SLEEP APNEA DOT PHYSICAL FAQs: Sleep apnea and sleep studies continue to be hot button topics with regard to DOT Physicals and in the trucking industry.  A well-known urgent care and occupation health chain recently adopted a policy that ALL drivers with a BMI 35 and above shall be referred for a sleep study and given a three month medical certificate/DOT card.  Drivers then have up to three months to get a sleep study, referred to as a polysomnography or polysomnography (the result of the test is a polysomnogram).  Policies such as this leave the physician no discretion and are arguably over-cautious and too conservative. 

If this has happened to you, you are probably wondering, “If DOT Medical Examiner tells me I need a sleep study, am I entitled to a second opinion?”

DOT Sleep Apnea FAQs Sleep Apnea DOT Physical FAQs:

 – What is Obstructive Sleep Apnea (OSA)?
– What are the Symptoms of OSA?
FMCSA, Sleep Apnea and DOT Physical.
FMCSA guidance to Medical Examiners.
Federal regulations that cover this?
Consequences of Untreated Sleep Apnea.

What is Sleep Apnea?  Simply put, sleep apnea is a condition where the body is deprived of oxygen, or oxygen to the body is reduced during sleep due to the slowing or cessation of breathing.  This often results in daytime sleepiness.

Symptoms of Sleep Apnea:  Those with sleep apnea may also note:

  • Waking up not feeling refreshed;
  • Abnormal daytime sleepiness, including falling asleep at inappropriate times;Erectile dysfunction;
  • Weight gain (Sleep decreases/inhibits cortisol production; cortisol produces belly fat);
  • Decreased cognition including memory loss, short attention span, and poor judgment;
  • Personality changes including depression, irritability.
  • Loud snoring, Periods of not breathing (apnea)

FMCSA, Sleep Apnea and DOT Physical.  The FMCSA holds that drivers must be alert at all times, and that any change in his/her mental state is in direct conflict with highway safety.  Even the slightest impairment in respiratory function under emergency conditions (when greater oxygen is necessary) may be detrimental to safe driving.

Conditions that interfere with oxygen exchange may result in incapacitation.  One of those conditions is sleep apnea.  If a Medical Examiner (ME) detects a respiratory dysfunction that is likely to interfere with the driver’s ability to safely control and drive a commercial motor vehicle (such as sleep apnea, emphysema, chronic asthma, etc.), the driver must be referred to a specialist for further evaluation and therapy.  The devil is in the details…here they are…

FMCSA guidance to Medical Examiners.  The primary safety goal regarding OSA is to identify drivers with moderate-to-severe OSA to ensure these drivers are managing their condition to reduce to the greatest extent practical the risk of drowsy driving.

Even if a driver has sleep apnea, they are not to be considered unfit; rather only that the ME makes a determination whether the driver needs to be evaluated, and if necessary, demonstrate they are managing their OSA to reduce the risk of drowsy driving.

Untreated obstructive sleep apnea is a disqualifying condition.  However, there are multiple ways of managing sleep apnea.  They include anything from weight loss to a constant positive airway pressure (CPAP) machine to surgery.  The Gold Standard for treatment is a CPAP as that is what most of the studies have been on.  An investigative journalist (if there are any of those left) may want to follow the paper trail on those studies…just for gee whiz!

Federal regulations that cover sleep apnea.  Whether or not you have been diagnosed with sleep apnea, 49 CFR § 392.3 will still apply:  Ill or fatigued operator.  No driver shall operate a commercial motor vehicle, and a motor carrier shall not require or permit a driver to operate a commercial motor vehicle, while the driver’s ability or alertness is so impaired, or so likely to become impaired, through fatigue, illness, or any other cause, as to make it unsafe for him/her to begin or continue to operate the commercial motor vehicle.  However, in a case of grave emergency where the hazard to occupants of the commercial motor vehicle or other users of the highway would be increased by compliance with this section, the driver may continue to operate the commercial motor vehicle to the nearest place at which that hazard is removed.

Health Consequences of Obstructive Sleep Apnea – Why you should be concerned.

About 35 BMI:  Although obesity is often associated with obstructive sleep apnea syndrome, some patients with this disorder are not overweight; morbid obesity is present only in a minority of patients.  In the absence of obesity, craniofacial abnormalities, such as micrognathia or retrognathia, are likely to be present.

Spontaneous resolution has been reported in association with reduction of body weight, but the course usually is progressive and can ultimately lead to premature death.  Profound functional impairment and life-threatening complications can occur.  No information is available on the prognosis of obstructive sleep apnea syndrome of mild severity.  OSA was accepted as a clinical diagnosis in the International Classification of Diseases 9 in 2006; however, potential health consequences has been largely ignored.  Left untreated OSA increases the risk of the following disorders:

  • Excessive daytime sleepiness (EDS)
  • Hypertension
  • Angina
  • Right-sided heart failure (cor pulmonale)
  • Myocardial infarction
  • Arrhythmias, including severe bradycardias
  • Dilated cardiomyopathy
  • Excessive carbon dioxide levels (hypercapnia)
  • Diabetes
  • Stroke
  • Sudden death

Cardiovascular and Psychiatric Morbidity in Obstructive Sleep Apnea (OSA) with Insomnia (Sleep Apnea Plus) versus Obstructive Sleep Apnea without Insomnia: A Case-Control Study from a Nationally Representative US Sample
Madhulika A. Gupta, Katie Knapp
PLoS One. 2014; 9(3): e90021. Published online 2014 March 5. doi: 10.1371/journal.pone.0090021