Over the past few years, Obstructive Sleep Apnea (OSA) has become the new buzz word in healthcare. Much like your little brother, it gets the blame for everything. The OSA madness has made its way into the trucking industry too, where medical examiners are sending more and more drivers for expensive testing that may be unnecessary.
Currently, the FMCSA has no requirement to test for OSA. However, the FMCSA has guidelines to help the medical examiners determine who is at risk for OSA. Lets keep in mind, just because a driver has risk factors, does not mean every driver should be subject to expensive testing. Determining who should and should not be tested for OSA is not a cookie cutter situation, like some medical examiners have made it.
Let’s take a look at the risk factors and symptoms associated with OSA, as published by the FMCSA.
• A family history of sleep apnea
• Having a small upper airway
• Being overweight
• Having a recessed chin, small jaw, or a large overbite
• A large neck size (17 inches or greater for men, 16 inches or greater for women)
• Smoking and alcohol use
• Being 40 years old or older
• Loud snoring
• Morning headaches and nausea
• Gasping or choking while sleeping
• Loss of sex drive/impotence
• Excessive daytime sleepiness
• Irritability and/or feelings of depression
• Disturbed sleep
• Concentration and memory problems
• Frequent nighttime urination
Having one of these risk factors does not mean the driver should be sent for a sleep study. For example, a driver who has a 17.5 inch neck, is a non-smoker, no family history of OSA and has a normal physical exam, most likely does not need this testing.
One of the current problems commercial drivers are facing is that clinical discretion has been taken away from some DOT medical examiners . The corporate structure of large chain urgent care facilities that perform DOT examinations set standards that do not allow the medical examiner to use clinical judgment. The standards they impose may be arbitrary in nature and not inline with the current FMCSA standards. In some cases, the corporate standards are set to increase revenues for those that employ the medical examiner.
The medical examiner should use their own judgment and clinical training to determine who should under-go sleep studies and not standards imposed on them. Using cookie cutter standards and recommendations from a larger corporate structure only serves to drive up cost for the employers and drivers.
In conclusion, if you encounter a medical examiner that states the FMCSA requires sleep studies for any driver with little or no clinical risk factors for OSA, please contact our office for a second opinion.
Dr. Richard L. Rodgers II D.C. CME
FMCSA Certified Medical Examiner