A new study out of Harvard, published in the Journal of Occupational and Environmental Medicine, has suggested that mandatory screenings for obstructive sleep apnea (OSA) and banning of doctor shopping can help prevent truck accidents and bus accidents caused by driver fatigue. The Harvard researchers also linked obesity to OSA and suggested that testing at-risk drivers more often can also help prevent vehicle accidents.

Stefanos N. Kales, the Harvard Medical School professor in charge of the study, noted that as America’s obesity rate increases, the rate of obesity among commercial truck drivers is also growing. Obesity can lead to a number of serious conditions, including OSA, which can affect a driver’s ability to drive safely. Kales notes that truck drivers with OSA, in particular, are far more likely to fall asleep at the wheel when compared with drivers without the condition. Kales’ research also uncovered that many truck drivers avoid treatment for OSA and even underreport symptoms.

OSA is a condition in which a patient does not get a restful sleep due to breathing difficulties during sleep. In the most common situations, the OSA causes a patient’s breathing to catch and effectively causes the patient to wake briefly but very frequently during the night. This results in daytime sleepiness and even a tendency to fall asleep suddenly during the daytime. OSA also increases the risk of cardiac disease, high blood pressure, and diabetes mellitus, all of which can also affect driver performance.

Obviously, this is a risk for truck drivers. According to Dr. Kales and his team of researchers, OSA increases the risk of a car accident, truck accident, or other vehicle accident twofold to sevenfold. In addition, OSA is very common among truck drivers. Kales believes that between 2.4 million and 3.9 million of the licensed commercial drivers across the country suffer from OSA.

Despite the frequency of OSA, however, it is an often under-diagnosed condition. Kales and his researchers found that many primary care doctors miss the symptoms of OSA. They also found that many truck drivers under-report their symptoms. Kales and his researchers examined 456 commercial drivers and found that 17% had symptoms or signs indicating possible OSA. Most of these drivers were obese, older, and had high blood pressure. 53 of the drivers were referred for further testing and studies, but 33 did not comply, while 20 who went for testing all were diagnosed with OSA. Of the 20 drivers with known OSA, only one driver sought treatment.

Kales believes that a significant number of truck drivers with OSA or suspected OSA seek medical certification from doctors who do not screen for OSA. By doctor shopping, they are able to avoid a diagnosis or mandatory treatment that might affect their jobs. Unfortunately, this means that a number of commercial drivers are on the roads with poorly treated or untreated OSA.
The Federal Motor Carrier Safety Administration has considered mandatory sleep apnea screening for all drivers with a body mass index (BMI) which indicates obesity. Currently, there is no mandatory screening for OSA in particular, but commercial truck drivers are required to undergo medical certification. Some truck companies, such as Swift Transportation Corp. of Phoenix, screen their drivers for OSA and pay for treatment and monitoring.