Abstract
Objective:Use independent diagnostic data to analyze the screening effectiveness of the pre-Registry commercial driver medical examination (CDME) for obstructive sleep apnea (OSA), and its sensitivity for hypertension; analyze certification lengths where relevant.Methods:CDME screening results for 1668 drivers were compared to polysomnogram diagnostic test results, and CDME screening results were evaluated for 1155 drivers with at least one insurance claim with a hypertension diagnostic code. Any CDME documentation of the medical condition was considered as detection by screening.Results:CDME sensitivity was 20.7% for moderate OSA (AHI≥15). While sensitivity was 77.5% for hypertension, 93.3% of drivers with Stage 3 hypertension were certified, contrary to Federal Motor Carrier Safety Administration standards.Conclusions:The pre-Registry CDME was ineffective in screening commercial drivers for OSA. Screening was better for hypertension; incorrect certifications were given to many hypertensive drivers.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 237-245 |
| Number of pages | 9 |
| Journal | Journal of occupational and environmental medicine |
| Volume | 62 |
| Issue number | 3 |
| DOIs | |
| State | Published - Mar 1 2020 |
Bibliographical note
Funding Information:Funding: The authors gratefully acknowledge the assistance of the executives and staff of the study firm in acquiring operational and medical data utilized. Financial assistance to the UMN Morris Truckers & Turnover Project has been received from the study firm, the Roadway Safety Institute (the USDOT Region 5 University Transportation Center, which is funded by the USDOT Office of the Assistant Secretary for Research and Tech-nology), and the University of Minnesota Morris. The research also received support from Harvard Catalyst, The Harvard Clinical and Trans-lational Science Center (NIH Award #UL1 RR 025758, financial contri-butions from Harvard University and its affiliated academic health care centers), and support from National Surface Transportation Safety Center for Excellence (Project# 12-UI-017). The content is solely the responsi-bility of the authors and does not necessarily represent the official views of any of the research sponsors.
Funding Information:
Conflicts of interest: Jeffrey Hickman, PhD has served as an expert witness on cases involving commercial drivers. Erin Mabry, PhD reports grants from National Surface Transportation Safety Center for Excellence. Mark Berger, MD, FCCP reports that he is an owner and CEO of Precision Pulmonary Diagnostics, LLC, which has received fees for sleep-apnea-related services from the study firm. In addition, Dr Berger has been issue US patents 7599892, US 7720696, US 8249896, and US 8200510. Dr Czeisler reports grants from Cephalon Inc., Jazz Pharmaceuticals Plc. Inc., National Football League Charities, Optum, Philips Respironics Inc., Regeneron Pharmaceuticals, ResMed Foundation, San Francisco Bar Pilots, Sanofi S.A., Sanofi-Aventis Inc., Schneider Inc., Sepracor Inc., Mary Ann & Stanley Snider via Combined Jewish Philanthropies, Sysco Corp., Takeda Pharmaceuticals Co. Ltd., Teva Pharmaceuticals Industries Ltd., and Wake Up Narcolepsy; and consulting fees from Bose Corporation, Boston Red Sox, Columbia River Bar Pilots, Samsung Electronics, Quest Diagnostics Inc., Teva Pharma Australia, Vanda Pharmaceuticals Inc., Washington State Board of Pilotage Commissioners; lecture fees from Ganésco Inc. and Zurich Insurance Company Ltd.; and fees for serving as a member of an advisory board for Institute of Digital Media and Child Development and the Klarman Family Foundation. In addition, Dr Czeisler holds a number of process patents in the field of sleep/circadian rhythms (eg, photic resetting of the human circadian pacemaker), and holds an equity interest in Vanda Pharmaceuticals Inc. Dr Czeisler is the incumbent of an endowed professorship provided to Harvard University by Cephalon Inc. Since 1985, Dr Czeisler has also served as an expert on various legal and technical cases related to sleep and/or circadian rhythms including those involving the following commercial entities: Casper Sleep Inc., Comair/Delta Airlines, Complete General Construction Company, FedEx, Greyhound, HG Energy LLC, Purdue Pharma, LP, South Carolina Central Railroad Co., Steel Warehouse Inc., Stric-Lan Companies LLC, Texas Premier Resource LLC and United Parcel Service (UPS). Dr Czeisler received royalties from the New England Journal of Medicine; McGraw Hill; Houghton Mifflin Harcourt/ Penguin; and Philips Respironics Inc. for the Actiwatch-2 and Actiwatch-Spectrum devices. Dr Czeisler’s interests were reviewed and managed by Brigham and Women’s Hospital and Partners HealthCare in accordance with their conflict of interest policies. Stefanos N. Kales MD, MPH has served as a consultant and expert witness on cases involving commercial drivers. The other authors have indicated no financial conflicts of interest. Non-financial disclosure: none.
Keywords
- commercial driver medical exam
- commercial motor vehicle
- commercial motor vehicle operator
- hypertension
- motor carrier
- obstructive sleep apnea
- polysomnogram
- truck driver
- truckload