OSA and truckers - recommended guidance

The Motor Carrier Safety Advisory Committee and the Medical Review Board of the FMCSA held a joint public meeting today on Obstructive Sleep Apnea  (was available live via the web) and in the end made some very significant recommendations to the FMCSA.  After several excellent presentation, the groups discussed what they heard, considering other information available and recognizing that detailed regulation and guidance would take some time, agreed it was time to do something.  There was a great deal of discussion on exactly how to address the driver with a BMI of 30 to 35 but it was agreed that for a driver with a BMI over 35, evaluation would be appropriate.  This guidance ONLY focuses on those drivers with the highest pre-test probability of having OSA and guidance on those drivers with a BMI of 30-35 and other clinical findings will be addressed in subcommittees.  Subcommittees of each group (which will work together) which will meet in January  to draft more detailed recommendations to the FMCSA. The full MRB and MCSAC will have a joint meeting Feb 6-9 and will finalize the more detailed recommendations. 

Remember this is recommended to be used as interim guidance pending full regulatory and guidance from FMCSA.  This is currently NOT official guidance from the FMCSA but recommendations from both the MRB and MCSAC and for now, just another criteria that examiners can use.  These recommendations do not mean that examiners cannot continue to use MEP, MRB or other guidelines that they consider best practice but provides, for now, another layer of expert, both medical and industry  guidance. It was indicated that before even the interim guidance could be “officially” adopted by FMCSA, it would need to be published and go out for public comment.

The recommendations to FMCSA were approved by both the MRB and MCSAC, I think I got most of the wording exact but the content is there.

Recommendation 1

A. FMCSA shall issue new guidance for medical examiners that drivers with a Body Mass Index (BMI) of greater than 35 need to be evaluated for obstructive sleep apnea(OSA) using an objective test

B. The driver may be given a 60 day conditional certification during the evaluation and treatment process

C. A driver diagnosed with OSA may maintain certification with evidence of appropriate treatment (if any) and effective compliance and if the examiner determines that the condition does not affect the drivers ability to safely operate a commercial motor vehicle (CMV).

1) Subsequent certification should be no longer than one year term

2) Future certification should depend on proof of continued compliance with treatment

Recommendation 2 – Immediate Disqualification (from Medical Expert Panel/Medical Review Board recommendations)

Drivers who should be immediately disqualified;

a. Individuals who report that they have experienced excessive sleepiness while driving

b. Individuals who have experienced a crash associated with falling asleep

c. Individuals with an AHI > 20, until such an individual has been adherent to CPAP. They can be conditionally certified based on the criteria for CPAP compliance

d. Individuals who have undergone surgery and who are pending the findings of a postoperative evaluation

e. Individuals who have been found to be effectively non-compliant with their CPAP treatment.
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This information courtesy of Natalie P.  Hartenbaum, MD, MPH,. FACOEM
President and Chief Medical Officer OccuMedix
occumedix@comcast.net