***Sleep Apnea Guideline Delayed Indefinitely
US Congress Passes Public Law 113-45 To ensure that any new or revised requirement providing for the screening, testing, or treatment of individuals operating commercial motor vehicles for sleep disorders is adopted pursuant to a rulemaking proceeding, and for other purposes.
Those opposed to new guidelines being developed for FMCSA lobbied for passage of Public Law 113-45 which requires the DOT to use the "Rule Making" process before making any change to the current sleep apnea guidelines. The rule is a long and arduous process. You should not expect any new sleep guidelines for quite some time.
Definition of Sleep Apnea: 30 hypoapnea events per hour
Neck Circumference: 17" males, 16" female
Reported Pauses in Breathing
Report of/or testing indicating daytime sleepiness
FMCSA is encouraging "Best Practice" for drivers with Sleep Apnea and they have removed all reference to Sleep Apnea from the FMCSA Medical Examiner's Handbook and their website.
The following guidance that has been provided in the past several years from FMCSA and as recommendations from the Medical Review Board. These could be used as a "Best Practice" basis for Certified Medical Examiners to support their requirements for drivers with suspected sleep apnea.
So what is the best practice for sleep apnea? Dr. Chipley has reviewed the literature and come to the following conclusions and recommendations: (Of course, none of this is binding on TeamCME members and should not be consider as medical advice. This is not required... but is reccomended)
Those who should be referred for a Sleep Test:
1. Drivers who disclose they have been told they pause in breathing when asleep should have a sleep test.
2. A driver with a Body Mass Index (BMI) over 35 with a history of hypertension, diabetes, MI or stroke should have a sleep test, but if they do not report or have testing that indicates daytime sleepiness that does not specifically mean they must be disqualified from driving unless you believe they have undiagnosed sleep apnea and could pose a risk. Other factors to consider would be loud snoring and whether they awake refreshed and the results of a current Epworth. If an Epworth indicated OSA testing is in order, disqualify until testing is obtained.
Drivers with a BMI over 35 without a history of hypertension, diabetes, MI or stroke should have a current Epworth. If indicated, testing should be performed. Other things to consider are loud snoring, awaking refreshed, or other sleep questionnaires, small jaw, and overall large body stature.
3. Drivers who have a 17" (male) or 16" (female) neck should not be required to have OSA testing on that basis alone.
4. Yearly testing should at least include a current Epworth to be conducted by the sleep specialist along with yearly clearance.
We hope this helps those with questions about the current policies and recommendations for certifying those who are concerned about loosing certification due to body mass index alone. For more information about the occupational services at Chipley Chiropractic: Click Here