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OPEN ROAD Q3

By Rebecca M. Brewster

By Rebecca M. Brewster President and COO, American Transportation Research Institute In March of this year, the Federal Motor Carrier Safety Administration (FMCSA) issued an Advanced Notice of Proposed Rulemaking (ANPRM) on Obstructive Sleep Apnea. The proposed rule was jointly published by FMCSA and the Federal Railroad Administration to seek information on the “prevalence of moderate-tosevere obstructive sleep apnea (OSA) among individuals occupying safety sensitive positions in highway and rail transportation, and on its potential consequences for the safety of rail and highway transportation.” As a result of the ANPRM, the Research Advisory Committee (RAC) of the American Transportation Research Institute (ATRI) recommended as a top research priority a study entitled, “Understanding the Impacts of Sleep Apnea on Commercial Drivers.” As a first task in this research, ATRI surveyed commercial drivers on their perspectives, personal experiences, and knowledge of sleep apnea. The survey, which was pre-tested with professional truck drivers, also solicited information on sleep apnea assessments and treatments that drivers may have received, as well as the perceived effectiveness of those treatments. All commercial drivers, even if they have no personal experience with sleep apnea diagnoses, were encouraged to participate in this confidential survey. Bob Stanton, a professional driver diagnosed with sleep apnea in 2002 and Co-Coordinator of Truckers for a Cause, a patient support group for drivers with sleep apnea said of ATRI’s survey when it was launched, “this is the first large-scale data collection effort that seeks to find out what professional drivers know about sleep apnea and for those who have been through a sleep test, to better understand what the impacts, especially costs, of testing and treatment are on drivers.” ATRI initially surveyed drivers at the Mid-America Trucking Show in Louisville, Kentucky and then posted the survey online for drivers to respond. The timeline for ATRI’s data collection was abbreviated in order to allow time for any interested individuals to utilize the findings of ATRI’s report in their respective comments to the ANPRM docket, which was originally scheduled to close for comments on June 8, 2016. FMCSA did subsequently extend the comment period to July 8, 2016, citing requests from organizations to have additional time to review ATRI’s study, which was released May 26th. ATRI’s report, Commercial Driver Perspectives on Obstructive Sleep Apnea, analyzed data from over 800 commercial drivers, and was the first study of its kind to quantify cost and other impacts drivers are experiencing as they are referred by their medical examiners for sleep studies. FINDINGS FROM ATRI’S STUDY INCLUDED: • Among drivers who had been referred to a sleep study, 53 percent paid some or all of the test costs, with an average of $1,220 in out-of-pocket expenses, representing just over 1.5 weeks of average driver pay at $793 per week. • Health insurance assistance with sleep study costs impacted driver out-of-pocket costs significantly – 61 percent of drivers with no health care coverage of their sleep study incurred out-of-pocket costs exceeding $1,000 compared to 32 percent of drivers whose health insurance did cover some portion of the sleep study with costs exceeding $1,000. 26 ❘ Open Road Q3 2016

• Among drivers reporting time away from work associated with sleep apnea screening, 41 percent indicated days off ranging from 1 – 30 days. • Use of a Continuous Positive Airway Pressure (CPAP) machine was the treatment regimen followed by the majority of drivers diagnosed with sleep apnea. This includes drivers in the ATRI sample diagnosed with mild sleep apnea, a condition that does not require treatment for medical certification. • Driver-perceived treatment efficacy varied by OSA severity, with drivers experiencing more positive effects of CPAP treatment the more severe their OSA diagnosis. Drivers diagnosed with severe OSA and being treated with CPAP reported increased amounts of sleep (71%), feeling better when they wake up (71%), and lower blood pressure (75%). • Conversely, among the 91 percent of drivers being treated with CPAP despite a diagnosis of mild sleep apnea, less than half experienced improved sleep as a result of CPAP treatment, with only 32 percent reporting increased amounts of sleep and 44 percent reported feeling better when they woke up. • Among both drivers who have had sleep studies and those who have not, there is concern about the use of neck circumference and Body Mass Index (BMI) as measures to refer drivers to sleep studies. Additionally, among drivers who have been tested, 64 percent believe that the DOT guidelines for referring drivers are too broad and that medical examiners do not follow the guidelines for referrals to sleep studies. More recently, FMCSA convened a meeting of its Medical Review Board (MRB) on August 22-23 for the purpose of reviewing the comments submitted to the ANPRM docket and to make recommendations to FMCSA on the proposed sleep apnea rule. ATRI was invited to present the findings of the driver survey to the MRB members as part of that meeting. SOME OF THE KEY POINTS FROM THE STUDY PRESENTED BY ATRI INCLUDED: • Rationale for OSA rulemaking – prior to issuing a rule, drivers are looking for FMCSA to clarify the relationship between OSA and crash risk. • Driver acceptance of sleep study referral criteria - drivers do not believe neck circumference and Body Mass Index (BMI) should be used as sole metrics for referral to sleep study. • Driver sleep study costs are significant – and as such, flexibility in the rule for home sleep studies will reduce cost impacts and reduce time off work for study. • Preventing conflicts of interest – drivers are concerned about the potential relationships between Certified Medical Examiners, sleep clinics and treatment providers. A copy of ATRI’s sleep apnea report is available online at www.atri-online.org. K Open Road Q3 2016 ❘ 27

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