Friday, May 14, 2010

Are professional truck drivers being denied adequate medical treatment for sleep apnea by the very regulatory agencies charged with their protection?

In an online news release today on the Occupational Health & Safety web site (ohsonline.com), there was an article that stated:

For commercial motor vehicle drivers with obstructive sleep apnea (OSA), effective treatment lowers health care costs and disability rates, reports a study in the May Journal of Occupational and Environmental Medicine, the official publication of the American College of Occupational and Environmental Medicine (ACOEM)....

On average, treatment for OSA led to “over $6,000 in total health plan and disability cost savings per treated driver,” the researchers noted. Total costs decreased by 41 percent in drivers treated for OSA (compared to an eight percent decrease in untreated drivers)....

Sleep apnea is an important preventable cause of motor vehicle accidents, and studies have found that treatment for OSA can lower the accident rate. Screening and treatment for OSA has recently been recommended for commercial motor vehicle drivers.

For truckers with sleep apnea, CPAP is the preferred and approved treatment of choice for sleep apnea. But despite the fact that many people cannot tolerate CPAP and despite the fact that CPAP is not always available in trucks or other places where truckers can sleep, oral appliance therapy is NOT an approved method of treatment because of the inability to document compliance with therapy.

This issue arose at the recent Sleep Apnea Truckers Conference held in Baltimore on May 11 - 12.

The problems with CPAP use for a trucker range from inability to tolerate the mask and unit, power supply problems, altitude problems, humidification and heat problems, water sloshing in the humidification chamber while partner is driving,anti-idling laws and problems with cleaning the unit. None of these problems apply to oral appliances and yet their use is not approved.

Patients are considered to be complying with CPAP usage if they wear their CPAP unit for a total of only 4 hours out of every 24 hour period. Is this sufficient for effective treatment? Does 4 hours of use reduce excessive daytime sleepiness to an acceptable level? Yet oral appliances are not approved since their compliance cannot be measured even though research has shown that oral appliances are often better tolerated and worn longer than CPAP.

So if a trucker cannot tolerate CPAP or if it is impossible to utilize the CPAP properly for the above reasons that truck driver cannot be offered an oral appliance simply because compliance cannot be measured.

The other reason for not using oral appliances is, as one speaker at the SATC meeting put it, the fact that oral appliances are not effective in severe sleep apnea.

Following this logic, for example, a driver with an AHI of 60 that cannot use CPAP for one reason or the other is best left uncertified, medically ill and unable to earn a living despite the fact that an oral appliance might only reduce his/her AHI to 20 and because appliance use cannot be quantified. Even if a patient who uses an oral appliance can be documented to show improvement by sleep study, this is not considered adequate evidence of compliance.

Oral appliances have been proven to be an effective treatment for obstructive sleep apnea and have been approved for use in mild to moderate sleep apnea. There is research to show that they are useful in some cases of severe sleep apnea as well.

To simply dismiss their use on the basis that compliance cannot be measured or that they are not as effective in severe sleep apnea as CPAP is dismissing a therapy can can save lives.

Your comments would be appreciated.

Dr. Barsh

1 Comments:

Blogger Jack Hadin said...

Nice post....thanks for sharing....

CPAP

August 12, 2012 at 2:46 AM  

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