Grandi Carolina Sleep Society 2011


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Presentation at the Carolina Sleep Society meeting 2011

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  • © 2010 American Association of Sleep Technologists I have no conflicts of interest to disclose other to say that my abiding interest to benefit those affected by sleep apnea.
  • 26. Is Sleep Apnea disqualifying?   Drivers should be disqualified until the diagnosis of sleep apnea has been ruled out or has been treated successfully. As a condition of continuing qualification, it is recommended that a CMV driver agree to continue uninterrupted therapy such as CPAP, etc. / monitoring and undergo objective testing as required. A driver with a diagnosis of (probable) sleep apnea or a driver who has Excessive Daytime Somnolence(EDS) should be temporarily disqualified until the condition is either ruled out by objective testing or successfully treated. Narcolepsy and sleep apnea account for about 70% of EDS. EDS lasting from a few days to a few weeks should not limit a driver’s ability in the long run. However, persistent or chronic sleep disorders causing EDS can be a significant risk to the driver and the public. The examiner should consider general certification criteria at the initial and follow-up examinations: Severity and frequency of EDS Presence or absence of warning of attacks Possibility of sleep during driving Degree of symptomatic relief with treatment Compliance with treatment.
  • Grandi Carolina Sleep Society 2011

    1. 1. Truckers & Sleep Apnea Presented to Carolina Sleep Society May 20, 2011 Edward Grandi, Exec. Director American Sleep Apnea Association
    2. 2. Conflict of Interest Disclosures Speaker: Edward Grandi 1. I do not have any potential conflicts of interest to disclose, OR 2. I wish to disclose the following potential conflicts of interest: X 3. The material presented in this lecture has no relationship with any of these potential conflicts, OR 4. This talk presents material that is related to one or more of these potential conflicts, and the following objective references are provided as support for this lecture: 1. 2. 3. Type of Potential Conflict Details of Potential Conflict Grant/Research Support Consultant Speakers’ Bureaus Financial support Other
    3. 3. ASAA is dedicated to reducing, injury, disability and death from sleep apnea and to enhancing the well-being of those affected by this common disorder.
    4. 4. Learning Objectives
    5. 5. The cast of characters from the land of acronyms <ul><li>DOT </li></ul><ul><ul><li>NTSB (investigates) </li></ul></ul><ul><ul><li>FMCSA (regulates/enforces) </li></ul></ul><ul><ul><ul><li>MRB – Medical Review Board </li></ul></ul></ul><ul><ul><ul><li>MEP – Medical Expert Panel </li></ul></ul></ul><ul><li>ACOEM </li></ul><ul><ul><li>Medical Examiner </li></ul></ul><ul><ul><ul><li>M.D., D.O., P.A., APN and D.C. </li></ul></ul></ul>
    6. 6. The cast of characters from the land of acronyms <ul><li>JTF – Joint Task Force (ACOEM, ACCP & NSF) </li></ul><ul><li>MCSAC </li></ul><ul><li>ATA (the big boys) </li></ul><ul><li>OOIDA (everybody else) </li></ul><ul><li>and </li></ul>
    7. 7. 12 – 28% of commercial truck drivers have OSA OSA increase the risk of vehicular accident 2- to 7-fold OSA patients are three to five times more likely to be involved in crashes that result in personal injuries.
    8. 8. What we know now… <ul><li>Current FMCSA regulations – </li></ul><ul><li>Part 391.43 (b)(5) </li></ul><ul><li>A person is physically qualified to drive a commercial motor vehicle if that person – </li></ul><ul><li>Has no established medical history or clinical diagnosis of respiratory dysfunction likely to interfere with his/her ability to control and drive a commercial motor vehicle safely . </li></ul>Medical Exam Report Yes No Sleep disorders, pauses in breathing while sleeping, daytime sleepiness, loud snoring
    9. 9. What’s medical examiner to do? <ul><li>Refer only if answer to question on sleep disorder is yes </li></ul><ul><li>Screen based on JTF rec. </li></ul><ul><ul><li>BMI > 35, HTN, neck circumstance </li></ul></ul><ul><li>Screen based on MEP </li></ul><ul><ul><li>BMI > 33 </li></ul></ul><ul><li>Screen based on MRB </li></ul><ul><ul><li>BMI > 30 </li></ul></ul>
    10. 10. Something has to be done Implement a program to identify commercial drivers at high risk for OSA and require that those drivers provide evidence through the medical certification process of having been appropriately evaluated and, if treatment is needed, effectively treated for that disorder before being granted unrestricted medical certification. - NTSB Recommendation (H-09-15) NTSB Chair Debra Hersman
    11. 11. Where we are headed… <ul><li>National Registry of Certified Medical Examiners </li></ul><ul><li>Mandatory screening for OSA </li></ul><ul><li>Mandatory testing for those at risk </li></ul><ul><li>Mandatory compliance monitoring </li></ul>The question is when do we get there…
    12. 12. Opportunities for the field… <ul><li>Screening </li></ul><ul><li>Testing – PSG & HST </li></ul><ul><li>Titration </li></ul><ul><li>Supporting those in therapy </li></ul>
    13. 13. Opportunities for the field… <ul><li>Screening/Education </li></ul>Outreach Using validated screening tools: STOP – BANG Berlin Questionnaire FOSQ - 10
    14. 14. Opportunities for the field… <ul><li>Testing – PSG & HST </li></ul>In – lab polysomnography Office based Mobile Units Home Sleep Testing Flexibility
    15. 15. Opportunities for the field… <ul><li>Titration </li></ul>The relationship does not end once the diagnosis is complete. Especially if the diagnosis is done using a home sleep test. Follow - up
    16. 16. Opportunities for the field… <ul><li>Supporting those in therapy </li></ul>The therapeutic relationship does not end with the diagnosis or the dispensing PAP therapy Persistence
    17. 17. Success in treating truck drivers <ul><li>Outreach </li></ul><ul><li>Flexibility </li></ul><ul><li>Follow-up </li></ul><ul><li>Persistence </li></ul>
    18. 18. Remember who we are dealing with here!
    19. 19. Conclusions <ul><li>Sleep apnea treatment in the trucking space is in a state of flux </li></ul><ul><li>Change is coming, perhaps not soon enough, but it is coming </li></ul><ul><li>The sleep medicine community has an opportunity to exercise leadership in the screening, diagnosis, treatment and follow-up for this at risk population </li></ul>
    20. 20. Thank you for your attention. Any questions?
    21. 21. Bibliography & Resources <ul><li>George CF. Sleep, Part 5: driving and automobile crashes in patients with obstructive sleep apnoea/hypopnoes syndrome. Thorax 2004;59:804-807 </li></ul><ul><li>Kingshott, RN, Cowan JO, Jones DR, et al. The role of sleep-disordered breathing, daytime sleepiness and impaired performance in motor vehicle crashes – a controlled study. Sleep Breath 2004; 8:61-72 </li></ul><ul><li>Mulgrew AT, Nasvadi G, Butt A, et al. Risk and severity of motor vehicle crashes in patients with obstructive sleep apnoea/hypopnoea. Thorax 2008;63:536-541 </li></ul><ul><li>***** </li></ul><ul><li>FMCSA Medical Expert Panel Recommendations – OSA & CMV Driver Safety </li></ul><ul><li> </li></ul><ul><li>***** </li></ul><ul><li>Truckers for A Cause – A.W.A.K.E. monthly conference call addressing sleep apnea related issues. </li></ul><ul><li>Apnea Support Forum – </li></ul><ul><li>Sleep Apnea & Trucking Conference toolkit available from </li></ul>
    22. 22. Links to the ASAA <ul><li> </li></ul><ul><li> </li></ul><ul><li> </li></ul><ul><li> </li></ul><ul><li> </li></ul><ul><li> </li></ul>