Tag Archives: sleep apnea

Regulators Pull Plan To Test Truckers, Train Operators For Sleep Apnea

Two agencies in the Transportation Department are ending their push for a rule that would have required truck drivers and train operators to be tested for obstructive sleep apnea, a sleep disorder that’s been linked to preventable accidents.

The agencies — the Federal Motor Carrier Safety Administration and Federal Railroad Administration — have withdrawn a proposed rule they published in March of 2016, when they wrote that when it goes undiagnosed or inadequately treated, obstructive sleep apnea, or OSA, “can cause unintended sleep episodes and resulting deficits in attention, concentration, situational awareness, and memory, thus reducing the capacity to safely respond to hazards when performing safety sensitive duties.”

While calling OSA “an on-going concern,” the regulators said the issue can be addressed through existing safety programs and rules.

According to the Associated Press, “The agencies argue that it should be up to railroads and trucking companies to decide whether to test employees. One railroad that does test, Metro-North in the New York City suburbs, found that 11.6 percent of its engineers have sleep apnea.”

The decision didn’t sit well with the National Transportation Safety Board. The agency, which has pushed for apnea screening and awareness, said it is “disappointed” by the move. The board cited its own findings that obstructive sleep apnea has been linked to 10 highway and rail accidents in the past 17 years.

“Medical fitness and fatigue, two of the NTSB’s 10 Most Wanted List of Transportation Safety Improvements for 2017 – 2018, are tied to obstructive sleep apnea,” says the agency’s media relations chief, Christopher O’Neil. He added, “The need for this rulemaking is well documented.”

Last spring, the FMCSA and FRA cited a number of cases of rail and trucking crashes that were linked to OSA in recent years, including a railway collision that took place near Red Oak, Iowa, in 2011.

That crash, which killed two crewmembers who were found to have been at risk of apnea, prompted the NTSB to urge the Federal Railroad Administration to “require railroads to medically screen employees with safety sensitive duties for sleep apnea and other sleep disorders.”

The agencies’ initial proposal also cited the 2013 derailment of a Metro-North Railroad passenger train that had been approaching the Spuyten Duyvil Station in New York City. In that crash that killed four passengers and injured more than 60 people, the engineer reported feeling dazed — and was later diagnosed with severe OSA.

Obstructive sleep apnea’s risk factors include being male, obese, and middle-age or older. Family history can also play a role.

Dr. Stefanos Kales of the Harvard School of Public Health, who has studied the link between sleep apnea and serious accidents, told NPR’s David Schaper last year, “Drivers with untreated obstructive sleep apnea who were noncompliant with treatment had a five-fold increase in the risk of serious preventable crashes.”

In announcing the withdrawal of the proposal, the FMCSA recommended that commercial drivers and their employers consult the North American Fatigue Management Program to boost their awareness of fatigue and its impact on performance.

Story by Bill Chappell at NPR

Should all drivers be tested for sleep apnea?

Members involved with the trucking, railroad and medical industries spoke out on the possibility of mandated sleep apnea testing during the first of three public listening sessions on Thursday in Washington, D.C.

The Federal Motor Carrier Safety Administration and Federal Railroad Administration published an advance notice of proposed rulemaking to receive feedback about any potential obstructive sleep apnea regulations on March 10. The 90-day comment period ends June 8.

Veteran owner-operator and OOIDA Life Member Dick Pingel and the American Trucking Associations’ Megan Bush, were among those who questioned whether crash statistics supported the need for a sleep apnea regulation.

“You can’t determine if there is a link between sleep apnea and the risk of crashing,” said Pingel, who is from Plover, Wis., and has been trucking for more than 35 years. “A driver can be tired for many reasons. They may be physically tired after securing a load or mentally tired after having a rough day that was emotionally draining.”

Pingel, who has more than 3.25 million accident-free miles, said the cost to truck drivers is too much.

“If a certified medical examiner tells me I must get tested for some arbitrary reason such as neck size, that appointment requires time off the road,” Pingel said. “It would be based on an assumption that a driver with sleep apnea somehow poses a risk. A real risk is to replace me with a brand-new driver who has zero years of experience going over mountains and dealing with other drivers. CMEs are getting kickbacks for referrals. Drivers are being told they must be tested in a sleep lab, which costs thousands of dollars.

“I’m asking you to objectively evaluate information you receive to determine if there is a link between sleep apnea and crashes. You need to take action to ensure the drivers are not used as a bottomless ATM. That is an unfortunate reality that needs to stop so we can keep experienced drivers on the road for a very long career.”

According to research on sleep apnea published by FMCSA and authored by Dr. Allan Pack of the University of Pennsylvania, “there is no statistical evidence in these data to suggest that the presence of sleep apnea significantly increases the likelihood or the risk of motor vehicle crashes.”

In addition, the percentage of large truck crashes related to drowsiness, asleep at the wheel, and/or fatigue has been consistently low. According to Large Truck and Bus Crash Facts 2014, only 1.8 percent of crashes reported a fatigued or sleeping driver.

As part of the FMCSA’s and FRA’s advanced notice of proposed rulemaking, the Department of Transportation cited only one incident of an accident involving a tractor-trailer that was blamed on sleep apnea. The accident occurred 16 years ago, and the report indicated several other factors as potential causes of the crash.

“As with any regulation, requiring obstructive sleep apnea screening and treatment for commercial truck drivers should be based on sound data and analysis,” said Megan Bush, manager of safety policy for the ATA. “FMCSA must consider the prevalence of severe OSA among the workforce, the potential cost to drivers and the supply chain to address it, and the corresponding safety benefits of doing so.”

Bush also said that not all of the accidents that involve fatigue have anything to do with sleep apnea.

“We must determine how many of those crashes are the result of sleep disorders versus other causes, such as failure to obtain adequate and proper rest,” she said. “We’re against rushing to impose a hastily conceived rule given the potential impact on drivers and the supply chain. A cautious and informed approach is necessary.”

There were also several doctors who discussed the dangers of sleep apnea.

“Every cell in your body needs oxygen if you are depleting those because you can’t breathe and can’t exhale,” Dr. Richard Klein said. “If you don’t get the nutrition of oxygen, that cell deteriorates. … It causes Type 2 diabetes, concentration problems, high blood pressure, strokes. I could go on for hours. That is how valuable controlling sleep apnea is for the average person.”

Klein also touted oral appliances as an effective way to treat sleep apnea for individuals who are not comfortable using a CPAP. He said oral devices are easier to transport and can be more cost effective.

“An oral appliance isn’t any better than a CPAP, but it is better than a CPAP in the closet,” he said.

There will also be listening sessions May 17 in Chicago and May 25 in Los Angeles.

Written comments regarding possible sleep apnea requirements can be submitted at the Regulations.gov website or by mailing Docket Services, U.S. Department of Transportation, West Building Ground Floor, Room W12-140, 1200 New Jersey Ave. SE, Washington, DC 20590-0001. You are asked to identify whether you are in the transportation industry or medical profession, but you can choose to remain anonymous.

By Mark Schremmer, Land Line staff writer

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