CDME Module 4: Respiratory (2025)-Withdrawal of Advanced Notice of Proposed Rulemaking (ANPRM) on Obstructive Sleep Apnea

Withdrawal of Advanced Notice of Proposed Rulemaking (ANPRM) on Obstructive Sleep Apnea

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The Department of Transportation (DOT) withdrew its Advanced Notice of Proposed Rulemaking (ANPRM) regarding the mandatory screening and treatment of obstructive sleep apnea (OSA) in commercial motor vehicle (CMV) drivers, leading to confusion among medical examiners and employers. The rulemaking would have established uniform criteria for screening, diagnostic testing, and treatment for drivers and railroad workers, as opposed to the current practice where guidelines vary. Despite the withdrawal, the DOT underscored the ongoing significance of OSA as a safety concern, due to its potential to induce sleep episodes, reduce attention, and impair safety during critical duties.<br /><br />The Federal Motor Carrier Safety Administration (FMCSA) continues to underline that no specific federal criteria are required, encouraging the use of the 2015 Bulletin to Medical Examiners and the 2016 Medical Review Board (MRB) recommendations. Examiners are expected to utilize their medical expertise, guidance from existing literature, and expert recommendations to make informed decisions about individual drivers' risk and the necessity for further evaluation or treatment.<br /><br />Historically, OSA has been a concern since DOT's 1991 Conference on Pulmonary/Respiratory Disorders, and its importance has been reiterated through various panels and recommendations. The National Transportation Safety Board (NTSB) has long advocated for attention to sleep disorders as a crucial part of transport safety. With no federal regulation enforcement, examiners rely on guidance, balancing risk assessments against the practicalities and accessibility of widespread testing.<br /><br />The announcement clarified that ignoring the risks posed by undiagnosed or untreated OSA in drivers is unacceptable. Medical examiners must rely on their clinical judgment and available resources to continue prioritizing public safety while the regulatory framework remains undefined.

Keywords

Department of Transportation

Advanced Notice of Proposed Rulemaking

obstructive sleep apnea

commercial motor vehicle drivers

Federal Motor Carrier Safety Administration

2015 Bulletin to Medical Examiners

2016 Medical Review Board recommendations

National Transportation Safety Board

transport safety

clinical judgment