Truckers Drive Their Own Assessment for Obstructive Sleep Apnea: A Collaborative Approach to Online Self-Assessment for Obstructive Sleep Apnea

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Truckers 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

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Disclosures

• 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

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Obstructive 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)

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Commercial 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.

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The Federal Motor Carrier Safety Administration
(FMCSA) Regulates CMVDs
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Background/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.

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Development 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.

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Methods

• 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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Not all word of mouth was good
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The Berlin Questionnaire (Netzer NC Annals 1999)

• I Snoring

1. Do you snore?
2. How loud do you snore?
3. How often do you snore?
4. Has your snoring ever bothered other people?
5. Has anyone noticed that you quit breathing during
   your sleep?
6. How often do you feel tired or fatigued after
   your sleep?
7. During your waking time, do you feel fatigued, or
   not up to par?
8. Have you ever nodded off or fallen asleep while
   driving a vehicle?
9. Do you have high blood pressure?
10. What is your BMI?

• II Sleepiness

• III Objective

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The Berlin Questionnaire (Netzer NC Annals 1999)

1. Do you snore?
2. How loud do you snore?
3. How often do you snore?
4. Has your snoring ever bothered other people?
5. Has anyone noticed that you quit breathing during
   your sleep?
6. How often do you feel tired or fatigued after
   your sleep?
7. During your waking time, do you feel fatigued, or
   not up to par?
8. Have you ever nodded off or fallen asleep while
   driving a vehicle?
9. Do you have high blood pressure?
10. What is your BMI?

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Aims 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.

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Data 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.

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Results

• 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)

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Sleepy 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)
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Witnessed 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)
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Conclusions

• 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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OSA Increases the Risk of Crash (FMCSA, 2007,
Tregear S, JCSM 2009)