Portable Diagnostic Devices for Identifying Obstructive Sleep Apnea among Commercial Motor Vehicle Drivers: Considerations and Unanswered Questions

Abstract

Obstructive sleep apnea (OSA), a syndrome defined by breathing abnormalities during sleep, can lead to fatigue and excessive daytime sleepiness (EDS) with an increased risk of motor vehicle crashes. Identifying commercial motor vehicle operators with unrecognized OSA is a major public health priority. Portable monitors (PMs) are being actively marketed to trucking firms as potentially lower-cost and more accessible alternatives to the reference standard of in-laboratory polysomnography (PSG) in the diagnosis of OSA among commercial motor vehicle operators. Several factors regarding PMs remain uncertain in this unique patient population: their sensitivity and specificity; the cost-benefit ratio of the PMs versus PSG; potential barriers from human factors; and evolving technologic advancement. Human factors that alter test accuracy are a major concern among commercial drivers motivated to gain/maintain employment. Current available data using PMs as a diagnostic tool among CMV operators indicate relatively high data loss and high loss to follow-up. Loss to follow-up has also been an issue using PSG in commercial motor vehicle operators. Furthermore, PM testing and PM results interpretation protocols may have no sleep specialist oversight, and sometimes minimal physician oversight and involvement. Additional studies comparing unattended and unmonitored PMs directly against full in-laboratory PSG are needed to provide evidence for their efficacy among commercial motor vehicle operators.

Association of Sleep Habits With Accidents and Near Misses in United States Transportation Operators

“…Nevertheless, in the case of transportation operators who try to avoid sleep disorders diagnoses because these can affect their work status, anonymous surveys are more likely to obtain truthful responses to sleep questions. 21,27,34 In addition, with respect to obesity, the high obesity prevalence among truck and bus drivers in our current survey was consistent with past studies. 30,31 …”

“…Means to identify such operators would be potentially valuable but difficult to elicit spontaneously in the occupational setting. 21 On the contrary, it may be possible to educate such operators that they are at high risk for an accident and persuade them to improve their sleep hygiene, be medically evaluated for a sleep disorder, or both. In addition, technologies that can identify drowsiness in real time through objective measures are also attractive as occupational safety strategies in the transportation industry.…”

“…These may include psychomotor vigilance testing, driving simulators, and eye movement sensors. 21–26 …”

“…A series of studies of OSA screening among truck drivers has found the prevalence to range from 12% to 28% with most of those truck drivers previously undiagnosed. 15,21 Those investigations using more sensitive methods have found an OSA prevalence among truck drivers in excess of 20%. 11,30,31 …”

Management of Obstructive Sleep Apnea in Commercial Motor Vehicle Operators: Recommendations of the AASM Sleep and Transportation Safety Awareness Task Force

“…The FMCSA has since required that medical examiners undergo training and certification, and be listed in a national registry, to address the issue of doctor shopping. 56,57 Investigations are needed to determine whether this registry increases the likelihood of case identification and effective treatment. These collective data support a need for mandated screening, testing, and compliance with therapy.…”