CDME Module 4: Respiratory-Final Report of Joint MRBMCSAC Public Meeting on Obstructive Sleep Apnea 2016

Final Report of Joint MRBMCSAC Public Meeting on Obstructive Sleep Apnea 2016

Pdf Summary

The Medical Review Board (MRB) and the Motor Carrier Safety Advisory Committee (MCSAC) have submitted joint recommendations regarding obstructive sleep apnea (OSA) to the Federal Motor Carrier Safety Administration (FMCSA) and the Federal Railroad Administration (FRA). The recommendations are based on a review of public comments from medical professionals and associations on the proposed rulemaking on OSA. <br /> <br />The recommendations include guidelines for the certification and disqualification of drivers with OSA. Drivers with an established diagnosis of OSA must be screened for diagnostic testing, and CMEs cannot issue medical cards for more than one year to drivers with OSA. Certification can be given to drivers who are being effectively treated, with the definition of effective treatment being the resolution of moderate to severe OSA to mild OSA or better, as determined by a board-certified sleep specialist. <br /> <br />Immediate disqualification is recommended for drivers who report excessive sleepiness while driving, experience a crash associated with falling asleep, are observed sleeping behind the wheel, or are non-compliant with treatment. Additionally, drivers who are at extremely high risk can be disqualified at the discretion of the CME. Drivers who are disqualified must remain so until they are evaluated and effectively treated with compliance. <br /> <br />Other recommendations include conditional certification for drivers at risk for OSA based on risk factors, referral for OSA diagnostic testing based on screening criteria, and guidelines for the method of diagnosis and severity of OSA. The recommendations also provide guidelines for the treatment of OSA, including the use of positive airway pressure (PAP) therapy as the preferred treatment, the use of oral appliance therapy for drivers who cannot tolerate PAP therapy, and guidelines for drivers who have undergone bariatric surgery, oropharyngeal or facial bone surgery, or tracheostomy. <br /> <br />The recommendations also call for an evaluation of the impacts of the regulations on driver health and wellness and safety, as well as an educational initiative to inform stakeholders about OSA symptoms, health consequences, risk factors, diagnosis, and treatment costs and benefits. The help of sleep experts and associations is recommended to provide tailored educational materials to Certified Medical Examiners, drivers, and motor carriers. <br /> <br />Overall, the recommendations aim to address the risk posed by OSA in the transportation industry by ensuring proper screening, diagnosis, and treatment of affected drivers.

Keywords

Medical Review Board

Motor Carrier Safety Advisory Committee

obstructive sleep apnea

Federal Motor Carrier Safety Administration

Federal Railroad Administration

certification and disqualification

diagnostic testing

board-certified sleep specialist

excessive sleepiness while driving

positive airway pressure therapy