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Screening for Obstructive Sleep Apnea During Commercial Driver Medical Examinations

Parks, Philip D. MD, MPH, MOccH; Durand, Gerardo MD; Tsismenakis, Antonios J. MA; Vela-Bueno, Antonio MD; Kales, Stefanos N. MD, MPH

Journal of Occupational and Environmental Medicine: March 2009 - Volume 51 - Issue 3 - p 275-282
doi: 10.1097/JOM.0b013e31819eaaa4
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Objective: To evaluate consensus criteria for screening commercial drivers for obstructive sleep apnea (OSA).

Methods: Consecutive drivers underwent OSA screening using Joint Task Force consensus criteria at commercial driver medical examinations. Outcomes included: clinical yield of screening; and drivers’ compliance with polysomnography (PSG) referrals and OSA treatment.

Results: Among 456 drivers, 53 (12%) were referred for PSG, and 20/20 were confirmed to have OSA, supporting a high positive predictive value. The other 33 drivers referred for PSG were lost to follow-up but demonstrated no significant differences from those with confirmed OSA. After diagnosis, only one of 20 drivers with confirmed OSA demonstrated treatment compliance.

Conclusions: Drivers identified by the consensus criteria have a high likelihood of OSA. Drivers’ poor compliance with PSGs and OSA treatment support federally mandated screening of commercial drivers.

From the Department of Environmental and Occupational Medicine and Epidemiology (Dr Parks, Dr Durand, Mr Tsismenakis, Dr Kales), Harvard School of Public Health, Boston, Mass; Department of Medicine (Dr Parks), Rhode Island Hospital, Lifespan Corporation, Providence, RI; Boston University School of Medicine (Mr Tsismenakis), Boston, Mass; The Cambridge Health Alliance (Mr Tsismenakis, Dr Kales), Harvard Medical School, Cambridge, Mass; Department of Psychiatry (Dr Vela-Bueno), Autonomous University of Madrid, Madrid, Spain.

Philip D. Parks, MD, MPH, MOccH, was funded by the Federal Motor Carrier Safety Administration (FMCSA), a resident research award from the American College of Occupational and Environmental Medicine (ACOEM), and the National Institute for Occupational Safety and Health (NIOSH) Education and Research Center (ERC) (Grant: T42 OH 008416-03).

Address correspondence to: Stefanos N. Kales, MD, MPH, The Cambridge Health Alliance—Employee & Industrial Medicine, Macht Building, Suite 427, 1493 Cambridge Street, Cambridge, MA 02139; E-mail: skales@hsph.harvard.edu.

©2009The American College of Occupational and Environmental Medicine