In this edition of SLEEP, Zhang and colleagues review the use of portable sleep monitors to address obstructive sleep apnea (OSA) in commercial drivers. Their work is timely and germane. In 2010, the Federal Motor Carrier Safety Administration (FMCSA) reported that the United States has 14 million holders of commercial driver's licenses (CDL), with 7 million employed as active interstate drivers. These drivers experience 341,000 crashes/year, which cause approximately 4,000 deaths per year. Fatigue is the largest cause (31%) of fatal-to-driver accidents. Afflicting between 28% and 80% of commercial truck drivers, OSA causes daytime sleepiness and increases fall-asleep-crash risk. This high prevalence of OSA in truck drivers is unsurprising, as they tend to be middle-aged, male, and obese, which are three major risk factors for OSA. Daytime sleepiness in this group is exacerbated by insufficient sleep, with 35% reporting that they sleep for an average of < 6 h per night. Where do we go from here? OSA is common, identifiable, and treatable. Untreated, it leads to expensive, injurious, and fatal crashes. It is time for the rubber to meet the road. A pressing need exists for the transportation industry to advance a culture of health and safety, so that drivers are able to lift the veil of secrecy and seek testing and treatment for OSA without fear of job loss. Indeed, employers may realize that screening programs lead to large return on investment due to reduction in health care costs and disability claims. The FMCSA must move forward with rulemaking in this area, as other countries have done. And finally, sleep medicine must address the unmet educational, clinical, and research needs in this area: to train medical examiners so that standards of evaluation for fitness are uniform and appropriate; to partner with the diagnostics industry to develop tamperproof chain-of-custody solutions; to streamline clinical pathways so that testing and treatment are accessible and affordable; to develop evidence-based, accurate, and cost-effective screening algorithms; and to research the economic and health outcomes of screening and management programs. The time has come for all of us to act, so that no additional lives are lost to this common and treatable disorder.
Gurubhagavatula, MD, MPH, Assistant Professor of Medicine, Division of Sleep Medicine, Perelman School of Medicine, University of Pennsylvania Medical Center, 3624 Market Street, Suite 205, Philadelphia, PA 19104