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Sleep Apnea Among Truck Drivers

A Study of Prevalence of Sleep Apnea Among Commercial Truck Drivers

The goal of the Federal Motor Carrier Safety Administration (FMCSA) is to reduce commercial vehicle related fatalities, as well as the number of persons injured in commercial vehicle related crashes, by 50 percent by the year 2010.

Introduction

Staying awake means staying alive. This is a slogan used to describe a research study on sleep apnea sponsored by the Federal Motor Carrier Safety Administration (FMCSA) and the American Transportation Research Institute of the American Trucking Associations (ATA). The research project addressed the prevalence of sleep apnea among commercial truck drivers, potential risk factors, and its impact on driving performance.

This Tech Brief summarizes the project’s final report, A Study of Prevalence of Sleep Apnea Among Commercial Truck Drivers.

Background

Sleep apnea is a major contributor to daytime drowsiness—a condition that could prove deadly for commercial truck drivers and involved passenger vehicles. It is a condition where, during sleep, a narrowing or closure of the upper airway causes repeated sleep disturbances leading to poor sleep quality and excessive daytime sleepiness. Since excessive sleepiness can be a consequence of sleeping disturbances, drivers with sleep apnea have compromised driving performance leading to increases in the risks of crashes. According to the Divided Attention Driving Task, a research test designed to mimic driving performance, individuals with sleep apnea perform, on average, as poorly as individuals whose levels of blood alcohol concentration exceed the legal limit. The results of this study show that the prevalence rates of sleep apnea among commercial truck drivers are similar to sleep apnea rates found in other general populations. This is in contrast to the extremely high prevalence rates reported previously by the Stoohs study. [Stoohs, Sleep and Sleep-Disordered Breathing in Commercial Long-Haul Truck Drivers, 1995]

Purpose

This research study had three objectives:

To estimate the prevalence of sleep apnea among a sample of commercial truck drivers living within a 50-mile radius of the University of Pennsylvania

To examine the relationship in commercial truck drivers between severity of sleep apnea and decreased function related to driving performance

To develop a profile of an overall sample of commercial truck drivers with regard to their sleep apnea-related characteristics and risks

Objective Measures of Sleepiness:

· Multiple Sleep Latency Test

This test, which measures the psychological pressure to fall asleep, studied the rate at which drivers fell asleep during daytime naps. Drivers were asked to fall asleep in a dark room at two-hour intervals, where the length of time it took to fall asleep was measured and the average of all nap opportunities was calculated.

· Psychomotor Vigilance Test (PVT)

Using a handheld device with a small visual display, this test measured driver reaction time to stimuli over a 10-minute period. Measurements that are sensitive to the effects of sleep loss, such as median reaction time, number of performance lapses, lapse duration, and optimum response time, were recorded.

· Divided Attention Driving Task

Designed to mimic driving performance, participants were tested using a driver-like model. They used a steering wheel device to track randomly moving targets, while simultaneously responding to numbers that randomly appeared at the corners of a computer screen. Each driver’s average deviation from the desired center point and slope of increase was computed over the time of the test.

· Digit Symbol Substitution Test (DSST)

This test assessed cognitive speed and accuracy by subjecting drivers to a 90-second test, whereby the participant viewed nine identified symbols and was asked to identify one symbol at a time by typing its corresponding number. As soon as the driver responded, a new symbol appeared. Excessive sleepiness greatly affected the ability to perform this test.

Findings

A major goal of the study was to determine the prevalence of sleep apnea in commercial truck drivers, based on the results of several tests conducted on a random sample of commercial driver’s license (CDL) holders living within a 50-mile radius of the University of Pennsylvania. The results of the study revealed that 17.6 percent of CDL holders had mild sleep apnea, 5.8 percent had moderate sleep apnea, and 4.7 percent had severe sleep apnea.

A significant research finding was that, although sleep apnea is common among commercial vehicle drivers, its prevalence is considerably less than the 78 percent reported for mild sleep apnea of CDL holders in the Stoohs study. Instead, the rates of prevalence are more similar to study results in other, more general populations, rather than commercial truck drivers as a group.

The study also revealed that the prevalence of sleep apnea depends on the relationship between two major factors, age and degree of obesity, with prevalence increasing with both. This relationship is important, because it provides the commercial driving industry with predictions that are useful in estimating the prevalence of sleep apnea in any population of drivers.

Another meaningful study finding showed that the prevalence of sleep apnea depends on the average duration of sleep over consecutive nights at home. Short sleep duration, six hours or less per night, results in an increase in the prevalence of sleep apnea. It was revealed that sleep duration is affected by the time at which drivers awake in the morning, and since more than 35 percent of commercial truck drivers terminate their sleep before 6:00 am, they have significantly shorter sleep durations and higher chances of daytime sleepiness. All measures of sleepiness showed that the effects of daytime performance depend, not only on the severity of sleep apnea, but also on the average sleep duration of the driver.

A large number of drivers indicated self-reported sleepiness on the subjective tests; however, it was not a determining factor of the presence and severity of sleep apnea, since no relationship was found between self-report measures and any of the performance ability tests. This lack of relationship is unclear, and indicates that self-reports of sleepiness are not a reliable source in identifying drivers who are likely to have sleep apnea. Conversely, almost all of the objective tests of performance showed a clear relationship between performance ability and the severity of sleep apnea, i.e. the relationship between the measurement of sleepiness, and rate of performance lapses and lane tracking ability.

Since sleep apnea and shortened sleep duration were prevalent in the CDL test group, any effort to deal with impaired driving performance, as a result of excessive sleepiness, needs to consider both issues. These issues are important, since the risk of having sleep apnea is higher in CDL holders who have shorter durations of sleep. Although the prevalence of severe sleep apnea and chronic inadequate sleep among commercial truck drivers gives rise to serious concerns, it can be a reversible condition with effective treatment. However, a major challenge to ensuring driver safety against the adverse effects of sleep apnea is to develop cost-effective ways of identifying at-risk drivers, and ensuring a solution to this treatable and preventable problem.



This information came from an
FMSCA online article.

*** Any law, statute, regulation or other precedent is subject to change at any time ***

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