Mixed signals on apnea

That obstructive sleep apnea (OSA) is a potentially dangerous medical condition for truck drivers — leading to fatigue, hypertension, Type II diabetes, and other afflictions — is not in doubt. Dealing with sleep apnea from a regulatory perspective, however, remains muddled at best.

At the recent Sleep Apnea & Trucking Conference held outside of Baltimore, MD, presentation after presentation noted that OSA is now considered to be a medical disqualification for a commercial truck driver based on the recommendations of the Federal Motor Carrier Safety Administration (FMCSA) medical review board.

However, this disqualification recommendation is merely “guidance” directed to the 40,000 or so medical examiners tasked with determining whether truck drivers are medically fit to work. Yet under current FMCSA regulations, medical examiners and fleets are not specifically required to screen their drivers for OSA, according to R. Clay Porter, a partner with the law firm of Dennis, Corry, Porter & Smith LLP, which specializes in motor carrier defense.

“The regulations are vague, but the advisory criteria are very clear: Sleep apnea is a health issue. And this particular health issue will be a liability area for motor carriers,” he said. “Know also that a DOT [Dept. of Transportation] medical disqualification trumps the ADA [Americans with Disabilities Act], so motor carriers are not obligated to hire, retain or make any reasonable accommodation for a FMCSR [Federal Motor Carrier Safety regulation] disqualified driver.”

Federal agencies are urging the broader use of sleep disorder screening among transportation workers in all modes — air, rail and marine, as well as trucking.

“All transportation operations need to become more aware of OSA,” Hart said. “The good news is that those suffering from sleep apnea can be treated and then return to work. But it's important that we find better ways to diagnose and treat such sleep disorders.”

Yet FMCSA in particular is continuing to recommend a “no driving” policy for truckers with sleep apnea. “Drivers with moderate to severe sleep apnea should be [medically] disqualified,” said Dr. Mary Gunnels, FMCSA's office of medical programs director.

“We recognize that sleep apnea is a highly sensitive issue, and the challenge is to develop screening and treatment options that are affordable and accepted by operators,” Anne Ferro, FMCSA's chief administrator, told conference attendees.

“But we know sleep apnea contributes to fatigue, and we consider fatigue to be a high-risk behavior, something we're addressing as part of our core mission to reduce severe and fatal crashes involving commercial motor vehicles (CMVs),” she said, noting that her agency's data indicates fatigue is a factor in 13% of all fatal truck crashes, rising to 28% in single CMV crashes.

“Sleep apnea interferes with safe driving,” Ferro noted. “Thus sleep apnea is a threat to safety.”