Journal
SLEEP
Volume 39, Issue 5, Pages 967-975Publisher
OXFORD UNIV PRESS INC
DOI: 10.5665/sleep.5734
Keywords
APAP; commercial motor vehicle operator; CPAP; motor carrier; obstructive sleep apnea; OSA; preventable crash; PSG; screening; truckload
Categories
Funding
- SNI
- Roadway Safety Institute (the USDOT Region 5 University Transportation Center)
- USDOT Office of the Assistant Secretary for Research and Technology
- MacArthur Foundation's Research Network on the Origins of Norms and Preferences
- Sloan Foundation
- University of Minnesota, Morris
- Harvard Catalyst, The Harvard Clinical and Translational Science Center (NIH) [UL1 RR 025758]
- Harvard University
- National Surface Transportation Safety Center for Excellence [12-UI-017]
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Study Objectives: To evaluate the effect of an employer-mandated obstructive sleep apnea (OSA) program on the risk of serious preventable truck crashes. Methods: Data are from the first large-scale, employer-mandated program to screen, diagnose, and monitor OSA treatment adherence in the US trucking industry. A retrospective analysis of cohorts was constructed: polysomnogram-diagnosed drivers (OSA positive n = 1,613, OSA negative n = 403) were matched to control drivers unlikely to have OSA (n = 2,016) on two factors affecting crash risk, experience-at-hire and length of job tenure; tenure was matched on the date of each diagnosed driver's polysomnogram. Auto-adjusting positive airway pressure (APAP) treatment was provided to all cases (i.e. OSA positive drivers); treatment adherence was objectively monitored. Cases were grouped by treatment adherence: Full Adherence (n = 682), Partial Adherence (n = 571), or No Adherence (n = 360). Preventable Department-of-Transportation-reportable crashes/100,000 miles were compared across study subgroups. Robustness was assessed. Results: After the matching date, No Adherence cases had a preventable Department of Transportation-reportable crash rate that was fivefold greater (incidence rate ratio = 4.97, 95% confidence interval: 2.09, 10.63) than that of matched controls (0.070 versus 0.014 per 100,000 miles). The crash rate of Full Adherence cases was statistically similar to controls (incidence rate ratio = 1.02, 95% confidence interval: 0.48, 2.04; 0.014 per 100,000 miles). Conclusions: Nontreatment-adherent OSA-positive drivers had a fivefold greater risk of serious preventable crashes, but were discharged or quit rapidly, being retained only one-third as long as other subjects. Thus, the mandated program removed risky nontreatment-adherent drivers and retained adherent drivers at the study firm. Current regulations allow nonadherent OSA cases to drive at another firm by keeping their diagnosis private. Commentary: A commentary on this article appears in this issue on page 961.
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