Sleep Apnea in Truckers Becoming Much More Difficult to Regulate than Expected

Following complaints from the Federal Motor Carrier Safety Administration’s own medical review board, the FMCSA will be making efforts to boost accessibility in regards to obstructive sleep apnea information for the medical experts conducting medical exams for truck drivers and assessing their ability to perform their jobs safely and efficiently.

A group of medical professionals on the agency’s medical review board have urged FMCSA leaders to link apnea-related information within the FMCSA’s medical examiners handbook, and made clear this necessary during last month’s virtual meeting. The current 250-page handbook was taken off FMCSA’s website six years ago and still requires major updates–which was, consequently, the main focus of May’s virtual meeting.

Because some medical examiners, as well as FMCSA, have hesitated to push the issue of sleep apnea and the knowledge surrounding it on truck drivers, the medical board’s physicians have even stressed that the overarching subject of sleep apnea has become far too “political.” As of now, FMCSA has not released any particular regulatory guidance on when a trucker at risk for apnea should be required to participate in a sleep lab study to better evaluate the actual risks at hand.

A big player in this issue is Congress’ 2013 legislation that has prohibited any official regulatory guidance in regards to a medical examiner’s ability to diagnose truck drivers who may be at risk for sleep apnea before undergoing the strenuous process for rule-making.

Referring to the attempt to bring back to light the sleep apnea problem in 2016 for regulatory apnea guidance through an Advance Notice of Proposed Rulemaking along with the Federal Railroad Administration, FMCSA’s associate administrator for policy, Larry Minor, noted during the virtual meeting that sleep apnea in truckers has become a “nearly nuclear” topic. FMCSA declared the currently-in-place fatigue risk management-related safety programs “are the appropriate avenues to address OSA” in 2017, and the Advance Notice of Proposed Rulemaking was withdrawn at that time. As of now, FMCSA has held on to the claim that apnea is not directly related to potential accidents, as determined by the present evidence.

FMCSA will, however, add further information about apnea to its examiner’s handbook and will indeed include a link and references to previous discussions and diagnosis recommendations, as well as treatment possibilities, from the medical review board. The agency still does not plan to issue any particular rule-making guidance on the topic, though.

Additionally, FMCSA has stated it does understand the worries regarding the potential risks related to a commercial trucker’s health and safety when it comes to moderate to severe obstructive sleep apnea.

“Drivers with untreated moderate to severe OSA are at increased risk of being fatigued while driving–regardless of the amount of off-duty time prior to the beginning of the work shift,” said FMCSA in a statement. “The agency believes all medical examiners on the National Registry of Certified Medical Examiners should be aware of the OSA risk factors so that drivers exhibiting such conditions are referred to a sleep specialist for evaluation.”

Even though this may sound promising, FMCSA maintains that the evidence needed for any potential rule-making is not yet present. The agency says it also “does not have sufficient data or information to support issuing a Notice of Proposed Rulemaking to establish requirements for mandatory OSA testing and treatment,” according to its statement.

Because of this lack of data, “we’re still not clear why it’s obstructive sleep apnea [acting as a major issue] more than anything else,” Minor explained during the meeting. He also added that there are currently no regulations mandating that an examiner screens “each and every driver that comes in for OSA, and we don’t have any regulatory criteria that says you must send him out for an OSA [sleep] test.”

Many medical professionals are saying this process should be much more of a no-brainer than it is during out to be.

“The board put a lot of effort in coming up with guidelines for sleep apnea that included a menu of symptoms and signs by which you could screen people, and then get sleep studies to look for the presence of sleep apnea,” said physician and review board member, Brian Morris. “The special interest groups stepped in and kind of torpedoed the whole process.”

One big roadblock in the way of these guidelines? Out-of-pocket costs for truckers.

“Drivers commonly don’t want to be screened for apnea because they may have to pay for sleep studies, which can cost more than $1,000,” noted Morris, who also serves as OccMed’s corporate director of medical surveillance in Boston.