Transcript Federal Motor Carrier Safety Administration

Commercial Motor Vehicle
Drivers and Sleep Apnea
Presented by
Nancy E. Vaughn, Federal Programs Manager
FMCSA – Delaware Division
April 4, 2014
Federal Motor Carrier Safety Administration
WHO are we?

The Federal Motor Carrier Safety Administration is an agency
under the United States Department of Transportation.
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FAA – Federal Aviation Administration
FRA – Federal Railroad Administration
FHWA – Federal Highway Administration
FTA – Federal Transit Administration
MARAD – Maritime Administration
NHTSA – National Highway Traffic Safety Administration
PHMSA – Pipeline & Hazardous Material Safety Administration
RITA – Research & Innovation Administration
STB – Surface Transportation Board
Federal Motor Carrier Safety Administration
WHAT do we do?
The primary mission of the Federal Motor Carrier
Safety Administration (FMCSA) is to reduce
crashes, injuries and fatalities involving large
trucks and buses.
Federal Motor Carrier Safety Administration
WHAT do we do?

Develop and enforce data-driven regulations that balance motor carrier (truck and
bus companies) safety with industry efficiency
 Federal Motor Carrier Safety Regulations
 Hazardous Material Regulations

Harness safety information systems to focus on higher risk carriers and drivers in
enforcing the safety regulations
 SMS (Safety Measurement System)

Targets educational messages to carriers, commercial drivers and the public.

Partner with stakeholders including Federal, State and local enforcement
agencies, the motor carrier industry, safety groups, and organized labor on efforts
to reduce bus and truck related crashes
Federal Motor Carrier Safety Administration
WHEN were we established?
The FMCSA was established as a separate administration within the
U.S. Department of Transportation (DOT) on January 1, 2000,
pursuant to the Motor Carrier Safety Improvement Act of 1999.
Federal Motor Carrier Safety Administration
WHERE are we located?
FMCSA is headquartered in Washington, DC and employs more than 1,000
people in all 50 States and District of Columbia all dedicated to improving
the safety of commercial motor vehicles (CMV) and saving lives.
US Territories: American Samoa, Guam, Northern Mariana Island, Puerto
Rico and the US Virgin Islands

The FMCSRs do not apply directly to these territories because those
jurisdictions do not fall within the definition of a "State“ However, they are
defined as "States" for purposes of the Motor Carrier Safety Assistance
Program (MCSAP).

Therefore, as a condition of accepting MCSAP funds, these territories
must adopt "compatible" our safety regulations. "Compatible" means that
"State laws and regulations applicable to interstate commerce and to
intrastate movement of hazardous materials are identical to the FMCSRs
and the HMRs or have the same effect as the FMCSRs."
Federal Motor Carrier Safety Administration
HOW do we regulate commercial motor vehicle drivers
and vehicles?


Safety specialists conduct:

New Entrant Safety Audits

Carrier and Driver Investigations

Enforcement Cases

Roadside Inspections
Make additional funding available to the states for safety initiatives:

MCSAP (Motor Carrier Safety Assistance Program) – A Federal grant program that
provides States with financial assistance to hire staff and implement strategies to enforce
our federal regulations.

PRISM (Performance & Registration Information Systems Management) – Federal-State
partnership which links Federal motor carrier safety records with the State’s vehicle
registration system. PRISM plays a key role in our effort to remove high-risk carriers from
our highways.
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Federal Motor Carrier Safety Administration
HOW do we regulate commercial motor vehicle drivers
and vehicles?

Increase outreach to industry and the general public.

Seek additional legislative authority to enhance enforcement efforts.

Moving Ahead for Progress in the 21st Century Act (MAP-21) - Congress directed
FMCSA to begin 29 rulemakings, 34 programmatic changes and 15 reports during the
two-year span of this bill signed into law on July 6, 2012 and effective October 1, 2012.
– Required a new rulemaking on electronic logging devices
– Set a deadline for establishing a new drug and alcohol clearinghouse for truck
drivers
– Increased penalties for operating without registration. Passenger carriers can now
been fined $25,000 for operating without the proper operating authority registration.
– Establishment of National Registry of Medical Examiner.
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Federal Motor Carrier Safety Administration
WHY is our agency important?
“Often called the greatest public works project in history, the Interstate
System changed the face of America, giving our country a
freedom of mobility unrivaled anywhere in the world. . . . . . . . . . In
many respects, however, our transportation system has
become the victim of its own success. Our growing economy
and standard of living have created a demand for travel and
movement of goods that is increasingly difficult to meet.
Congestion and delays have become a fact of life on our
highways and in our airports and seaports.”
-J. Richard Capka, FHWA Administrator (June 7, 2006)
The Commercial Driver
Commercial drivers are operators of commercial motor
vehicles. A commercial motor vehicle is defined by our
agency as:
 A vehicle used in interstate commerce with a gross vehicle
weight rating of 10,001 lbs or more.
 A vehicle used to transport 9 or more passengers.
 A vehicle used to transport hazardous materials.
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A CMV can be a . . . . . .

School bus

Large Truck (18 wheelers)

Cargo tank truck

Tow truck

Pick-up truck and a trailer (Landscaper)

Dump truck

Hotel/Airport shuttle van

Truck which carries cars

Motorcoach/Bus

Limo

Utility truck

Crane trucks

Propane Delivery Truck

Moving Trucks (Household Goods)
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A Study of Prevalence of Sleep Apnea Among
Commercial Truck Drivers
 A research study on sleep apnea sponsored by the
FMCSA and ATA (American Trucking Associations).
 Addressed the prevalence of sleep apnea among
commercial truck drivers, potential risk factors and its
impact on driving performance.
A Study of Prevalence of Sleep Apnea Among
Commercial Truck Drivers
 The study had three objectives:
 Estimate the prevalence of sleep apnea among a sample of
commercial truck drivers living in Pennsylvania within 50 miles
of the University of Pennsylvania.
 Examine the relationship in commercial truck drivers between
severity of sleep apnea and decreased function related to
driving performance
 Develop a profile of an overall sample of commercial truck
drivers with regard to their sleep apnea-related characteristics
and risks.
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A Study of Prevalence of Sleep Apnea Among
Commercial Truck Drivers
How were the participants of the study selected:
 The Pennsylvania Department of Motor Vehicles
provided a random sample of CDL holders (drivers of
vehicles with a GVWR of 26,001 lbs. or more)
 4,826 drivers which lived within 50 miles of the University of
Pennsylvania.
 Approximately 1,391 participants responded
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A Study of Prevalence of Sleep Apnea Among
Commercial Truck Drivers
 Participants were put into 2 categories based on MAP
(Multivariable Apnea Predication) score:
 Higher risk for likelihood of sleep apnea
 Lower risk for likelihood of sleep apnea
 MAP score was calculated based on:
 Age
 Gender
 Body mass index
 Responses to survey question about symptoms of sleep
apnea
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A Study of Prevalence of Sleep Apnea Among
Commercial Truck Drivers
 High risk group:
 Low risk group:
 778 drivers
 551
 All were enrolled in
in-laboratory testing
 Enrolled in random
order for
in-laboratory testing
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A Study of Prevalence of Sleep Apnea Among
Commercial Truck Drivers
Subjective Measures of
Sleepiness
Objective Measures of
Sleepiness

Epworth Sleepiness Scale

Multiple Sleep Latency

Karolinska Sleepiness Scale

Psychomotor Vigilance Test

Stanford Sleepiness Scale

Divided Attention Driving Task

Functional Outcomes of Sleep
Questionnaire

Digit Symbol Substitution Test
Self-report questionnaires which
measured drivers’ self-perception
of sleepiness and functional
impairment.
Assessment of reaction times,
performance lapses and lane
tracking ability.
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A Study of Prevalence of Sleep Apnea Among
Commercial Truck Drivers
FINDINGS
 28% of CDL holders have sleep apnea
 17.6% of CDL holders had mild sleep apnea
 5.8% of CDL holders had moderate sleep apnea
 4.7% of CDL holders had severe sleep apnea
 Prevalence of sleep apnea depends on the
relationship between 2 major factors:
 Age
 Degree of obesity
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A Study of Prevalence of Sleep Apnea Among
Commercial Truck Drivers
FINDINGS (.cont)
 Prevalence of sleep apnea depends on the average
duration of sleep over consecutive nights at home
 Short sleep duration (6 hours or less) results in an increased
prevalence of sleep apnea
 Daytime performance depends not only on the severity of
sleep apnea but also the average sleep duration of the driver.
 Sleep duration is affected by the time the drivers wake up in
the morning
– 35% of commercial truck drivers wake up before 6 am and
have shorter sleep durations and therefore higher chances
of daytime sleepiness
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A Study of Prevalence of Sleep Apnea Among
Commercial Truck Drivers
FINDINGS (.cont)
 Subjective vs. Objective Measures of Sleepiness
 While a large number of drivers indicated self-reported
sleepiness on subjective test it was not a determining factor of
the presence of severity of sleep apnea.
 No relationship was found between self report measures and
the performance ability test.
 However all objective tests of performance showed a clear
relations between performance ability and the severity of
sleep apnea.
 There was a strong relationship between the measurement of
sleepiness and rate of performance lapses and lane tracking
ability.
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Sleep Apnea Crash Risk Study
 Another study was completed using the UPenn’s sleep
apnea database to assess the risks of commercial
motor vehicle (CMV) crashes due to the presence of
sleep apnea among truck drivers.
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Sleep Apnea Crash Risk Study
 The primary objectives of the study were to:
 Obtain additional and more meaningful crash data by linking
UPenn’s sleep apnea database to the FMCSA Motor Carrier
Management Information crash database (MCMIS)
 Understand the impact of sleep apnea and driver impairment
on crash involvement, the number of crashes, and the severity
of crashes.
 Gain insight into how crash rates are impacted before and
after drivers are diagnosed with sleep apnea
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Sleep Apnea Crash Risk Study

This study involved the 406 drivers that were selected from the
original 1,391 responses that were returned from the sample of
CDL drivers within a 50 mile radius of UPenn.

The 406 drivers participated in an overnight laboratory study.

The crash history for these drivers was obtained from the Motor
Carrier Safety Management Information System (MCMIS) for
seven years prior to diagnosis in the UPenn sleep study (19891996)

This allowed researchers to link the crash data to the patient data
for each of the 406 drivers who underwent in-laboratory testing
during the UPenn sleep apnea study.
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Sleep Apnea Crash Risk Study
 A crash is defined by FMCSA as an occurrence
involving a motor carrier in which one or more the
following occurs:
 A fatality
 Bodily injury to a person who, as a result of the injury
immediately received medical treatment away from the scene
of the accident
 Towed due to disabling damage as a result of the accident
requiring the motor vehicle to be transported away from the
scene by a tow truck or other motor vehicle.
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Sleep Apnea Crash Risk Study
FINDINGS

Older drivers were at higher risk for sleep apnea

The mean age of drivers with some degree of sleep apnea was 48.7
vs. 45.5 for those who were not diagnosed with sleep apnea.

There was a significant relationship between severe sleep apnea
and severe motor vehicle crashes.

There was no compelling statistical evidence was found that
showed sleep apnea increases crash risk among commercial
driver.

No evidence from the data used to suggest the crash risk is
impacted before and after drivers were diagnosed with sleep
apnea.
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Sleep Apnea Crash Risk Study
 The results of the study contradicted several previous
studies which found there was a strong relationship
between sleep apnea and motor vehicle crashes:

Limitations of data

Self reported information may have been untruthful or misinterpreted

Incomplete crash and driving records

Majority of subject were short-haul drivers who operated local routes,
driving in urban areas, requiring a higher level of alertness than longhaul drivers who drive on highway under more monotonous driving
conditions and are more susceptible to fatigue and daytime
sleepiness.
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Commercial Drivers and Sleep Apnea
 We know for sure about commercial drivers and sleep
apnea:
 Commercial drivers are at increased risk of having sleep
apnea
 Untreated sleep apnea causes excessive daytime sleepiness
which:
– Impairs judgment
– Causes attention deficits
– Slows reaction times
– Decreases alertness
– Increases driver’s risk for being involved in a fatiguerelated motor vehicle crash
 Highly treatable disorder
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Commercial Drivers and Sleep Apnea
 RISK FACTORS FOR SLEEP APNEA:

Family history of sleep apnea

Having a small upper airway

Being overweight

Having a recessed chin, small jaw, or large overbite

A large neck size
– 17 inches or more for men
– 16 inches or more for women

Smoking and alcohol use

Being age 40 or older

Ethnicity

Heart Disease

High blood pressure

BMI (Body mass index)
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Diagnosing Sleep Apnea in Commercial Drivers

Most drivers first hear the words “Sleep Apnea” during a medical
examination to physically qualify them to drive commercial motor
vehicles.

A commercial driver is required to undergo this examination at
least once every 24 months. Depending on the evaluation of the
medical examiner the examination may be required more
frequently.

Medical examinations to determine commercial driver fitness are
required for anyone who drives a CMV in interstate commerce

A vehicle used in interstate commerce with a gross vehicle weight
rating of 10,001 lbs or more.

A vehicle used to transport 9 or more passengers.

A vehicle used to transport hazardous materials.
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Diagnosing Sleep Apnea in Commercial Drivers

For those drivers who only operate in intrastate commerce:

Each state sets it own medical standards for driving a commercial
motor vehicle

Many states have adopted the medical regulations found under Part
391 of the FMCSRs and have determined that sleep apnea is a
disqualifying condition

Delaware has only adopted the FMCSRs for CDL vehicles and
drivers (drivers of vehicles with a GVWR of 26,001 lbs. or more)
– Intrastate drivers of non-CDL vehicles (GVWR of 10,001bs to
26,000 lbs)
– Intrastate drivers of CDL vehicle (GVWR of 26,001 lbs. or more)

Maryland has fully adopted the FMCSRs for intrastate drivers. All
commercial drivers operating only in the state of Maryland must be
medically certified.
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Diagnosing Sleep Apnea in Commercial Drivers

According to the FMCSRs if a driver is diagnosed with sleep
apnea it is not a disqualifying condition.

A medical examiner MUST disqualify a driver who:

Fails to meet a physical qualification requirement cited in the
standards
– Vision test result
– Hearing loss test result
– Epilepsy
– Insulin use

Believes the driver has a medical condition that endangers the health
and safety of the driver and the public.
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Diagnosing Sleep Apnea in Commercial Drivers

The medical advisory criteria for medical examiners states under
Respiratory Dysfunction:

There are many conditions that interfere with oxygen exchange and may
result in incapacitation, including emphysema, chronic asthma, carcinoma,
tuberculosis, chronic bronchitis and sleep apnea. If the medical examiner
detects a respiratory dysfunction, that in anyway is likely to interfere with the
driver’s ability to safety control and drive a commercial motor vehicle, the
driver MUST be referred to a specialist for further evaluation and
therapy.

The medical advisory criteria directs the medical examiner to the Expert
Panel Recommendations available to the medical examiner that can be found
on our website.
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Diagnosing Sleep Apnea in Commercial Drivers

Expert Panel Recommendations for Obstructive Sleep Apnea and
Commercial Vehicle Driver Safety (January 14, 2008) states”:

“A diagnosis of obstructive sleep apnea precludes an individual from
obtaining unconditional certification to drive a CMV for the purposes of
interstate commerce.

A diagnosis of obstructive sleep apnea, however, should not exclude all
individuals with the disorder from driving a CMV; certification may be possible
in some instances. An individual with a diagnosis of obstructive sleep apnea
may be certified to drive a CMV if that individual meets the following criteria
– Has untreated obstructive sleep apnea with an AHI ≤ 20 AND
– Has no daytime sleepiness, OR
– Has obstructive sleep apnea that is being effectively treated.

An individual with OSA who meets the requirements for certification described
above should be recertified on an annual basis, based on demonstrating
satisfactory compliance with therapy.”
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Diagnosing Sleep Apnea in Commercial Drivers

CAN A DRIVER STILL DRIVE IF THEY HAVE SLEEP APNEA?

YES. While FMCSA regulations do not specifically address sleep
apnea however they do prescribe that a person with a medical
history or clinical diagnosis of any condition likely to interfere
with their ability to driver safety cannot be medically qualified to
operate a commercial motor vehicle in interstate commerce.
However once successfully treated a driver may regain their
“medically-qualified-to drive” status. It is important to note that most
cases of sleep apnea can be treated successfully.

The disqualifying level of sleep apnea is moderate to severe,
which interferes with safe driving. The medical examiner must
qualify and determine a driver’s medical fitness for duty.

This is why it is important to have medical examiners who are
properly qualified to make the determination for commercial driver
fitness.
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Medical Examiners & the National Registry of Certified
Medical Examiners
 The medical examiner as defined by the FMCSRs:
 For medical examinations, conducted BEFORE May 21,
2014, a person who is licensed certified, and/or registered, in
accordance with applicable state laws and regulations, to
perform physical examinations. The term includes but is not
limited to , doctors of medicine, doctors of osteopathy,
physicians assistants, advanced practice nurses, and doctors
of chiropractic.
 For medical examinations conducted ON and AFTER May
21, 2014, an individual certified by FMCSA and listed on the
National Registry of Certified Medical Examiners in
accordance with Subpart D of this Part
– Subpart D – National Registry of Certified Medical Examiners
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Medical Examiners & the National Registry of Certified
Medical Examiners

In order to make sure that commercial drivers are properly medically
examined and certified by qualified medical examiners the FMCSA has
created the National Registry of Certified Medical Examiners:

The National Registry of Certified Medical Examiners lists medical examiners (MEs) who
have been trained, tested and certified to perform medical examinations for commercial
motor vehicle (CMV) drivers in interstate commerce. These MEs fully understand the
medical standards in the FMCSA Regulations, related guidance and how they relate to
the medical demands of operating a commercial motor vehicle.

The goal of the National Registry is to promote and preserve the highest level of
professional standards, training and care among medical examiners. Therefore, the
National Registry requires that medical examiners performing CMV driver examinations
be trained and certified.

All healthcare professionals are eligible to apply to become a certified medical examiner
if their scope of practice authorizes them to perform physical examinations, as defined by
the State in which they practice.
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Medical Examiners & the National Registry of Certified
Medical Examiners


The objectives of the National Registry are to:

Ensure that medical examiners understand fully the medical standards in the Federal
Motor Carrier Safety Regulations (FMCSRs) and related guidance and how they apply to
CMV drivers

Maintain ongoing competency of medical examiners through training, testing, certification
and recertification

Promote public confidence in the quality of the medical examinations of CMV drivers

Ensure that the list of certified medical examiners is easily accessible
FMCSA is and will continue to be involved in all facets of the National
Registry program development and implementation and maintain an
oversight role. Implementation of the National Registry program
demonstrates the commitment of the Department of Transportation and
Federal Motor Carrier Safety Administration to making our Nation’s
highways safer.
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Medical Examiners & the National Registry of Certified
Medical Examiners

390.101 - 390.115 Subpart D - National registry of certified medical
examiners

390.101 Scope.

390.103 Eligibility requirements for medical examiner certification.

390.105 Medical examiner training programs.

390.107 Medical examiner certification testing.

390.109 Issuance of the FMCSA medical examiner certification credential.

390.111 Requirements for continued listing on the National Registry of Certified Medical Examiners.

390.113 Reasons for removal from the National Registry of Certified Medical Examiners.

390.115 Procedure for removal from the National Registry of Certified Medical Examiners.
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Medical Examiners & the National Registry of Certified
Medical Examiners

Subpart D - National registry of certified medical examiners
§ 390.103 - Eligibility requirements for medical examiner certification.
(a) To receive medical examiner certification from FMCSA a person must:
(1) Be licensed, certified, or registered in accordance with applicable State laws and
regulations to perform physical examinations. The applicant must be an advanced
practice nurse, doctor of chiropractic, doctor of medicine, doctor of osteopathy, physician
assistant, or other medical professional authorized by applicable State laws and
regulations to perform physical examinations.
(2) Complete a training program that meets the requirements of §390.105.
(3) Pass the medical examiner certification test provided by FMCSA and administered by
a testing organization that meets the requirements of §390.107 and that has
electronically forwarded to FMCSA the applicant's completed test and application
information no more than three years after completion of the training program required by
paragraph (a)(2) of this section. An applicant must not take the test more than once
every 30 days.
(b) If a person has medical examiner certification from FMCSA, then to renew such
certification the medical examiner must remain qualified under paragraph (a)(1) of this section
and complete additional testing and training as required by §390.111(a)(5).
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What Are The Obligations of A Motor Carrier Concerning
A Driver with a Diagnosis of Sleep Apnea

The motor carrier may not required or permit a driver to operate a
CMV if the driver has a condition, including sleep apnea, that
would affect his or her ability to safely operate a commercial
motor vehicle.

It is important to note:
 A motor carrier is not required to pay for a driver’s medical
examination.
 A motor carrier is not required to pay for a driver’s sleep
apnea treatment.
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Questions & Answers
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IF I HAVE QUESTIONS WHO DO I
CONTACT?
CONTACT INFORMATION:
Nancy E. Vaughn, Federal Programs Manager
Federal Motor Carrier Safety Administration
1203 College Park Drive
Suite 102
Dover, DE 19904
[email protected]
(302)734-3973
Visit our website: www.fmcsa.dot.gov