Title: Truckers Drive Their Own Assessment for Obstructive Sleep Apnea: A Collaborative Approach to Online Self-Assessment for Obstructive Sleep Apnea
1Truckers Drive Their Own Assessment for
Obstructive Sleep Apnea A CollaborativeApproach
to Online Self-Assessment for Obstructive Sleep
Apnea
- Ben Smith, MS, North Carolina State University
- Gary Hull, TFAC/AWAKE
- Bob Stanton, TFAC/AWAKE
- Barbara Phillips, MD, MSPH, FCCP, University of
Kentucky
2Disclosures
- Benjamin Smith
- IBM PhD Fellowship
- NSF Career Grant No. 0346903
- Gary Hull-None
- Bob Stanton-None
- Barbara Phillips
- Department of Transportation, FMCSA
- Cephalon
- PriMed (funded by ResMed, Philips)
- Barnwell, Whaley, LLC
3Obstructive Sleep Apnea (OSA) and Commercial
Motor Vehicle Drivers (CMVDs)
- Approximately 5,600 people are killed every year
in crashes with commercial motor vehicles. - Between 20 and 30 of crashes with CMVDs are
sleep-related (Akerstedt T J Sleep Res 2000) - At least 25 of CMVDs have OSA (Pack A AJRCCM
2006)
4Commercial Drivers Carry Increased Risk for Crash
- They may
- operate larger vehicles
- transport hazardous materials
- carry multiple passengers
- operate for longer stretches of time
- have an economic incentive to continue driving
when private drivers may choose to stop for a
medical reason or road conditions.
5The Federal Motor Carrier Safety Administration
(FMCSA) Regulates CMVDs
6Background/Rationale
- Based on an evidence review
- The FMCSA Medical Expert Panel recommended that
CMVDs undergo testing for OSA if - they have a positive Berlin Questionnaire and/or
- BMI gt 33 kg/m2.
- The FMCSA Medical Review Board recommended that
CMVDs undergo testing for OSA if - they have a positive Berlin Questionnaire and/or
- BMI gt 30 kg/m2.
7Development of Collaboration
- Truckers for a Cause- Alert, Well, And Keeping Ene
rgetic (TFAC-AWAKE), responding to requests from
participants, desired to host a screener for OSA
on its website. - TFAC-AWAKE leader sought help with website
screener development. - Collaborators agreed to publish the anonymous
results. - The study was exempted by UK IRB.
8Methods
- We adapted the Berlin Questionnaire (Netzer NC
Ann Intern Med 1999) to be taken online. - TFAC-AWAKE hosted the survey on their website.
- TFACs XM radio, word of mouth and trucking
industry press contacts offered promotion. - We collected IP addresses to ensure that each
participant only took the survey once, but we
collected no other identifying data.
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10Not all word of mouth was good
11The Berlin Questionnaire (Netzer NC Annals 1999)
- Do you snore?
- How loud do you snore?
- How often do you snore?
- Has your snoring ever bothered other people?
- Has anyone noticed that you quit breathing during
your sleep? - How often do you feel tired or fatigued after
your sleep? - During your waking time, do you feel fatigued, or
not up to par? - Have you ever nodded off or fallen asleep while
driving a vehicle? - Do you have high blood pressure?
- What is your BMI?
12The Berlin Questionnaire (Netzer NC Annals 1999)
- Do you snore?
- How loud do you snore?
- How often do you snore?
- Has your snoring ever bothered other people?
- Has anyone noticed that you quit breathing during
your sleep? - How often do you feel tired or fatigued after
your sleep? - During your waking time, do you feel fatigued, or
not up to par? - Have you ever nodded off or fallen asleep while
driving a vehicle? - Do you have high blood pressure?
- What is your BMI?
13Aims and Hypotheses
- Aims
- to determine if truckers would assess their OSA
risk online. - to collect demographic data from self-selected
truckers. - Hypotheses
- those with OSA symptoms (snoring, sleepiness)
would be more likely to report drowsy driving,
but - objective data (BMI, hypertension history) would
predict sleepy driving better than would
subjective data. -
14Data analysis
- The website was active to collect data from
January 11, 2010 until September 24, 2010. - We performed Logistic Regression Analyses using
the R statistical package.
15Results
- 595 of CMVDs took the survey
- 55.9 positive on overall Berlin
- 78.3 positive on objective (BMI, bp) part
- 69.6 had a BMI gt 30 Kg/m 2
- 47.6 had BMI gt 33 Kg/m 2
- 20.5 reported falling asleep while driving (on
Berlin)
16Sleepy Driving Associated with
Question Significance (Logit. Regression p -value)
Overall Berlin Score 0.00
Do you snore? lt 0.01
How loud is your snoring? lt 0.0001
Does your snoring bother other people? lt 0.01
How often do you snore? lt 0.0001
How often has someone noticed that you quit breathing during your sleep? lt 0.0001
How often do you feel tired or fatigued after your sleep? 0.00
During your wake time, how often do you feel fatigued, or not up to par? 0.00
What kind of commercial vehicle do you drive? lt 0.05 (Commercial Vehicles the highest)
17Witnessed Apneas Associated with
Question Significance (Logit. Regression p-value)
Overall Berlin Score 0.00
Do you snore? Yes (p0.00), Maybe (p0.09)
How loud is your snoring? 0.00
Does your snoring bother other people? lt 0.01
How often do you snore? 0.00
How often has someone noticed that you quit breathing during your sleep? 0.00
During your wake time, how often do you feel fatigued, or not up to par? 0.00
What kind of commercial vehicle do you drive? lt 0.05 (Commercial Vehicles the lowest)
18Conclusions
- This was a unique and interesting collaboration!
- Truckers willingly assess their OSA risk online.
- The rate of obesity is high in this group.
- More than two-thirds of those who do so would be
required to undergo polysomnography (PSG) if
suggested guidelines become regulation. - Subjective symptoms were associated with sleepy
driving, but objective findings were not. - Sleep health professionals need to develop
expedient, non-punitive tools to keep CMVDs
healthy and driving.
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20OSA Increases the Risk of Crash (FMCSA, 2007,
Tregear S, JCSM 2009)