Public Release: 

Crash risk soars among truck drivers who fail to adhere to sleep apnea treatment

Transportation safety is threatened when obstructive sleep apnea remains untreated

American Academy of Sleep Medicine

DARIEN, IL - Truck drivers who fail to adhere to treatment for obstructive sleep apnea are a public safety threat on U.S. roadways, according to results from the largest study of sleep apnea and crash risk among commercial motor vehicle drivers.

The study, which has been accepted for publication in the journal Sleep, involved 1,613 truck drivers with obstructive sleep apnea and an equal number of control drivers who were matched by job experience and tenure with the trucking firm. Drivers who were diagnosed with sleep apnea were prescribed positive airway pressure (PAP) therapy and were given an auto-adjusting machine that could be used both at home and in the truck sleeper berth while on the road. Objective treatment adherence data were downloaded from the PAP machine's internal memory chip.

Results show that the rate of serious, preventable crashes was 5 times higher among truck drivers with sleep apnea who failed to adhere to PAP therapy, compared with matched controls. In contrast, the crash rate of drivers with sleep apnea who were fully or partially adherent with treatment was statistically similar to controls.

"The most surprising result of our study is the strength and robustness of the increase in the crash risk for drivers with sleep apnea who fail to adhere to mandated treatment with positive airway pressure therapy," said lead author Stephen V. Burks, PhD, professor of economics and management and principal investigator of the Truckers & Turnover Project at the University of Minnesota, Morris. "The results of our study support the establishment of obstructive sleep apnea screening standards for all drivers through the commercial driver's medical exam."

The accepted manuscript was posted on the website of the journal Sleep on March 21, 2016.

"This study emphasizes that untreated obstructive sleep apnea is a pervasive threat to transportation safety," said American Academy of Sleep Medicine President Dr. Nathaniel Watson, who was not involved in the study. "It is critical for transportation companies to implement comprehensive sleep apnea screening and treatment programs to ensure that truck drivers stay awake at the wheel."

According to the American Academy of Sleep Medicine, obstructive sleep apnea (OSA) is a common sleep disease afflicting at least 25 million adults in the U.S. A frequent warning sign for sleep apnea is excessive daytime sleepiness, which can manifest as drowsy driving. The first-line treatment option for obstructive sleep apnea is PAP therapy, which helps keep the airway open by providing a stream of air through a mask that is worn during sleep.

Study data were gathered from the obstructive sleep apnea screening, diagnosis and treatment program implemented in 2006 by North American trucking firm Schneider. Treatment was covered without out-of-pocket costs to drivers under Schneider's employee health insurance. A health care team provided ongoing assistance, education, troubleshooting and monitoring to help drivers with sleep apnea become adherent to treatment. Drivers with sleep apnea who remained non-adherent to PAP therapy eventually were terminated after a process of remediation failed. However, it is likely that many of these truckers subsequently began driving for other trucking firms that do not screen for sleep apnea.

According to the authors, panels of medical experts previously convened by the Federal Motor Carrier Safety Administration (FMCSA) have recommended comprehensive sleep apnea screening for commercial drivers. However, rather than instituting mandatory screening, current federal regulations rely on drivers to self-report sleep apnea symptoms during a biennial medical examination to determine their fitness for duty. On March 8, 2016, the FMCSA and Federal Railroad Administration (FRA) issued a joint Advance Notice of Proposed Rulemaking, which is the first step as both agencies consider whether to propose specific requirements for screening, evaluating and treating rail workers and commercial motor vehicle drivers for obstructive sleep apnea.

"We found that truck drivers with untreated obstructive sleep apnea are at dramatically greater risk of serious, preventable truck crashes, consistent with the greatly increased risk of motor vehicle crashes among automobile drivers with untreated obstructive sleep apnea," said study co-author Charles A. Czeisler, PhD, MD, FRCP, chief of the Division of Sleep and Circadian Disorders at Brigham and Women's Hospital, and Baldino Professor of Sleep Medicine at Harvard Medical School in Boston. "Given that the risk of heart disease, cancer, diabetes, dementia and premature death are similarly increased in people with untreated obstructive sleep apnea, regulatory agencies worldwide owe it to truck drivers and to the motorists who share the road with them to require objective screening, diagnostic testing, and treatment adherence monitoring for all commercial drivers."

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The research team led by Dr. Burks at the University of Minnesota, Morris included biostatistician Jon Anderson, PhD, and several research students. The team also received interpretative and medical writing assistance from Dr. Stefanos N. Kales of the Harvard T.H. Chan School of Public Health; Dr. Mark Berger of Precision Pulmonary Diagnostics in Houston, Texas; Jeffrey S. Hickman, PhD, and Erin Mabry, PhD, of the Virginia Tech Transportation Institute; and Dr. Atul Malhotra of the University of San Diego.

Funding for the Truckers & Turnover Project was provided by Schneider; the University of Minnesota, Morris; and the Roadway Safety Institute, which is the Region 5 University Transportation Center of the U.S. Department of Transportation. Additional funding for this research analysis was provided by the MacArthur Foundation, the Sloan Foundation, Harvard Catalyst/Harvard Clinical and Translational Science Center of Harvard University, and by the National Surface Transportation Safety Center for Excellence at the Virginia Tech Transportation Institute.

The monthly, peer-reviewed, scientific journal Sleep is published online by the Associated Professional Sleep Societies, LLC, a joint venture of the American Academy of Sleep Medicine and the Sleep Research Society. The AASM is a professional membership society that improves sleep health and promotes high quality patient centered care through advocacy, education, strategic research, and practice standards (http://www.aasmnet.org). More information about sleep, along with a searchable directory of AASM accredited sleep centers, is available at http://www.sleepeducation.org.

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