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FMCSA seeks to adopt sleep apnea recommendations as rule guidance

FMCSA said in a notice published in the Federal Register that it “proposes to adopt the recommendations as regulatory guidance after reviewing and evaluating comments received from the public.”

By DOROTHY COX
The Trucker Staff

4/19/2012

WASHINGTON — The Federal Motor Carrier Safety Administration today said it wants to adopt sleep apnea recommendations made by its two medical advisory bodies as regulatory guidance for a future rulemaking.

According to an FMCSA spokesperson, the recommendations were provided to FMCSA in February by the agency’s Medical Review Board and the Motor Carrier Safety Advisory Committee or MCSAC “for future rulemaking on obstructive sleep apnea.”

The processes for guidance and rulemaking are “complimentary but on separate tracks,” explained spokesperson Candice Tolliver Burns. A timeline for an apnea rule was not given, although the recommendations currently are “under agency review,” Burns said. Before a rulemaking comes down the road, however, the recommendations will be used for clarification of existing regulatory guidance on respiratory dysfunctions likely to interfere with the ability to control and drive a CMV safely, of which obstructive sleep apnea or OSA, is one.

The recommendations include a body mass index or BMI of 35 or greater and an Apnea Hypopnea Index or AHI of 20 or more (moderate to severe sleep apnea) as being triggers for testing and treatment, with treatment meaning use of a Positive Airway Pressure or PAP machine. Use of dental appliances to treat sleep apnea were “not approved alternatives at this time,” the recommendations stated.

FMCSA said in a notice published in the Federal Register that it “proposes to adopt the recommendations as regulatory guidance after reviewing and evaluating comments received from the public.” Comments must be received on or before 30 days from today.

A driver with a BMI of 35 or greater could be conditionally certified for 60 days pending a sleep study and treatment if diagnosed with OSA. Within 60 days, if the driver was compliant with treatment, he or she could get an additional 90-day certification.

If, after 90 days the driver is still compliant with treatment he or she could get certification for a year depending on continued compliance.

PAP compliance is defined as “at least” four hours a day of use on 70 percent of days with seven or more hours of daily use during sleep deemed “preferable.”

A commercial driver with a diagnosis of obstructive sleep apnea (OSA) can be certified if he or she has only mild to moderate OSA (an AHI of less or equal to 20) and if the driver “does not admit to experiencing excess sleepiness during the major wake period or the driver’s OSA is being effectively treated.”

The AHI is used to measure the severity of sleep apnea and has to do with the number of times a night a person stops breathing. In their recommendation notes, the Motor Carrier Safety Advisory Committee (MCSAC) and the Medical Review Board (MRB) said the AHI threshold is used “to prioritize drivers with OSA who need immediate treatment” and that the threshold was set at 20 “because crash risk in the moderate-to-severe OSA range is statistically higher than for drivers with mild OSA.”

However, the notes also said that drivers with mild OSA (AHI levels as low as 5) “may benefit from OSA treatment and should be encouraged to explore treatment options.”

The recommendations also state that drivers with mild OSA “should be encouraged to seek treatment if they have a history involving a fatigue-related crash or DOT-defined single vehicle crash or if they report sleepiness while operating a motor vehicle.”

Drivers would be immediately disqualified or denied certification if they admit to excessive daytime sleepiness while driving; experienced a crash associated with falling asleep or have been non-compliant with PAP treatment.

Comments must contain the Federal Docket Management System Docket No. FMCSA 2012-0102. They can be submitted online by going to this address and following the instructions.

By mail, send to Docket Management Facility, U.S. Department of Transportation, 1200 New Jersey Avenue, S.E., West Building Ground Floor, Room W12-140, Washington, DC 20590-0001.

Hand deliveries may be made to West Building Ground Floor, Room W12-140, 1200 New Jersey Ave., S.E., Washington, DC between 9 a.m. and 5 p.m. Monday through Friday except federal holidays.

Or fax comments to (202) 493-2251.

Dorothy Cox of The Trucker staff can be reached to comment on this article at dlcox@thetrucker.com.

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