Sleep Disorders & the Commercial Driver: Schneider National’s Screening Program

Wake Up Michigan! Symposium

Darrel Drobnich

Chief Program Officer – Policy, Education & Research

National Sleep Foundation

1522 K Street, NW, Suite 500

Washington, DC 20005

www.sleepfoundation.org

Obstructive Sleep Apnea , Drowsy Driving

& the Commercial Driver

Best Practices

NSF’s 2007 Healthy Sleep Community Award to Schneider National, Inc.

Sleep Apnea and Truck Drivers

FMCSA study of 4,826 commercial truck drivers

17.6% had mild sleep apnea

5.8% had moderate sleep apnea

4.7% had severe sleep apnea

Prevalence was closely linked with age and degree of obesity

Prevalence also depends on the average duration of sleep over consecutive nights at home.

Health Effects of OSA

Prevalence of SDB Compared to Other Chronic Disorders In U.S.

High Blood Pressure 25 – 30 million

Asthma 15 – 17 million

COPD 14 – 16 million

Diabetes 14 – 16 million

SDB: 12-18 million 4% of middle-aged men, 2% of middle-aged women 10% or more in geriatric populations

Heart Failure 4 – 6 million

Sleep Apnea Risk Factors & Co-morbidities

58% of patients that suffer from diabetes have sleep apnea

35% of Hypertension patients have OSA (80% of all drug resistant hypertensive patients)

50% of Congestive Heart Failure patients have OSA

Obesity is the most important risk factor for OSA

58% of patients that suffer from diabetes have sleep apnea

35% of Hypertension patients have OSA (80% of all drug resistant hypertensive patients)

50% of Congestive Heart Failure patients have OSA

Obesity is the most important risk factor for OSA

Co-morbidities Obesity Male gender Increasing age Family history Alcohol or sedative

use Anatomic

abnormalities of the upper airway

Smoking Endocrine and

metabolic disorders

Risk Factors

Three of the Top Healthcare Expenditures in the Trucking Industry

Hypertension Diabetes Cardiovascular Disease

Prevalence of Sleep Apnea Co-morbidities

Sjostrom et al.Thorax 2002

Logan et al.J. Hypertension 2001

Javaheri et al.Circulation 1999

O’Keefe, Patterson.Obes Sugery 2004

Einhorn et al.Amer Diab 2005

Somers et al.ATS Pres. 2004

80%

50%

45%

35%

77%

50%Diabetes

Morbidly Obese

All Hypertension

Atrial Fibrillation

Congestive HeartFailure

Drug-ResistantHypertension

Safety Effects of OSA

Risk of Motor Vehicle Crashes in OSA (2x –7Xs)

Jackson, Tennessee, July 26, 2000

Tennessee State Trooper KilledDriver of Chevy Blazer Seriously Injured

Driver stated he may have fallen asleep

Involved in similar accident in Utah 3 years prior

Prior diagnoses of obstructive sleep apnea and hypothyroidism

NTSB Findings

Schneider National OSA Screening Program - Education

First ever fleet-wide screening of drivers for sleep apnea

Started by educating leadership (!) and special personnel

– Training engineers – effect first line screen in classroom and cab

– Disease management vendors responsible for chronic disease management

– Physical therapists at operating centers– Loss prevention teams throughout company– Medical review teams at time of hire

Schneider National OSA Screening Program - Education

Monthly newsletters sent to drivers homes (spousal recognition of symptoms crucial)

Text messages are sent to drivers in their trucks regarding setting up sleep study or follow up appointments

Driver handbooks have been updated “Drive-time tapes” are provided to diagnosed drivers to

help educate them about their disorder and proper management.

Schneider National OSA Screening Program - Medical Screening

They screen applicants once they complete driver training for those at risk

Worked with drivers to develop system to keep them out of service for only 12 hours for diagnosis and first treatment.

Makes testing mandatory if the driver screens at high risk

They use data on DOT long form physicals to determine who is at risk also

Pharmaceutical claims data is reviewed for certain meds including sleep aides and Modofinal

Schneider National OSA Screening Program – Medical Screening

They use a screening tool developed with Precision Pulmonary Diagnostics

Uses objective and subjective data that are supported by research to predict OSA BMI, Heavy snoring, hypertension

Objective data is important since drivers may feel pressure to deny symptoms out of fear of being put out of service.

Boasts a predictive value of 85% among a high at-risk group such as commercial drivers.

Schneider National OSA Screening Program – Compliance

Only data base of its size that have all been screened- close to 12,000 Over 1000 diagnosed and treated in 2006---

averaging about 50 a month this year SNI is making testing mandatory if you screen at high risk.

Compliance with CPAP treatment is KEY for safety and Return on Investment

Schneider National Sleep Apnea Screening Program

30% accident reduction in this group $500-$700 per driver per month health care savings 12

months post CPAP as compared to 12 months pre CPAP in this cohort depending on time with SNI 4.

Retention in this group at the time of the study (done 2x) shows twice the retention as in regular fleet. (important in a high turnover industry)

Sleep Apnea and Special Populations – NFL Lineman

2002 study involving more than 300 players from 8 randomly selected teams

Sleep apnea was found in 14% of players overall, 5xs higher than similar aged adults

OSA was found in 34% of linemen

Sleep apnea present in young, physically fit men who are in top condition otherwise

George, C. et al, NEJM, Han 23, 2003

New DOT Guidelines Coming

An industry “Joint Statement” issued in September 2006 recommends that all CMV drivers with typical signs of sleep apnea be tested and treated, including:

– Body Mass Index > 35– Neck size > 17– Hypertension that is uncontrolled– Snoring, excessive daytime fatigue or witnessed apneas– A positive Epworth Sleepiness Scale score >10

The “Joint Statement” is expected to influence an updated DOT guideline in the future

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Get on the Road to Better HealthRecognize the Dangers of Sleep Apnea

A joint program of the Federal Motor Carrier Safety Administration

and the National Sleep Foundation

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about sleep apnea and other sleep disorders including associated dangers, risk factors, symptoms and treatments.

• Encourage drivers and others in the trucking and motorcoach industries to seek medical help if they are experiencing symptoms of sleep apnea or other sleep disorders.

• Ease driver and industry fears around sleep apnea by communicating that treatment will help reduce crash risk and by clarifying guidelines regarding fitness for duty.

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For More Information, Visit

www.fmcsa.gov

www.drowsydriving.org

www.sleepfoundation.org

Summary

28.1% of truck drivers have sleep apnea28.1% of truck drivers have sleep apnea 2-7x increased risk for crash2-7x increased risk for crash OSA is co-morbid with other major and costly chronic

diseases.

Treatment can not only improve safety and driving performance, but other health outcomes.

Treating all US drivers suffering from apnea would Treating all US drivers suffering from apnea would save $11.1B in collision costs and save 980 lives save $11.1B in collision costs and save 980 lives

annually annually ((Sassanai, et al. SLEEP 2004)