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Updated Sleep Apnea Screening Recommended for Commercial Drivers

on an extensive review of the latest sleep apnea research and existing medical guidelines related to OSA from the US Department of Transportation agencies. Recommendations provide an updated description of sleep apnea, based on how sleep apnea is currently defined by professional organizations and other federal agencies. Patients with sleep apnea include those with repetitive partial or complete obstruction of upper airway tissues during sleep, resulting in sleep disruption, gas exchange abnormalities, and cardiovascular changes. In addition, sleep experts advise that the diagnosis and severity of sleep apnea be established using the apnea-hypopnea index.

The joint task force also suggests a screening process that bases driver certification on severity of sleep apnea. These recommendations suggest certifying a driver at lower risk for sleep apnea for a maximum of 3 months, pending a medical evaluation (in-service evaluations), while drivers with more severe risk factors or a motor vehicle crash likely related to sleep disturbances should be prohibited from returning to work until they receive a medical evaluation (out-of-service evaluations). Furthermore, the task force suggests expanding the screening process to include a more extensive medical and physical history, flagging such risk factors as body mass index, neck circumference, family history of OSA, and history of comorbidities. For those diagnosed with sleep apnea, experts strongly recommend using positive airway pressure for a minimum of 4 hours within a 24-hour period via a machine that is able to measure time on pressure. Current guidelines do not specify minimum use of positive airway pressure.

“Difficulty in identifying those drivers at highest risk of OSA and accidents due to OSA has been a significant challenge for the commercial driver medical examiner. In addition, outdated guidance from the FMCSA has left medical examiners in conflict with current sleep guidelines,” said Nat
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