Commercial Drivers License

It is known that commercial drivers in the US have a much higher rate of obstructive sleep apnea (OSA) than other drivers. This has led to a change in the legal and medical atmosphere surrounding tired drivers and Department of Transportation (DOT) medical examinations.

On the DOT health history, each driver is asked if there is a history of:

  1. Sleep disorders
  2. Pauses in breathing while asleep
  3. Daytime sleepiness
  4. Loud snoring

THIS MUST BE ANSWERED TRUTHFULLY.

Case in point:

A recent legal case brought criminal charges against a truck driver who killed a member of a road crew in Kansas. Even though he had not logged excessive hours prior to the accident, nor been up late the night before and blood samples verified that he had no alcohol or drugs in his body at the time of the accident; he was still found guilty of involuntary manslaughter, a felony conviction.

The driver admitted to being drowsy during the day and continued to drive. He said that he thought that daytime drowsiness was normal. He was diagnosed with obstructive sleep apnea 3 months after the accident.

DAYTIME DROWSINESS IS NOT NORMAL. IT IS A RED FLAG THAT SLEEP IS IMMINENT!

Employers are aware that treatment of obstructive sleep apnea creates a 73% reduction in preventable driving accidents among drivers diagnosed with OSA. This translates to savings in time and money for both the driver and the employer. Treatment of OSA can save your life. Not just from a vehicular accident, but treatment of OSA decreases your risk of heart attack and stroke.

Oral devices are acceptable treatment for OSA.

In the DOT Medical Examination by Natalie Hartenbaum, MD, MPH, she gives a description of when oral devices are acceptable treatment:

  1. Oral appliances should only be used as a primary therapy if the initial AHI (number of breathing events per hour) is less than 30.
  2. Prior to returning to service, the driver must have a follow-up sleep study demonstrating ideally AHI of 5, but up to 10 is acceptable.
  3. All reported symptoms of sleepiness must be resolved and blood pressure must be controlled.

Weight loss and surgery are acceptable, but you must still have a follow-up sleep study that verifies that your AHI is ideally 5-10 to document efficacy.

Oral devices, in unselected patients, return 52% to an AHI under 10. With further titration of the oral device during the follow-up sleep study, the success rate for patients vastly increases.

Throat surgery is much less effective. Weight loss requires a 20% weight loss to drop your AHI by half. Everyone will agree that CPAP is the most effective treatment. When using CPAP, 90% of OSA sufferers return to normal breathing.

Save a life. Treat your sleep apnea.

Background Resources:
DOT Medical Examination Report 649-F(6045)
Clancy v Indiana in 33 Kan.App.N.E. 2nd203.2005, Indiana
Carper DL and Levendowski DJ Assessment of Obstructive Sleep Apnea Risk and Severity in Truck Drivers: Commentary on the Legal Implications for Ignoring a National Safety Concern. Sleep Diag Ther Vol3 (2) April-May, 2007
Hartenbaum NP ED. The DOT Medical Examination: A Guide to Commercial Drivers Medical Certification OEM Press 4th Edition 2008 Ferguson KA et al, Oral Appliances for Snoring and Obstructive Sleep Apnea: a review.Sleep.2006;29(2):244-262
Almeida FR et al, Effect of Titration Polysomnogram on Treatment Success with a Mandibular Repositioning Device. In print.
Elshaug A et al, Redefining Success in Airway Surgery for Obstructive Sleep Apnea: a meta-analysis and synthesis of evidence. Sleep.2007;(4):461-470

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