truckers drive their own assessment for obstructive sleep apnea: a collaborative approach to online self-assessment for

1. Truckers Drive Their Own Assessment for Obstructive Sleep Apnea: A CollaborativeApproach to Online Self-Assessment for Obstructive Sleep Apnea Ben Smith, MS, North Carolina State University Gary Hull, TFAC/AWAKE Bob Stanton, TFAC/AWAKE Barbara Phillips, MD, MSPH, FCCP, University of Kentucky TFAC – Truckers for a Cause AWAKE – Alert Well and Keeping Energetic TFAC – Truckers for a Cause AWAKE – Alert Well and Keeping Energetic

3. Obstructive Sleep Apnea (OSA) and Commercial Motor Vehicle Drivers (CMVDs) Approximately 5,600 people are killed every year in crashes with commercial motor vehicles. Between 20 and 30% of crashes with CMVDs are sleep-related (Akerstedt T J Sleep Res 2000) At least 25% of CMVDs have OSA (Pack A AJRCCM 2006)

4. Commercial Drivers Carry Increased Risk for Crash They may operate larger vehicles transport hazardous materials carry multiple passengers operate for longer stretches of time have an economic incentive to continue driving when private drivers may choose to stop for a medical reason or road conditions. Because crashes of CMVD’s are so much more deadly than those of nonprofeessional drivers, these drivers are not protected by the Americans with Disability Act. Because crashes of CMVD’s are so much more deadly than those of nonprofeessional drivers, these drivers are not protected by the Americans with Disability Act.

5. The Federal Motor Carrier Safety Administration (FMCSA) Regulates CMVD’s Because crashes involved CMVD’s are so dangerous, these drivers are regulated by the Federal Motor Carrier Safety Administration, the FMCSA, through their Medical Program. CMVD’s must undergo certifying physical examinations at least every 2 years in order to maintain the commercial driver’s license (CDL). The physical requirements necessary to be certified are established by the FMCSA’s medical program. Because crashes involved CMVD’s are so dangerous, these drivers are regulated by the Federal Motor Carrier Safety Administration, the FMCSA, through their Medical Program. CMVD’s must undergo certifying physical examinations at least every 2 years in order to maintain the commercial driver’s license (CDL). The physical requirements necessary to be certified are established by the FMCSA’s medical program.

6. Background/Rationale Based on an evidence review The FMCSA Medical Expert Panel recommended that CMVDs undergo testing for OSA if they have a positive Berlin Questionnaire and/or BMI > 33 kg/m2. The FMCSA Medical Review Board recommended that CMVDs undergo testing for OSA if they have a positive Berlin Questionnaire and/or BMI > 30 kg/m2.

7. Development of Collaboration Truckers for a Cause- Alert, Well, And Keeping Energetic (TFAC-AWAKE), responding to requests from participants, desired to host a screener for OSA on its website. TFAC-AWAKE leader sought help with website screener development. Collaborators agreed to publish the anonymous results. The study was exempted by UK IRB.

8. Methods We adapted the Berlin Questionnaire (Netzer NC Ann Intern Med 1999) to be taken online. TFAC-AWAKE hosted the survey on their website. TFAC’s XM radio, word of mouth and trucking industry press contacts offered promotion. We collected IP addresses to ensure that each participant only took the survey once, but we collected no other identifying data.

10. Although truckers themselves approached us to set up this screening tool, some truckers were opposed to this, as in the publication for the owner-operater Independent driver association, which says, “click here to hurt your career,” and which advised truckers to stay away from this anonymous screen. This issue is a hot button for truckers, with some resisting any attempts at regulation and screening. Although truckers themselves approached us to set up this screening tool, some truckers were opposed to this, as in the publication for the owner-operater Independent driver association, which says, “click here to hurt your career,” and which advised truckers to stay away from this anonymous screen. This issue is a hot button for truckers, with some resisting any attempts at regulation and screening.

11. The Berlin Questionnaire (Netzer NC Annals 1999) Do you snore? How loud do you snore? How often do you snore? Has your snoring ever bothered other people? Has anyone noticed that you quit breathing during your sleep? How often do you feel tired or fatigued after your sleep? During your waking time, do you feel fatigued, or not up to par? Have you ever nodded off or fallen asleep while driving a vehicle? Do you have high blood pressure? What is your BMI? This is the tool we used. It is divided into 3 sections: snoring, sleepiness and objective findings (obesity and hypertension). We included an automatic BMI calculator, which did the calculation and reported it after the participants entered height and weight. This is the tool we used. It is divided into 3 sections: snoring, sleepiness and objective findings (obesity and hypertension). We included an automatic BMI calculator, which did the calculation and reported it after the participants entered height and weight.

12. The Berlin Questionnaire (Netzer NC Annals 1999) Do you snore? How loud do you snore? How often do you snore? Has your snoring ever bothered other people? Has anyone noticed that you quit breathing during your sleep? How often do you feel tired or fatigued after your sleep? During your waking time, do you feel fatigued, or not up to par? Have you ever nodded off or fallen asleep while driving a vehicle? Do you have high blood pressure? What is your BMI? These 2 questions from the Berline were used a outcome (??am I saying that correctly?) variables. These 2 questions from the Berline were used a outcome (??am I saying that correctly?) variables.

13. Aims and Hypotheses Aims to determine if truckers would assess their OSA risk online. to collect demographic data from self-selected truckers. Hypotheses those with OSA symptoms (snoring, sleepiness) would be more likely to report drowsy driving, but objective data (BMI, hypertension history) would predict sleepy driving better than would subjective data.

14. Data analysis The website was active to collect data from January 11, 2010 until September 24, 2010. We performed Logistic Regression Analyses using the R statistical package.

15. Results 595 of CMVDs took the survey 55.9% positive on overall Berlin 78.3% positive on objective (BMI, bp) part 69.6% had a BMI > 30 Kg/m 2 47.6% had BMI > 33 Kg/m 2 20.5% reported falling asleep while driving (on Berlin) 26.7% national average in 2009. WAY higher rate of obesity.26.7% national average in 2009. WAY higher rate of obesity.

16. Sleepy Driving Associated with…

17. Witnessed Apneas Associated with…

18. Conclusions This was a unique and interesting collaboration! Truckers willingly assess their OSA risk online. The rate of obesity is high in this group. More than two-thirds of those who do so would be required to undergo polysomnography (PSG) if suggested guidelines become regulation. Subjective symptoms were associated with sleepy driving, but objective findings were not. Sleep health professionals need to develop expedient, non-punitive tools to keep CMVDs healthy and driving.

20. OSA Increases the Risk of Crash (FMCSA, 2007, Tregear S, JCSM 2009) Untreated sleep apnea has been well-demonstrated to increase the risk of crash, with the average estimate of increased risk being about a two-fold increase in risk. Untreated sleep apnea has been well-demonstrated to increase the risk of crash, with the average estimate of increased risk being about a two-fold increase in risk.