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Employer-Mandated Sleep Apnea Screening and Diagnosis in Commercial Drivers

Berger, Mark MD, FCCP; Varvarigou, Vasileia MD; Rielly, Albert MD, MPH; Czeisler, Charles A. PhD, MD, FRCP; Malhotra, Atul MD; Kales, Stefanos N. MD, MPH, FACP, FACOEM

Journal of Occupational and Environmental Medicine: August 2012 - Volume 54 - Issue 8 - p 1017–1025
doi: 10.1097/JOM.0b013e3182572e16
Original Articles

Introduction: Obstructive sleep apnea (OSA) is common among commercial drivers and associated with health/safety risks, leading several trucking firms to mandate OSA screening.

Methods: A total of 19,371 commercial drivers were screened for OSA with an online questionnaire (Somni-Sage[reg]) through employer mandates. Questionnaire and polysomnography results were analyzed retrospectively.

Results: Screening categorized 5908 drivers (30%) as higher risk. To date, employers have sent 2103 higher-risk drivers for polysomnography, demonstrating that 68% of high-risk drivers tested had an apnea–hypopnea index (AHI) greater than 10 and 80% had an AHI of 5 or more. A conservative prevalence estimate for OSA (AHI > 10) was 21% among the drivers studied.

Conclusions: Online screening followed by polysomnography for high-risk drivers demonstrates as many as 21% of commercial drivers may have OSA. Mandatory screening can have a high yield among commercial drivers.

Supplemental digital content is available in the text.

From the Precision Pulmonary Diagnostics (Dr Berger), Houston, TX; Department of Environmental and Occupational Medicine & Epidemiology (Drs Varvarigou, Rielly, and Kales), Harvard School of Public Health, Cambridge, Mass; Division of Sleep Medicine (Drs Czeisler and Malhotra), Department of Medicine, Brigham and Women's Hospital, Boston, MA; Division of Sleep Medicine (Drs Czeisler, Malhotra, and Kales), Harvard Medical School, Boston, MA; and Department of Medicine (Drs Varvarigou, Rielly, and Kales), Division of Occupational Medicine, Employee Health and Industrial Medicine, Cambridge Health Alliance, Cambridge, MA.

Address correspondence to: Stefanos N. Kales, MD, MPH, FACP, FACOEM, The Cambridge Hospital, 1493 Cambridge Street, Macht Bldg, Suite 427, Cambridge, MA 02139. E-mail:

This work was conducted with support from Harvard Catalyst/The Harvard Clinical and Translational Science Center (NIH Award #UL1 RR 025758 and financial contributions from Harvard University and its affiliated academic health care centers). The content is solely the responsibility of the authors and does not necessarily represent the official views of Harvard Catalyst, Harvard University, and its affiliated academic health care centers, the National Center for Research Resources, or the National Institutes of Health.

Dr Berger is the President of Precision Pulmonary Diagnostics, LLC; PPD has received royalty payments for the use of the Somni-Sage[reg] questionnaire.

Supplemental digital content is available for this article. Direct URL citation appears in the printed text and is provided in the HTML and PDF versions of this article on the journal's Web site (

©2012The American College of Occupational and Environmental Medicine