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Sleep. 2016 May 1;39(5):967-75. doi: 10.5665/sleep.5734.

Nonadherence with Employer-Mandated Sleep Apnea Treatment and Increased Risk of Serious Truck Crashes.

Author information

1
Division of Social Science, University of Minnesota, Morris, MN.
2
Center for Transportation Studies, University of Minnesota, Morris, MN.
3
Institute for the Study of Labor (IZA), Bonn, DE.
4
Division of Science and Math, University of Minnesota, Morris, MN.
5
Virginia Tech Transportation Institute, Blacksburg, VA.
6
Precision Pulmonary Diagnostics, Houston, TX.
7
Division of Pulmonary and Critical Care Medicine, School of Medicine, University of California, San Diego, San Diego, CA.
8
Division of Sleep Medicine and Circadian Disorders, Department of Medicine and Neurology, Brigham and Women's Hospital, Boston, MA.
9
Division of Sleep Medicine, Harvard Medical School, Boston, MA.
10
Department of Environmental and Occupational Medicine and Epidemiology, Harvard TH Chan School of Public Health, Boston, MA.
11
Occupational Medicine, Cambridge Health Alliance, Harvard Medical School, Cambridge, MA.

Abstract

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.

KEYWORDS:

APAP; CPAP; OSA; PSG; commercial motor vehicle operator; motor carrier; obstructive sleep apnea; preventable crash; screening; truckload

PMID:
27070139
PMCID:
PMC4835318
DOI:
10.5665/sleep.5734
[Indexed for MEDLINE]
Free PMC Article

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