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Editorials |

Paying Attention to At-Risk Commercial Vehicle Operators

Nancy Collop, MD, FCCP; Natalie Hartenbaum, MD, MPH; Ilene Rosen, MD, FCCP; Barbara Phillips, MD, FCCP
Author and Funding Information

Affiliations: Baltimore, MD
 ,  Dresher, PA
 ,  Philadelphia, PA
 ,  Lexington, KY
 ,  Dr. Collop is Associate Professor of Medicine, the Johns Hopkins University. Dr. Hartenbaum is President and Chief Medical Officer, OccuMedix, Inc, and Adjunct Assistant Professor of Emergency/Occupational Medicine, University of Pennsylvania. Dr. Rosen is Assistant Clinical Professor of Medicine, the University of Pennsylvania. Dr. Phillips is Professor of Medicine, the University of Kentucky.

Correspondence to: Nancy Collop, MD, FCCP, Johns Hopkins University, Division of Pulmonary/CCM, Johns Hopkins University DOM, 1830 E Monument St, Room 555, Baltimore, MD 21205; e-mail: ncollop@aol.com



Chest. 2006;130(3):637-639. doi:10.1378/chest.130.3.637
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Extract

In this issue of CHEST (see page 902) is an executive summary from an article written by a tri-society task force that is entitled “Sleep Apnea and Commercial Motor Vehicle Operators.”1 This summary and the original article, published in the Journal of Occupational and Environmental Medicine,2 were authored by members of the American College of Chest Physicians, the American College of Occupational and Environmental Medicine, and the National Sleep Foundation, and were endorsed by the boards of all three societies. This task force was convened to provide updated recommendations based on the current literature in this field. The last time this topic had been systematically examined was almost a decade ago. The current US federal medical standard for commercial motor vehicle (CMV) operators that covers obstructive sleep apnea (OSA) is in section 49 CFR 391.41 (b)(5) of the Federal Motor Carrier Safety Regulations. In this section, it states that the CMV driver “Has no established medical history or clinical diagnosis of a respiratory dysfunction likely to interfere with his ability to control and drive a motor vehicle safely.” The most recent guidelines that a commercial driver medical examiner would have to refer to for the “respiratory dysfunction” of OSA were two Federal Highway Administration conference reports from a 1991 Conference on Respiratory/Pulmonary Disorders and Commercial Drivers3 and a 1998 Conference on Neurologic Disorders and Commercial Drivers.4 The 1991 report suggested that drivers should be screened by asking whether they snore and frequently fall asleep during the day, and those with suspected or diagnosed but untreated OSA should not be medically qualified to drive until the diagnosis was eliminated or the condition successfully treated. Once the condition was diagnosed, it was recommended that drivers not return to work for 1 month. Prior to returning to work, the driver should undergo either a repeat sleep study showing resolution of the apneas or a multiple sleep latency test (MSLT) yielding normal results. Yearly sleep studies or MSLTs were recommended for follow-up. The neurologic disorders report4 recommended that CMV operators with sleep apnea and any of the symptoms related to excessive daytime sleepiness not be permitted to operate in interstate commerce. Only surgical treatment was addressed in this report, and a 3-month wait and laboratory studies (eg, MSLT or polysomnogram) were recommended prior to allowing operators to resume commercial driving. In 2000, a new medical examination form went into use that required drivers to indicate whether they had a sleep disorder, pauses in breathing while asleep, daytime sleepiness, or loud snoring, but provided no additional guidance on diagnosis, treatment or follow-up.

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