk of heart failure
- Make arrhythmias (irregular heartbeats) more likely
The goals of treating sleep apnea are to “restore regular breathing during sleep and to relieve symptoms such as loud snoring and daytime sleepiness.”
While sleep apnea is a chronic condition that requires long-term management, NIH points out that lifestyle changes and/or the use of an oral appliance (“mouthpiece”) may relieve mild sleep apnea.
Those with moderate or severe sleep apnea may need to use CPAP (Continuous Positive Airway Pressure) breathing devices or undergo surgery. A CPAP machine gently blows air into the throat through a mask that fits over the mouth and nose or just over nose. That air pressure helps keep the airway open during sleep.
As to surgery, NIH says the type required and how well it works will depend on the cause of the sleep apnea. Surgery to widen breathing passages usually involves shrinking, stiffening, or removing excess tissue in the mouth and throat or resetting the lower jaw.
NIH notes that physicians diagnose sleep apnea based on taking medical and family histories, conducting a physical exam and reviewing sleep-study results. A primary-care physician may evaluate symptoms first and then decide if a patient needs to see a sleep specialist.