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NEWS FROM
CAMBRIDGE HEALTH ALLIANCE
March 10, 2009
Obesity Linked to Dangerous Sleep Apnea in Truck
Drivers
New study supports mandatory screenings and prohibition
of "doctor shopping" to reduce significant public safety
risk
Somerville, MA...Truck crashes are a significant
public health hazard causing thousands of deaths and injuries each
year, with driver fatigue and sleepiness being major causes. A new
study has confirmed previous findings that obesity-driven testing
strategies identify commercial truck drivers with a high likelihood
of obstructive sleep apnea (OSA) and suggests that mandating OSA
screenings could reduce the risk of truck crashes.
"Truck drivers with sleep apnea are much more likely to fall
asleep at the wheel, and the condition is increasingly common as
Americans become more obese," said the study's senior author,
Stefanos N. Kales, MD, MPH, Medical Director of Employee and Industrial
Medicine at Cambridge Health Alliance, where the study was conducted.
"Additionally, we found that drivers who suffer from obstructive
sleep apnea frequently underreport symptoms and diagnoses and often
do not follow through with sleep study referrals and sleep apnea
treatment."
OSA is a syndrome characterized by sleep-disordered breathing,
resulting in excessive daytime sleepiness, sleep attacks, psychomotor
deficits, and disrupted nighttime sleep. It increases the risk of
a vehicular accident by two- to seven-fold, and is common among
truck drivers. Approximately 2.4 - 3.9 million licensed commercial
drivers in the U.S. are expected to have OSA. In addition to being
unrecognized or unreported by drivers, OSA often remains undiagnosed
by many primary care clinicians despite the fact that OSA increases
the risks of hypertension, diabetes mellitus, and heart disease.
Over the 15-month study period, 456 commercial drivers were examined
from over 50 different employers. Seventy-eight (17%) met the screening
criteria for suspect OSA. These drivers were older and more obese,
and had a higher average blood pressure. Of the 53 drivers who were
referred for sleep studies, 33 did not comply with the referral
and were lost to follow-up. The remaining 20 were all confirmed
to have OSA, but, after diagnosis, only one of these 20 drivers
with confirmed OSA complied with treatment recommendations. "It
is very likely that most of the drivers who did not comply with
sleep studies or sleep apnea treatment sought medical certification
from examiners who do not screen for sleep apnea and are driving
with untreated or inadequately treated sleep apnea," said Dr.
Kales.
The study, published today by the Journal of Occupational and
Environmental Medicine, has significant policy ramifications,
as the Federal Motor Carrier Safety Administration is currently
deliberating recommendations to require sleep apnea screening for
all obese drivers based on body mass index or "BMI" (BMI
is calculated based on height and weight). The Administration requires
medical certification of licensed commercial drivers at least every
two years. These occupational medicine exams present a unique opportunity
for detecting OSA as part of determining a driver's safety behind
the wheel.
"OSA screenings of truck drivers will be ineffective unless
they are federally mandated or required by employers," said
Dr. Kales, who serves as an assistant professor at both Harvard
Medical School and Harvard School of Public Health. The study's
authors also support the prohibition of "doctor shopping."
Dr. Kales added, "Such action would prohibit drivers diagnosed
with a serious disorder that might limit driving or require treatment
to seek out more lenient or less rigorous medical examiners."
"Screening for Obstructive Sleep Apnea During Commercial Driver
Medical Examinations" published by the Journal of Occupational
and Environmental Medicine. March 2009, Vol. 51, Issue 3. Authors:
Philip D. Parks, MD, MPH, MOccH; Gerardo Durand, MD; Antonios J.
Tsismenakis, MA; Antonio Vela-Bueno, MD; and Stefanos N. Kales,
MD, MPH. The study was supported by the Federal Motor Carrier Safety
Administration, a research award from the American College of Occupational
and Environmental Medicine, and the National Institute for Occupational
Safety and Health Education and Research Center.
Cambridge Health Alliance is an innovative, award-winning
health system that provides high quality care in Cambridge, Somerville,
and Boston's metro-north communities. It includes three hospital
campuses, a network of primary care and specialty practices, the
Cambridge Public Health Dept., and the Network Health plan. CHA
is a Harvard Medical School teaching affiliate and is also affiliated
with Harvard School of Public Health, Harvard School of Dental Medicine,
and Tufts University School of Medicine. Visit us online at www.challiance.org.
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Media Contact
David Cecere
Media Relations Manager
Phone: 617-503-8428
Cell: 617-921-9613
Pager: 617-546-1879
dcecere@challiance.org
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