This story appears in the July 18 print edition of Transport Topics.
Although welcomed by medical professionals and nonprofit safety groups, the prospects of regulatory guidance for truck driver diagnosis and treatment of obstructive sleep apnea continues to raise concerns in the trucking industry.
In written comments on an advanced proposed rulemaking, some truck drivers and trade associations said research is mixed on whether drivers with severe-to-moderate sleep apnea are at greater crash risk, while others fear testing and treatment would be too hard on their wallets and require time off the job.
The Owner-Operator Independent Drivers Association said that, in most cases, the cost of testing and treating OSA often are not covered by insurance and can take the driver off the road.
“These financial losses can be devastating for drivers and owner- operators who frequently must bear the financial burden of screening, testing and downtime themselves,” OOIDA wrote.
OOIDA said an American Transportation Research Institute study documented that drivers without health care incurred out-of-pocket costs exceeding $1,000, with some even reporting out-of-pocket costs over $6,000.
“In 2014, the OOIDA Foundation conducted a survey concerning the medical examination which found that a sleep study, also called a polysomnogram, can cost up to $7,000,” OOIDA wrote.
Nearly 200 written comments were filed in recent weeks on the advance rulemaking notice issued jointly by the Federal Motor Carrier Safety Administration and the Federal Railroad Administration in March. The agencies since have been seeking public comment on the effects of screening, evaluating and treating commercial motor vehicle drivers and rail workers for obstructive sleep apnea, or OSA.
The comment period closed July 8.
The agencies maintain that an estimated 22 million Americans might be suffering from undiagnosed sleep apnea, a respiratory disorder characterized by a reduction or cessation of breathing during sleep.
According to medical experts, the disorder can cause unintended sleep episodes and deficits in attention, concentration, situational awareness, memory and the capacity to respond safely to hazards.
The Mayo Clinic said there is a critical need to give medical examiners clear standards to assess a driver or railroad engineer’s risk for the condition.
“We believe that it is important to provide specific objective guidelines to certified examiners since the individual driver or engineer with OSA is typically the last person to perceive an issue and who is often in denial when quizzed about symptoms and signs of sleep-related disordered breathing,” Mayo wrote.
A large number of truck drivers passionately characterized the agency’s spotlight on OSA as another instance of overregulation. They also expressed concerns that they would be referred for sleep studies based solely on such risk factors as a high body mass index, large neck size or for being overweight.
Truck driver David McDonel said he was one of those tested for OSA.
“No symptoms. Don’t have it,” he wrote. “Company made anyone that was overweight get tested. My weight gain is due to being in truck driving since 1992.”
McDonel added, “Most of the sleep problems and fatigue are due to irregular work schedules.”
The Truckload Carriers Association said it supported an objective standard to identify drivers with OSA but had concerns that a regulatory requirement could exacerbate an industry shortage of drivers.
TCA said it interviewed one carrier member that developed a proactive approach to OSA and the treatment of sleep disorders among its driver population.
“In approximately six months of participation in this program and an estimated $600,000 in costs for testing, equipment and monitoring, the carrier experienced a higher turnover rate and zero change in accident rate with just over 350 drivers going through the testing,” TCA wrote. “In other words, with the incorporation of an aggressive and expensive program to combat the effects of OSA, this carrier experienced what turned out to be a net loss due to the higher turnover rate.”
“ATA recognizes the growing interest in obstructive sleep apnea as a safety concern,” American Trucking Associations wrote in comments. “As with any regulation, any future rule to require OSA screening and treatment for commercial truck drivers should be based on sound data and analysis, including the potential costs and benefits.”
ATA added, “It is also vital that the Federal Motor Carrier Safety Administration has a firm understanding of the actual crash risk that OSA poses, of which there has been minimal data to date.”
Steve Owings, founder of Road Safe America, said surveys by the Insurance Institute for Highway Safety show that an alarming percentage of truck drivers admit having fallen asleep at the wheel within the past year.
“In our opinion, it is astounding that airline pilots, whose planes fly themselves a great deal of the time a flight is in the air, are required to be screened for sleep apnea,” Owings wrote. “Yet truck drivers, who need to pay attention every second they are on the road, are not.”