Breathe easy: Sleep apnea and transportation safety

By Mary Ebeling
Obstructive sleep apnea is a respiratory disorder that causes breathing to stop and start repeatedly during sleep, sometimes as many as 400 times a night. The condition results in increased daytime drowsiness and reduced reaction time among sufferers, and this has drawn the attention of the transportation safety community. Drowsiness is of particular concern among sectors responsible for freight movement on the nation’s highways and rails. In a step towards establishing rules specific to obstructive sleep apnea (OSA) the Federal Motor Carrier Safety Administration (FMCSA) and the Federal Rail Administration (FRA) have issued an Advance Notice of Proposed Rulemaking (ANPRM) to address the challenge of finding a balance between government’s interest in protecting public safety on highways and the industry’s workforce concerns about the ability of truckers to earn a living.
The ANPRM solicits public comments and relevant data on the prevalence of this disorder in the population of commercial truck and rail operators. The rulemaking will also consider input on the costs and benefits that truck drivers could experience with the proposed rule. Results from a new study released in March 2016 concludes the rate of preventable crashes caused by commercial truck drivers is five times higher for drivers with moderate to severe OSA than for drivers without the disorder. This leads the authors to conclude that “untreated obstructive sleep apnea is a pervasive threat to transportation safety.” Currently, safety regulators will provide medical clearance for drivers suffering from moderate to severe OSA only if they are being successfully treated for the problem, and this data supports that practice.
Another recent report released in May 2016 by the American Transportation Research Institute (ATRI), contains data from a survey of 800 truck drivers, 261 of whom completed a sleep study and received a diagnosis of moderate to severe OSA. The report provides information about the costs and benefits for drivers, as well as an industry perspective on the prevalence and treatment of OSA. The study suggests these additional factors be considered for the rule: develop measures linking OSA screening and treatments with safety outcomes; document how these rules will impact the population of drivers with OSA; and consider ways to decrease the cost burden on drivers required to undergo a sleep study, since the costs for these studies are substantial and vary depending on insurance coverage. The study found the cost of a sleep study to diagnose a driver with OSA to average over $1,000 in out-of-pocket costs. With an average median truck driver weekly income at $805 in 2015, this is a significant expense.
Public comments on the ANPRM can be submitted until July 8th. Information on submitting comments can be found here:
Mary Ebeling is a Transportation Policy Analyst at SSTI.