New research on sleep apnoea

Sleep apnoea is a condition known to cause high levels of fatigue and sleepiness in those affected. Discussions on the topic have shown that drivers working in the trucking industry have a higher risk of suffering from a debilitating lack of sleep, although few realise they are dealing with a serious medical condition.

Now a comprehensive study has been made of the subject, interviewing a large number of truckies and testing them for sleep apnoea. And the results should be of concern to all those involved in the trucking industry.

The condition studied in the report is more correctly known as obstructive sleep apnoea (OSA) and is caused when the airways become blocked during sleep causing a pause in breathing or taking low breaths. These breathing difficulties create disturbed sleep and low oxygen uptake as the affected person can stop breathing many times an hour. Upon awakening, most sufferers are not aware they have had an issue and do not make a connection to the daytime drowsiness they may feel, which occurs as a result of sleep apnoea.

To bring the topic into focus, Lisa Sharwood presented the results of a study carried out by the George Institute for Global Health in Sydney at the recent ATA Convention.

According to Lisa, who led the team doing the research, new fatigue rules require a medical check including a number of questions aimed at identifying apnoea sufferers. As there is a perception of higher risk of truck crashes if the driver suffers from OSA, the study aimed to ascertain whether the current procedures are an effective method of identifying OSA in truck drivers.

The team interviewed 517 truck drivers asking them a number of questions about their driving experience, personal health, shift schedules, payments and whether they felt they have problems with sleep and tiredness. 4.4 per cent had previously been diagnosed with sleep apnoea but testing found 41 per cent were likely to have sleep apnoea. However, only 12 per cent of the drivers reported daytime sleepiness. The study also found that 36 per cent of the drivers were overweight while another 50 per cent were obese, 49 per cent were cigarette smokers.

The study concluded sleep apnoea to be a significant and unrecognised problem in truck drivers. It suggested objective testing for OSA should be considered as truck drivers were not reporting symptoms, failing to identify the risks of driving while suffering with sleep apnoea. It concluded the current medical questions required to assess drivers for suitability in fatigue management schemes are inadequate in identifying at risk drivers.

Drivers involved with the study were given a sleep monitor to give the researchers an indication as to whether they may ease suffering from OSA. The single channel sleep monitor can be worn taped to the nose overnight and sent back to the research team the following day. If the results proved to be positive, the team would contact the driver giving them a confidential report on the results. This was followed up by a telephone call to ensure they had received results and understood the implications of them.

If the subject suffers over 18 reduced or stopped breathing events in one hour they are regarded as suffering moderate OSA, over 30 is reckoned to indicate severe OSA. Among those studied, one driver was found to be averaging 102 stopped breathing events every hour.

“The main take-home point from our study is that if you ask a driver if they are sleepy when they are driving, and their livelihood depends on it, are they going to give you a true answer?” says Sharwood. “The problem is many drivers are unaware of the degree to which they are affected.

“The message from our study is there is a problem. There needs to be a regulatory requirement to ensure drivers get assistance in identifying sleep apnoea and other health risks at large. We can have paper regulation as much as we like, but if you are tired, you need to pull over and have a nap. The fact of the matter is, if no one is taking responsibility for the health of the drivers then everyone on the road is at risk.

“We have an opportunity here to make a difference, to make sure we have a healthier population of people who are driving the biggest vehicles on the road. I would suggest we need to have a national regulation to start testing and treating apnoea sufferers. It is starting to be encouraged in the US.”

Schneider National, a large US trucking company, already identified obstructive sleep apnoea as a major risk factor for their operation back in 2004. They also found drivers were incentivised to deceive their employers when asked about drowsiness while driving. The company developed a number of survey techniques and used this to screen drivers to find those at highest risk of suffering from OSA. These drivers were sent for a polysomnogram test to assess their sleep cycles. The pre-screening proved to be over 90 per cent accurate in predicting the likelihood of a driver suffering OSA.

“At Schneider we have found around 17 per cent of our drivers are suffering from moderate to severe OSA,” said Schneider National SVP Safety & Security, Don Osterberg, who also spoke at the recent ATA event. “We pre-screen our drivers and send them to a sleep clinic to study their sleep. Today, we have over 2000 drivers who have been diagnosed with OSA and they are using a CPAP unit.”

The CPAP unit is a ‘continuous positive airway pressure’ device used to treat those suffering with OSA. It keeps the sufferer's airways open using a flow of pressurised air into the throat. A facial mask is connected via a flexible tube to a bedside machine, which generates air pressure.

The company found there was a significant reduction in accident rates among those drivers who had been tested and treated for apnoea. Even more significantly, they found a dramatic decrease in the healthcare costs associated with those drivers, as large companies cover the healthcare costs of their employees in the US. The reduction in health costs amounted to over $500 per driver per month being shaved off their health cost bill. An unintended benefit also occurred with a 30 per cent increase in driver retention among those treated. It would appear the drivers appreciated the attention their employers were paying to their health.

“This is a real issue,” said Osterberg. “If you have 20 truck drivers in your employ and you don't have a program for testing for OSA, I can guarantee you have drivers afflicted by OSA and they probably don't know it. So you have to ask the fundamental question, if in a safety sensitive arena like trucking, you have a driver afflicted with OSA, would you want to know? I believe the only responsible answer is yes, it obligates you to do something. We have case study after case study where drivers tell how they didn't know about the condition and realise how good they feel after treatment.”

Doing something about the problem of OSA in the trucking workforce is likely to have a triple effect in improving outcomes for truck operators. Reductions in fatigue related accidents due to improved sleep outcomes are the first effect. Treatment of sleep apnoea also creates better health outcomes all round for the drivers involved as a number of other problems like obesity and diabetes are also commonly found to be associated with apnoea sufferers. Helping drivers to get real health benefits from identification and treatment of OSA also generates a feeling of good will and wellness among employees whose overall well-being is improved through OSA treatment.

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