Does sleep apnea exist in public transit?

Posted on October 22, 2009 by Alex Roman - Also by this author

This week, the National Transportation Safety Board (NTSB) delivered a safety recommendation to the Federal Motor Carrier Safety Administration (FMCSA) urging them to implement a program to identify commercial drivers at high risk for obstructive sleep apnea (OSA) and require those drivers to provide medical certification that they have been evaluated and, if necessary, effectively treated before being granted unrestricted medical certification. In another recommendation, the NTSB also urged the FMCSA to “develop and disseminate guidance for commercial drivers, employers and physicians regarding the identification and treatment of individuals at high risk of OSA, emphasizing that drivers who have OSA that is effectively treated and routinely approved for continued medical certification.”

Individuals who suffer from OSA obstruct their own airways while sleeping, typically resulting in hypoxia at night, interruptions in breathing lasting several seconds at a time, loud snoring and non-restful sleep. Most are unaware of the condition. Individuals with OSA may have extreme daytime sleepiness and often fall asleep within minutes in a quiet or monotonous environment, and the condition is associated with significant cognitive and psychomotor deficits that are partially reversible with appropriate treatment. The condition can only be formally diagnosed through a sleep study where patients sleep under controlled conditions and are extensively monitored.

In its letter to the FMCSA the NTSB pointed out that if OSA goes untreated, it increases the likelihood of other dangerous medical conditions, including stroke, heart failure, coronary artery disease and diabetes. Additionally, the letter stated that obesity and high blood pressure are associated with the increased risk for OSA, with one study finding that more than 50 percent of patients with a body mass index of 40.0 have OSA. The NTSB also cited a 2002 review of the epidemiology of OSA, which estimated that roughly seven percent of adults have at least moderate OSA. An FMCSA-commissioned study on the prevalence of OSA in commercial drivers found that 17.6 percent of drivers studied had mild OSA, 5.8 percent had moderate OSA and 4.7 percent had severe OSA.

What was most bothersome about the NTSB’s letter to the FMCSA was when it mentioned that there is currently no program in place for public transit operators:

“The Federal Transit Administration (FTA) has no formal medical standards for transit operators; each authority independently arranges medical programs for its operators, and many operators are required, either due to their functions or by the authority for which they work, to maintain a current commercial driver license. The NTSB is not aware of any existing programs that routinely screen transit operators for OSA.”

With so many lives at risk, it would be prudent for transit agencies to ensure their drivers are not suffering from OSA and are properly certified to safely operate vehicles if they do. Does your agency have anything in place to ensure drivers with OSA are properly identified and treated?

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