Regulatory News

FMCSA: Medical Examiners Should Rely on “Medical Training and Expertise” for OSA Diagnosis, Treatment

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FMCSA bulletin

In a bulletin issued this month by the Federal Motor Carrier Safety Administration (FMCSA), the agency reminds its certified medical examiners to use their “medical training and expertise in determining whether a driver exhibits symptoms and/or multiple risk factors for OSA [obstructive sleep apnea].”

“The current regulations and advisory criteria do not include guidelines concerning OSA screening, diagnosis, and treatment,” the bulletin states. “Medical examiners should rely upon their medical training and expertise in determining whether a driver exhibits symptoms and/or multiple risk factors for OSA, and they should explain to the driver the basis for their decision if the examiner decides to issue a medical certificate for a period of less than two years to allow for further evaluation, or to deny a driver the medical certificate.”

The bulletin appears to give medical examiners wide latitude in screening, diagnosis, and treatment options. The bulletin states that home sleep tests that ensure chain of custody are acceptable diagnostic tools and that weight loss and oral appliances are included in the spectrum of acceptable treatments for truckers.

Specifically, the bulletin states:

  • Screening: With regard to identifying drivers with undiagnosed OSA, FMCSA’s regulations and advisory criteria do not include screening guidelines. Medical examiners should consider common OSA symptoms such as loud snoring, witnessed apneas, or sleepiness during the major wake periods, as well as risk factors, and consider multiple risk factors such as body mass index (BMI), neck size, involvement in a single-vehicle crash, etc.
  • Diagnosis: Methods of diagnosis include in-laboratory polysomnography, at-home polysomnography, or other limited channel ambulatory testing devices which ensure chain of custody.
  • Treatment: OSA is a treatable condition, and drivers with moderate-to-severe OSA can manage the condition effectively to reduce the risk of drowsy driving. Treatment options range from weight loss to dental appliances to Continuous Positive Airway Pressure (CPAP) therapy, and combinations of these treatments. The Agency’s regulations and advisory criteria do not include recommendations for treatments for OSA and FMCSA believes the issue of treatment is best left to the treating healthcare professional and the driver.”

The FMCSA also states that drivers with “moderate-to-severe OSA” are the primary safety goal, defining that as an AHI greater than or equal to 15.