Truckers Drive Their Own Assessment for Obstructive Sleep A - PowerPoint Presentation

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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 KentuckySlide2

DisclosuresBenjamin 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, LLCSlide3

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)Slide4

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. Slide5

The Federal Motor Carrier Safety Administration (FMCSA) Regulates CMVD’sSlide6

Background/RationaleBased 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

>

33

kg/m

2

.

The FMCSA

Medical Review Board

recommended that CMVDs undergo testing for OSA if

they have a positive Berlin Questionnaire and/or

BMI

>

30

kg/m

2

. Slide7

Development of CollaborationTruckers for a Cause-

A

lert, 

W

ell, 

A

nd 

K

eeping 

E

nergetic (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. Slide8

Methods

We adapted the Berlin

Questionnaire

(

Netzer

NC Ann Intern Med 1999)

to be taken online.

TFAC-AWAKE hosted the survey on their website.

TFAC’s

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. Slide9
Slide10

Not

all

word of mouth was good…Slide11

The 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?

I: Snoring

II: Sleepiness

III: ObjectiveSlide12

The 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?Slide13

Aims and HypothesesAims

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 analysisThe website was active to collect data from January 11, 2010 until September 24, 2010.

We performed Logistic Regression Analyses using the R statistical package.Slide15

Results595 of

CMVDs

took the survey

55.9% positive on overall Berlin

78.3% positive on objective (BMI,

bp

) part

69.6% had a BMI

>

30 Kg/m 2

47.6% had BMI > 33 Kg/m 2

20.5% reported falling asleep while driving (on Berlin)Slide16

Sleepy Driving Associated with…

Question

Significance

(

Logit

. Regression

p

-value)

Overall

Berlin Score

0.00

Do

you snore?

< 0.01

How loud is your snoring?

< 0.0001

Does your snoring bother

other people?

< 0.01

How often do you snore?

< 0.0001

How often has someone noticed that you quit breathing during your sleep?

<

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?0.00What kind of commercial vehicle do you drive?< 0.05(Commercial Vehicles the highest)Slide17

Witnessed Apneas Associated with…

Question

Significance

(

Logit

. Regression

p

-value)

Overall

Berlin Score

0.00

Do

you snore?

Yes

(

p

=0.00), Maybe (

p

=0.09)

How loud is your snoring?

0.00

Does your snoring bother

other people?

< 0.01

How often do you snore?

0.00

How often has someone noticed that you quit breathing during your sleep?

0.00During your wake time, how often do you feel fatigued, or not up to par?

0.00What kind of commercial vehicle do you drive?< 0.05(Commercial Vehicles the lowest)Slide18

ConclusionsThis 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.Slide19
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OSA Increases the Risk of Crash (FMCSA, 2007, Tregear

S, JCSM 2009)