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Hits and Misses: Screening Commercial Drivers for Obstructive Sleep Apnea Using Guidelines Recommended by a Joint Task Force

Platt, Alec B. MD, MSCE; Wick, Lindsay C. M.Phil.Ed., M.S.Ed.; Hurley, Sharon BA; Soto-Calderon, Haideliza BS; Wieland, Will BA; Staley, Beth BA; Maislin, Greg MS, MA; Gurubhagavatula, Indira MD, MPH

Journal of Occupational and Environmental Medicine: September 2013 - Volume 55 - Issue 9 - p 1035–1040
doi: 10.1097/JOM.0b013e318298fb0e
Original Articles

Objective: To evaluate joint task force criteria-based screening for severe obstructive sleep apnea (s-OSA) in commercial drivers.

Methods: Among a community-based cohort of licensed commercial vehicle drivers, we assessed utility of the joint task force criteria. We conducted full, 14-channel overnight polysomnography in all drivers, defining s-OSA as an apnea–hypopnea index of 30 or more per hour.

Results: One hundred of 104 drivers with successful polysomnography studies were predominantly obese (median body mass index = 32.8 kg/m2; interquartile range = 26.8 to 37.4) and had a median apnea—hypopnea index of 20.6 per hour (interquartile range = 10.0 to 34.2). Examination-based criteria were more effective (sensitivity = 80%; negative posttest probability [nPTP] = 17%) than symptom-based criteria (sensitivity = 63%; nPTP = 23%). Examination and symptom-based criteria combined had high sensitivity (97%) and low nPTP (7%), but poor specificity (19%).

Conclusions: Examination-based criteria missed 20% of s-OSA cases. Combining examination with confidentially reported symptoms improved sensitivity but required confirmatory polysomnography in 86%, supporting universal screening of all drivers.

From Respiratory Specialists (Dr Platt), Wyomissing; Division of Sleep Medicine (Drs Platt and Gurubhagavatula), Perelman School of Medicine of the University of Pennsylvania; Center for Sleep and Circadian Neurobiology (Mrs Wick, Hurley, Soto-Calderon, Wieland, Staley, and Maislin, and Dr Gurubhagavatula), University of Pennsylvania Medical Center, Philadelphia; and Pulmonary, Critical Care and Sleep Section (Dr Gurubhagavatula), Philadelphia VA Medical Center, Penn.

Address correspondence to: Alec B. Platt, MD, MSCE, FCCP, 2608 Keiser Blvd, Wyomissing, PA 19610 (alecplatt@gmail.com).

The study was supported by NIOSH/CDC R01-OH009149. Embla Inc provided an unrestricted loan of sleep diagnostic equipment.

The authors declare no conflicts of interest.

Dr Platt presented the results of this paper in abstract form at the annual meeting of the American Thoracic Society conference on May 22, 2013 in Philadelphia, PA.

Copyright © 2013 by the American College of Occupational and Environmental Medicine