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Sleep Disorders & the Commercial Driver: Schneider National’s Screening Program
Wake Up Michigan! Symposium
Darrel Drobnich
Chief Program Officer – Policy, Education & Research
National Sleep Foundation
1522 K Street, NW, Suite 500
Washington, DC 20005
www.sleepfoundation.org
Sleep Apnea and Truck Drivers
FMCSA study of 4,826 commercial truck drivers
17.6% had mild sleep apnea
5.8% had moderate sleep apnea
4.7% had severe sleep apnea
Prevalence was closely linked with age and degree of obesity
Prevalence also depends on the average duration of sleep over consecutive nights at home.
Prevalence of SDB Compared to Other Chronic Disorders In U.S.
High Blood Pressure 25 – 30 million
Asthma 15 – 17 million
COPD 14 – 16 million
Diabetes 14 – 16 million
SDB: 12-18 million 4% of middle-aged men, 2% of middle-aged women 10% or more in geriatric populations
Heart Failure 4 – 6 million
Sleep Apnea Risk Factors & Co-morbidities
58% of patients that suffer from diabetes have sleep apnea
35% of Hypertension patients have OSA (80% of all drug resistant hypertensive patients)
50% of Congestive Heart Failure patients have OSA
Obesity is the most important risk factor for OSA
58% of patients that suffer from diabetes have sleep apnea
35% of Hypertension patients have OSA (80% of all drug resistant hypertensive patients)
50% of Congestive Heart Failure patients have OSA
Obesity is the most important risk factor for OSA
Co-morbidities Obesity Male gender Increasing age Family history Alcohol or sedative
use Anatomic
abnormalities of the upper airway
Smoking Endocrine and
metabolic disorders
Risk Factors
Three of the Top Healthcare Expenditures in the Trucking Industry
Hypertension Diabetes Cardiovascular Disease
Prevalence of Sleep Apnea Co-morbidities
Sjostrom et al.Thorax 2002
Logan et al.J. Hypertension 2001
Javaheri et al.Circulation 1999
O’Keefe, Patterson.Obes Sugery 2004
Einhorn et al.Amer Diab 2005
Somers et al.ATS Pres. 2004
80%
50%
45%
35%
77%
50%Diabetes
Morbidly Obese
All Hypertension
Atrial Fibrillation
Congestive HeartFailure
Drug-ResistantHypertension
Jackson, Tennessee, July 26, 2000
Tennessee State Trooper KilledDriver of Chevy Blazer Seriously Injured
Driver stated he may have fallen asleep
Involved in similar accident in Utah 3 years prior
Prior diagnoses of obstructive sleep apnea and hypothyroidism
NTSB Findings
Schneider National OSA Screening Program - Education
First ever fleet-wide screening of drivers for sleep apnea
Started by educating leadership (!) and special personnel
– Training engineers – effect first line screen in classroom and cab
– Disease management vendors responsible for chronic disease management
– Physical therapists at operating centers– Loss prevention teams throughout company– Medical review teams at time of hire
Schneider National OSA Screening Program - Education
Monthly newsletters sent to drivers homes (spousal recognition of symptoms crucial)
Text messages are sent to drivers in their trucks regarding setting up sleep study or follow up appointments
Driver handbooks have been updated “Drive-time tapes” are provided to diagnosed drivers to
help educate them about their disorder and proper management.
Schneider National OSA Screening Program - Medical Screening
They screen applicants once they complete driver training for those at risk
Worked with drivers to develop system to keep them out of service for only 12 hours for diagnosis and first treatment.
Makes testing mandatory if the driver screens at high risk
They use data on DOT long form physicals to determine who is at risk also
Pharmaceutical claims data is reviewed for certain meds including sleep aides and Modofinal
Schneider National OSA Screening Program – Medical Screening
They use a screening tool developed with Precision Pulmonary Diagnostics
Uses objective and subjective data that are supported by research to predict OSA BMI, Heavy snoring, hypertension
Objective data is important since drivers may feel pressure to deny symptoms out of fear of being put out of service.
Boasts a predictive value of 85% among a high at-risk group such as commercial drivers.
Schneider National OSA Screening Program – Compliance
Only data base of its size that have all been screened- close to 12,000 Over 1000 diagnosed and treated in 2006---
averaging about 50 a month this year SNI is making testing mandatory if you screen at high risk.
Compliance with CPAP treatment is KEY for safety and Return on Investment
Schneider National Sleep Apnea Screening Program
30% accident reduction in this group $500-$700 per driver per month health care savings 12
months post CPAP as compared to 12 months pre CPAP in this cohort depending on time with SNI 4.
Retention in this group at the time of the study (done 2x) shows twice the retention as in regular fleet. (important in a high turnover industry)
Sleep Apnea and Special Populations – NFL Lineman
2002 study involving more than 300 players from 8 randomly selected teams
Sleep apnea was found in 14% of players overall, 5xs higher than similar aged adults
OSA was found in 34% of linemen
Sleep apnea present in young, physically fit men who are in top condition otherwise
George, C. et al, NEJM, Han 23, 2003
New DOT Guidelines Coming
An industry “Joint Statement” issued in September 2006 recommends that all CMV drivers with typical signs of sleep apnea be tested and treated, including:
– Body Mass Index > 35– Neck size > 17– Hypertension that is uncontrolled– Snoring, excessive daytime fatigue or witnessed apneas– A positive Epworth Sleepiness Scale score >10
The “Joint Statement” is expected to influence an updated DOT guideline in the future
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Get on the Road to Better HealthRecognize the Dangers of Sleep Apnea
A joint program of the Federal Motor Carrier Safety Administration
and the National Sleep Foundation
Get
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Apn
ea Campaign Goals• Increase driver and industry awareness
about sleep apnea and other sleep disorders including associated dangers, risk factors, symptoms and treatments.
• Encourage drivers and others in the trucking and motorcoach industries to seek medical help if they are experiencing symptoms of sleep apnea or other sleep disorders.
• Ease driver and industry fears around sleep apnea by communicating that treatment will help reduce crash risk and by clarifying guidelines regarding fitness for duty.
Get
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For More Information, Visit
www.fmcsa.gov
www.drowsydriving.org
www.sleepfoundation.org
Summary
28.1% of truck drivers have sleep apnea28.1% of truck drivers have sleep apnea 2-7x increased risk for crash2-7x increased risk for crash OSA is co-morbid with other major and costly chronic
diseases.
Treatment can not only improve safety and driving performance, but other health outcomes.
Treating all US drivers suffering from apnea would Treating all US drivers suffering from apnea would save $11.1B in collision costs and save 980 lives save $11.1B in collision costs and save 980 lives
annually annually ((Sassanai, et al. SLEEP 2004)