30 |
Overdrive
| September 2014
sleep apnea q&a
own best professional judgment on how
to apply it," says Stanton. To date, there
have been three different sets of this
sort of guidance on screening for sleep
apnea from federally convened boards
and panels.
The first, in 2006, specified a set
of seven procedures. A 2008 Medical
Expert Panel specified a BMI greater
than 33, among other factors such as
neck size and various questionnaires.
The 2012 joint recommendations from
the MRB/MCSAC joint meeting took
the BMI recommendation higher to 35,
again among other consider-
ations.
So not only has FMCSA
failed to specify exactly what
approach a medical examiner
has to take regarding apnea,
there exist three different
"general guidance" standards
for an examiner to interpret
under his own judgment.
Why are doctors
now more aggres-
sive on apnea?
Two answers: One has to
do with new training all
docs giving DOT physi-
cals have been required
to take. The other has to
do with liability.
Dr. Randolph Rosarion, based
in College Point, N.Y., says his
sleep apnea referrals are less
than two in 10 drivers he sees
for testing. Rosarion says he re-
lies not only on BMI measure-
ment but also on sleep habits
and reporting of episodes of
daytime sleepiness.
Add in diabetes and/or high
blood pressure as contributing
factors, and the driver's condi-
tion may rise to the level where
Rosarion would refer him "to a
pulmonary specialist who prac-
tices sleep medicine," he says,
as required in the regulations.
If the driver has insurance,
it usually covers the visit and
any subsequent test in a sleep
lab or using a portable unit
at home – a less-expensive
option that in some ways is
more appealing. In others, not
so much, speculates Rosarion,
given less-than-ideal diagnostic
capabilities: "I prefer to send
the person to a sleep expert
and have them evaluated with
a formal sleep study" in a lab.
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