CSA 2010

The National Transportation Safety Board (NTSB) renewed its campaign this week to broaden the use of sleep disorder screening across all modes of transportation – air, rail, marine, and trucking – as part of long-term effort to significantly reduce the negative effects of fatigue.

 “Last summer we recommended that all modes begin identifying people with high risk for sleep disorders and guide them to medical treatment,” Christopher Hart, NTSB’s vice chairman, said in a speech at the Sleep Apnea and Trucking Conference. All transportation operations need to become more aware of OSA [obstructive sleep apnea],” Hart said. “The good news is that those suffering from sleep apnea can be treated and then return to work. But it’s important that we find better ways to diagnose and treat such sleep disorders.”

According to NTSB, OSA is a condition where airways become obstructed while sleeping, typically resulting in “hypoxia” or low blood oxygen levels at night. The obstruction leads to interruptions in breathing lasting several seconds at a time, loud snoring, and non-restful sleep. Individual with OSA are frequently entirely unaware of the condition, NTSB said, with the disorder leading to extreme daytime sleepiness and sufferers often falling asleep within minutes in a quiet or monotonous environment.

In addition to the substantial risks of impairment result of the fatigue associated with OSA, the untreated disorder increases the risk of other medical conditions such as diabetes, stroke, coronary artery disease and heart failure.

At this time, there are few rules in transportation addressing OSA, the NTSB noted. The Federal Aviation Administration (FAA) does not provide any guidance regarding risk factors for sleep disorders or identify any symptoms (for example, snoring) that might be related to OSA, while the Federal Transit Administration (FTA) has no formal medical standards for transit operators.

In the trucking industry, the FMCSA does ask about sleep disorders, snoring, OSA and daytime sleepiness on the questionnaire completed by commercial truck drivers undergoing their medical certification exam. The FMCSA Medical Review Board did, in 2008, recommend that the administration require OSA screening for all drivers with a body mass index (BMI) over 30, but the FMCSA has yet to act on that recommendation at this time.

According to industry studies, 28% of truck drivers suffer from OSA or “sleep apnea” compared to 6% for the general population. Government data developed from its truck causation study identified fatigue as a factor in 13% of all fatal truck crashes and 28% in single CMV crashes. The challenge however, is to develop an effective screening and treatment option that is affordable and accepted by operators. Sleep apnea does contribute to fatigue and it interferes with safe driving. Sleep apnea is a threat to safety.