Obstructive sleep apnea

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beachdoc

Obstructive sleep apnea

Post by beachdoc » Mon May 05, 2014 10:26 am

Has there been any further developments in the area of OSA screening. Last posting appear to be in October.



Robert Swotinsky MD
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Re: Obstructive sleep apnea

Post by Robert Swotinsky MD » Fri May 09, 2014 12:06 pm

The most recent significant development is that Congress directed FMCSA that it needs to go through the regulatory process rather than issuing guidance with regard to medical qualification and obstructive sleep apnea. FMCSA can and does issue (and sometimes change or remove) guidance on an ongoing basis without going through the regulatory process (Notice of Proposed Rulemaking, public comment, fiscal analysis by GAO, input by other agencies, Final Rule, etc.). FMCSA was likely going to issue guidance on obstructive sleep apnea. Medical Examiners for the most part do not distinguish between guidance and rules - we follow them both. But, with the action by Congress late last year, FMCSA is relegated to the rulemaking process if it wants to address medical qualification and obstructive sleep apnea. The rulemaking process is much more cumbersome and demanding of evidence. It will likely be years, if at all, before FMCSA issues a final rule on this topic.

So, until then ....?

The most important advice I can offer is to do something about any driver who is morbidly obese, or who indicates history suggestive of OSA. As to what to do, there are diverse approaches being used, some more rigorous and complex than others. Evidence is lacking that one approach is more effective in this setting than other approaches. But, it would seem reckless to not address the issue at all, so do something.

I also point out that the FMCSA Medical Examiner Handbook cites an AHI of 30 or above as evidence of uncontrolled OSA. Keep that in mind, because for clinical purposes OSA is defined at AHI of 5 or above.

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