+ Site Statistics
+ Search Articles
+ PDF Full Text Service
How our service works
Request PDF Full Text
+ Follow Us
Follow on Facebook
Follow on Twitter
Follow on LinkedIn
+ Subscribe to Site Feeds
Most Shared
PDF Full Text
+ Translate
+ Recently Requested

Nonadherence with Employer-Mandated Sleep Apnea Treatment and Increased Risk of Serious Truck Crashes

Nonadherence with Employer-Mandated Sleep Apnea Treatment and Increased Risk of Serious Truck Crashes

Sleep 39(5): 967-975

To evaluate the effect of an employer-mandated obstructive sleep apnea (OSA) program on the risk of serious preventable truck crashes. Data are from the first large-scale, employer-mandated program to screen, diagnose, and monitor OSA treatment adherence in the US trucking industry. A retrospective analysis of cohorts was constructed: polysomnogram-diagnosed drivers (OSA positive n = 1,613, OSA negative n = 403) were matched to control drivers unlikely to have OSA (n = 2,016) on two factors affecting crash risk, experience-at-hire and length of job tenure; tenure was matched on the date of each diagnosed driver's polysomnogram. Auto-adjusting positive airway pressure (APAP) treatment was provided to all cases (i.e. OSA positive drivers); treatment adherence was objectively monitored. Cases were grouped by treatment adherence: "Full Adherence" (n = 682), "Partial Adherence" (n = 571), or "No Adherence" (n = 360). Preventable Department-of-Transportation-reportable crashes/100,000 miles were compared across study subgroups. Robustness was assessed. After the matching date, "No Adherence" cases had a preventable Department of Transportation-reportable crash rate that was fivefold greater (incidence rate ratio = 4.97, 95% confidence interval: 2.09, 10.63) than that of matched controls (0.070 versus 0.014 per 100,000 miles). The crash rate of "Full Adherence" cases was statistically similar to controls (incidence rate ratio = 1.02, 95% confidence interval: 0.48, 2.04; 0.014 per 100,000 miles). Nontreatment-adherent OSA-positive drivers had a fivefold greater risk of serious preventable crashes, but were discharged or quit rapidly, being retained only one-third as long as other subjects. Thus, the mandated program removed risky nontreatment-adherent drivers and retained adherent drivers at the study firm. Current regulations allow nonadherent OSA cases to drive at another firm by keeping their diagnosis private. A commentary on this article appears in this issue on page 961.

Please choose payment method:

(PDF emailed within 0-6 h: $19.90)

Accession: 058416930

Download citation: RISBibTeXText

PMID: 27070139

DOI: 10.5665/sleep.5734

Related references

Employer-mandated sleep apnea screening and diagnosis in commercial drivers. Journal of Occupational and Environmental Medicine 54(8): 1017-1025, 2012

Risk assessment for CPAP nonadherence in adults with newly diagnosed obstructive sleep apnea: preliminary testing of the Index for Nonadherence to PAP (I-NAP). Sleep and Breathing 18(4): 875-883, 2014

Nonadherence to antihypertensive medications in adults with high risk for obstructive sleep apnea. Journal of Clinical Hypertension 19(5): 540-542, 2017

Medium Increased Risk for Central Sleep Apnea but Not Obstructive Sleep Apnea in Long-Term Opioid Users: A Systematic Review and Meta-Analysis. Journal of Clinical Sleep Medicine 12(4): 617-625, 2016

Untreated Sleep Apnea: An Analysis of Administrative Data to Identify Risk Factors for Early Nonadherence. Journal of Clinical Sleep Medicine 14(8): 1303-1313, 2018

Sleepy driving and risk of obstructive sleep apnea among truck drivers in Saudi Arabia. Traffic Injury Prevention 20(5): 498-503, 2019

High risk for obstructive sleep apnea in truck drivers estimated by the Berlin questionnaire: prevalence and associated factors. Chronobiology International 21(6): 871-879, 2004

Sleep in detoxified alcoholics: impairment of most standard sleep parameters and increased risk for sleep apnea, but not for myoclonias--a controlled study. Journal of Studies on Alcohol 58(1): 30-36, 1997

Self-efficacy in sleep apnea: instrument development and patient perceptions of obstructive sleep apnea risk, treatment benefit, and volition to use continuous positive airway pressure. Sleep 26(6): 727-732, 2003

Estimated cost of crashes in commercial drivers supports screening and treatment of obstructive sleep apnea. Accident; Analysis and Prevention 40(1): 104-115, 2008

Sleep disorders and increased risk of autoimmune diseases in individuals without sleep apnea. Sleep 38(4): 581-586, 2015

Increased risk of obstructive sleep apnea in obese women with polycystic ovary syndrome (a review of two related articles). Articles reviewed: 'Increased prevalence of obstructive sleep apnea syndrome in obese women with polycystic ovary syndrome' and 'Polycystic ovary syndrome is associated with obstructive sleep apnea and daytime sleepiness: role of insulin resistance'. Sleep Medicine 3(3): 287-289, 2002

Sleep quality, obstructive sleep apnea, and psychological distress in truck drivers: a cross-sectional study. Social Psychiatry and Psychiatric Epidemiology 53(5): 531-536, 2018

Sleep disorders and increased risk of subsequent acute coronary syndrome in individuals without sleep apnea: a nationwide population-based cohort study. Sleep 36(12): 1963-1968, 2013

Sleep Apnea, Sleep Debt and Daytime Sleepiness Are Independently Associated with Road Accidents. A Cross-Sectional Study on Truck Drivers. Plos one 11(11): E0166262, 2016