MRB’s apnea cart is before horse
Advisory committees move to recommend sleep apnea screening for drivers with a BMI of 35 or greater

By Charlie Morasch, staff writer

Two advisory committees agreed in early December 2011 to approve recommendations that could pull millions of truck drivers from the road and require billions of dollars to be spent on sleep medicine industry products and services.

In a joint meeting of FMCSA’s Medical Review Board and Motor Carrier Safety Advisory Committee on Dec. 8, 2011, both groups agreed to recommend drivers with a body mass index of 35 or greater be required to “be evaluated for obstructive sleep apnea,” and drivers with potential sleep problems be immediately disqualified from driving.

The meeting, however, appeared to include little exchange of information among the experts.

Instead, medical doctors on the Medical Review Board appeared to ignore points of concern brought by commercial vehicle experts, MCSAC members, and even medical experts seated in the audience.

Medical Review Board members watched anecdotal truck crash descriptions before moving forward with the BMI recommendation. MRB members appeared to rarely acknowledge dissenting opinion.

OOIDA Executive Vice President Todd Spencer and other trucking industry and health professionals questioned the speed with which MRB members pushed for an immediate recommendation.

“I think the cart is way ahead of the horse on this issue,” Spencer said. “Everyone we have heard from has had an economic interest in expanding what they characterize as an epidemic.”

Spencer pointed out that examiners aren’t given guidance to look at other sleep disorders, or a simple lack of sleep because of a number of factors U.S. truckers face on a daily basis.

“Unquestionably, apnea is fairly common in society,” Spencer added later. “Does apnea result in very many crashes? Real accident analysis suggests it doesn’t. It’s going to be far more likely that somebody just didn’t have the opportunity to get restorative sleep because that’s not an easy thing for truck drivers to do.

“Every day those who are on the road – their struggle is to find someplace where they can stop and sleep. And where they won’t get bothered, rousted and run out. Those things people need to do to maintain alertness we’re discouraged from. Drivers don’t set their own schedules; they work around everyone else’s.”

Others agreed.

“I take issue with a lot of the data presented,” said Rob Abbott, vice president for safety policy at American Trucking Associations. “I think it’s inaccurate and misleading.”

Aside from the timing, an FMCSA regulation that could require millions to be tested might have unintended consequences. ATA’s Abbott said removing drivers who may possibly be at risk for apnea also will severely shrink the truck driver pool.

“We have to approach this very cautiously,” Abbott said. “Thirty percent of the 6 million (CDL holders) would be affected? I submit that that may be a concern. … This industry is 98 percent small business, and you don’t have the same sort of health benefits for drivers. What you’re doing is pushing them out of the industry. When we push them out of the industry, we’re inviting others in.”

Edward Grandi, executive director of the American Sleep Apnea Association cautioned members of both committees about the ramifications of their recommendations. Grandi pointed out that apnea carries a stigma that can hurt a driver and motivate CDL holders to keep personal health concerns underground.

Diagnosing or red-flagging an individual for sleep concerns is “putting someone on a long journey – a journey that will probably be with them for the rest of their lives,” he said.

“You have to keep in mind there are going to be drivers who will struggle with being compliant,” Grandi said. “Make it a safe place both for drivers to disclose that they have problems and to show they’re compliant.”

Ben Hoffman, chief medical officer for General Electric Healthcare and chairman of the MRB, signaled that he wasn’t interested in dialogue about whether apnea causes truck crashes.

“The train is out of the station, folks,” Hoffman said. “It’s a matter of trying to make this final regulation something that’s palatable to a large number of parties.”

Later, as MRB members quibbled over the required number of nightly hours drivers with apnea would need to demonstrate compliance, Hoffman noted how arbitrary it was to define a specific number.

“But then,” Hoffman said, “all of this is arbitrary in a sense.”

Under the recommended guidance, medical examiners won’t be required to send drivers with a BMI of 35 to sleep labs, but the guidance would serve as a strong hint.

In addition to the guidance, the committees agreed to approve a recommendation that drivers would be immediately disqualified from driving if they admit to falling asleep behind the wheel; have a fatigue-related crash; have an apnea-hypopnea index greater than 20 until they’re treated by CPAP; have undergone apnea surgery, until post-surgical evaluation; and don’t comply with CPAP treatment.

The Medical Review Board is advisory, and cannot approve its suggestions. The MRB’s recommendations are forwarded to FMCSA, which can choose to adopt, amend or ignore the recommendations.

A 5-foot-9-inch person weighing 237 pounds has a BMI of 35. The average U.S. female height is 5 feet 4 inches. A 204-pound person at that height has a BMI of 35.

Larry Minor, FMCSA representative, clarified the power of guidance by saying medical examiners would be told: “If you encounter this situation, you should consider deferring the granting of a medical card.” LL