CDME Module 4: Respiratory-NTSB Recommendation Letter Obstructive Sleep Apnea and Commercial Drivers

NTSB Recommendation Letter Obstructive Sleep Apnea and Commercial Drivers

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The National Transportation Safety Board (NTSB) has investigated accidents involving operators with sleep disorders in all modes of passenger transportation. These accidents include highway accidents where commercial drivers with obstructive sleep apnea (OSA) were involved. The NTSB found that the failure to detect and remove medically unfit drivers with sleep disorders from service was a cause of these accidents. The NTSB also identified risk factors for OSA in drivers involved in accidents where the disease could not be linked directly to the cause. Other investigations in aviation, rail, and maritime transportation modes have highlighted the importance of screening for and treating OSA among operators.<br /><br />OSA is a condition where individuals obstruct their own airways while sleeping, resulting in interruptions in breathing, snoring, and non-restful sleep. Individuals with OSA may experience extreme daytime sleepiness and have a higher risk of accidents. OSA can be effectively treated through continuous positive airway pressure (CPAP) devices worn at night or surgery. Risk factors for OSA include obesity and high blood pressure.<br /><br />The Federal Motor Carrier Safety Administration (FMCSA) includes questions on sleep disorders and OSA in the medical certification process for commercial drivers. However, the FMCSA currently does not provide guidance on identifying drivers at risk for OSA. Other modal agencies like the Federal Aviation Administration (FAA) and the Federal Transit Administration (FTA) also lack formal screening processes for OSA.<br /><br />The NTSB has issued safety recommendations to ensure that operators in different transportation modes are appropriately screened, evaluated, and treated for OSA. The NTSB recommends implementing a program to identify commercial drivers at high risk for OSA and providing guidance for commercial drivers, employers, and physicians on the identification and treatment of individuals at high risk for OSA.<br /><br />The NTSB has also recommended that the FMCSA requires evidence of appropriate evaluation and treatment for OSA before granting unrestricted medical certification to drivers.

Keywords

National Transportation Safety Board

sleep disorders

operators

obstructive sleep apnea

screening

treatment

CPAP devices

obesity

high blood pressure

safety recommendations