Occupational Health & Safety

It Pays to Treat Sleep Apnea

• By Jerry Laws
• Sep 01, 2008

Treating commercial truck drivers who have sleep apnea significantly lowers their health care costs, lowers their preventable accident rate, and reduces their turnover.While the Federal Motor Carrier Safety Administration revised the hours of service rule in this decade to reduce fatigue-related commercial motor vehicle crashes, the evidence in two recent studies is an even more compelling reason for trucking companies to address sleep apnea. But it is more than that. Every safety manager now has a reason.

One of the studies was presented June 11 at the SLEEP 2008 conference in Baltimore. Sleep researcher Dr. Najib Ayas, assistant professor of medicine at the University of British Columbia in Vancouver, and colleagues reported they did not find obstructive sleep apnea (OSA) was a significant factor in the occupational injuries suffered by 706 patients who were referred to the university hospital’s sleep lab from May 2003 to April 2006. But when they considered only falls and motor vehicle crashes, they found rates of those incidents were 5.1 times higher in OSA patients than in non-OSA patients, and the effect of OSA persisted even after controlling for age, gender, alcohol use, and bluecollar occupation. (Remember, falls and vehicle crashes are leading causes of U.S. workplace fatalities.)

“A lot of patients without sleep apnea may be sleepy for other reasons. Our study is probably an understatement,”Ayas told me. Indeed, workers may not self-report OSA because they fear being fired. Another sleep researcher, Dr. Allan Pack, professor of medicine and director of the Center for Sleep and Respiratory Neurobiology at the University of Pennsylvania School of Medicine, said commercial drivers stopped self-reporting their snoring during required biennial physicals when they realized the admission could lead to a sleep apnea diagnosis.

“In commercial drivers’ major crashes, the driver falling asleep is probably involved in more than half of them,” said Pack, who served on an FMCSA expert panel that recommended an OSA screening policy to the agency early this year. Give truckers with a body mass index of 33 or above one month to be diagnosed and start CPAP treatment if necessary, the panel said, then check their adherence to therapy at three months. Pack said FMCSA’s medical advisory board dropped the recommendation to a BMI of 30 or higher, but the policy hasn’t been issued. (About 40 percent of the nation’s more than 6 million truck and bus drivers are at 30 or higher, he said.)

The second study proved truckers will use CPAP machines, need much less health care after treatment begins, and stay with that employer longer.A company that employs 1,000 drivers can expect to save more than $500,000 in health costs annually, according to this study, which involved Schneider National Inc. drivers who received CPAP treatment.

This article originally appeared in the September 2008 issue of Occupational Health & Safety.

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