The Truckers & Turnover Project, led by Stephen Burks, with the University of Minnesota Morris, has earned the University of Minnesota Center for Transportation Studies 2019 Robert C. Johns Research Partnership Award for researching commercial drivers and untreated obstructive sleep apnea (OSA). In the study, the research team identified that non-adherent drivers had a preventable crash-risk five times higher than those who treated their OSA.
Burks answered questions on how programs for diagnosing and treating obstructive sleep apnea correlate with preventable tractor-trailer collisions.
What is obstructive sleep apnea and how is it diagnosed?
Professor Burks: If you have OSA, your airway collapses when the airway in your neck relaxes while you are asleep. This stops your breathing, so your brain partly wakes up to restart your breathing. An individual may not be aware that this occurs. The continual repetition of this process during the night causes all kinds of nasty physical and mental effects, not the least of which is that you never get fully rested. If this happens five times per hour you probably have a mild case, and some of the people we studied were measured at closer to once a minute. That is pretty serious.
Why are tractor-trailer drivers with OSA a concern?
PB: Standard tractor-trailers weigh about 30,000 pounds empty, and up to 80,000 pounds fully loaded. So if a tractor-trailer collides with a car, the car generally loses. To safely drive a tractor-trailer on the public highways requires a steady level of vigilance and attention. If you have OSA, you are never rested and are much more likely to lose focus on what you are doing, or even to “micro-sleep.” That is to nod out for several seconds at a time. Other environmental factors held equal, this sharply raises the chance that your truck will crash in a way that could have been prevented if you were fully attentive.
What are current treatment options for OSA?
PB: The medical device industry is always evolving, but the treatment of choice today for most people with OSA is an automatic continuous airway pressure (APAP) device. This is a small filtered and humidified air pump that connects via a hose to a mask you wear while sleeping. The pump responds to your breathing pattern and keeps the pressure high enough in your airway that it does not collapse and stop your breathing when you relax in sleep.
What are the potential cost savings associated with diagnosed drivers having regular OSA treatments?
PB: There are at least three potential cost savings to a motor carrier that puts in place a mandatory program to screen, diagnose, and treat OSA in its drivers. First, the risk of serious preventable truck crashes is significantly reduced. Second, a firm which is self-insured for its employee medical plan will see significant savings in overall medical insurance claims. Untreated OSA is connected to higher medical bills for associated medical conditions such as heart disease and diabetes. Third, tractor-trailer has a high driver turnover. Drivers with treated OSA tend to quit less, which reduces the costs of driver replacement and training.
What are you doing to advance research on sleep-apnea health treatments and vehicular collisions?
PB: The contribution of the Truckers & Turnover Project research team at UMN Morris, along with our co-investigators at other institutions, has been to do careful work on a fairly difficult statistical task—to retrospectively analyze the first-ever program to screen, diagnose, and treat OSA that was mandated by a large motor carrier for its drivers. We hope other large motor carriers and insurance companies will consider our analysis of the effectiveness of this crash-risk program—along with forthcoming work on cost savings the program generated—when they consider an OSA program. It will also come to the attention of federal safety regulators when they consider the costs and benefits of requiring OSA screening for tractor-trailer drivers.