FMCSA’s Proposed Sleep Apnea Guidance

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On April 20, 2012, the Federal Motor Carrier Safety Administration (FMCSA) published proposed guidance in the Federal Register intended to assist medical examiners in diagnosing commercial motor vehicle drivers with obstructive sleep apnea (OSA). FMCSA rescinded the guidance later that same day, claiming that it was premature and not intended for publication. FMCSA has been in the process of developing this guidance since the present direction to medical examiners on respiratory conditions (such as OSA) is widely regarded as vague and insufficient. In short, it directs the medical examiner to ensure that the driver does not have respiratory dysfunction likely to impair the driver’s ability to operate a CMV according to the examiner’s “professional judgment.”

FMCSA now anticipates publishing the new guidance later this year or perhaps early next year. Although FMCSA announced that the guidance document was published prematurely, ATA believes it will very closely resemble the final document when it is ultimately made public. The document released in April was based on a joint recommendation by two agency federal advisory committees: the Motor Carrier Safety Advisory Committee and the Medical Review Board. The proposed (and subsequently withdrawn) guidance is summarized below:

Certifying drivers:

A medical examiner may certify a driver if the individual:
1) Does not exhibit symptoms of OSA suggesting that a sleep study is warranted; or
2) Has been diagnosed with mild OSA with an apnea-hypopnea index1 (AHI) of 20 or less2 AND the driver reports no symptoms of excessive daytime sleepiness, (note: treatment is not required if AHI is 20 or less); or
3) Has OSA that is being effectively treated.3

Driver who should be tested for sleep apnea:

Medical examiners should refer a driver for a sleep study if the individual:
1) Has a Body Mass Index (BMI) of 35 or more kg/m2 or
2) Has a BMI of 20 or more and, in the judgment of the medical examiner, exhibits other conditions that are likely to indicate the patient suffers from OSA, including: a small or recessed jaw, a small airway, a neck of greater than or equal to 17 inches (males) or 15.5 inches (female), hypertension (treated or untreated), Type 2 diabetes (treated or untreated), or hypothyroidism (untreated). The guidance states that the following conditions are also indicative of possible OSA, but not as strongly indicative of those listed previously: a BMI of greater than or equal to 28 kg/m2, age 42 or older, a family history of OSA, being male or a post-menopausal woman, or being involved in a single-vehicle crash... Read the Full Document.