Commercial Driver License and FMCSA Updates




Question:  I have a commercial driver license and was diagnosed with obstructive sleep apnea. Can I wear an oral appliance instead of CPAP?


This is only one aspect of a very controversial topic and unfortunately there are no clear answers for the time being. Studies show that between one third and three quarters of commercial drivers suffer from some form of sleep-disordered breathing,  which has created significant concerns for the drivers, their employers, medical examiners, sleep medicine providers and regulatory agencies.  All of these stakeholders have recently participated in a series of public discussions, in an effort to update and clarify the existing protocols used to identify, test and treat at-risk drivers.   Because the FMCSA (Federal Motor Carrier Safety Administration)  has so far only issued recommendations, rather than universal rules, it is up to the individual medical examiners to decide which treatment guidelines they want to use – and there are several guidelines available, some of which allow the use of an oral appliance for mild to moderate apnea, while others discourage it.  

As the articles below explain, FMCSA does not require specific diagnostic testing/treatment, but the agency permits the ME to use medical best practices to govern his/her decisions” (Papp). However, this has created considerable confusion and frustration, so it is generally hoped that within the next year the agency will be able to issue clearer, definitive guidelines to be followed by everyone, addressing which drivers are at the greatest risk of sleep-related accidents and which treatment options/ protocols are acceptable in order to maintain one’s commercial driver license. 

The use of oral appliances to treat mild and moderate sleep apnea is very well established by the current practice parameters of the American Academy of Sleep Medicine in the general population – however for CDL purposes the protocol may also need to incorporate compliance-tracking technology such as the Braebon Dentitrac chip, which can be embedded into Somnomed and other appliances and record up to 6 months of wear data, just like CPAP monitors. Of course a follow-up efficacy study demonstrating  that the appliance can reduce the AHI below 5 (or 10 with elimination of daytime sleepiness, according to some guidelines) is also an essential requirement to prove successful treatment, just as in the general population.

 


Here are a number of useful links that may provide further information on the topic:


FMCSA Panels Advance Sleep Apnea Recommendations

Sleep Review October 26, 2016   
http://www.sleepreviewmag.com/2016/10/fmcsa-panels-advance-sleep-apnea-recommendations/

Full text: http://www.ttnews.com/articles/printnews.aspx?storyid=43664

 

8 FMCSA Rulemaking Myths Debunked

Sleep Review April 4, 2016

http://www.sleepreviewmag.com/2016/04/8-fmcsa-rulemaking-myths-debunked/

 

 

SomnoMed Earns FDA Clearance on Oral Appliance with Compliance Microrecorder

Sleep Review June 30, 2015

http://www.sleepreviewmag.com/2015/06/somnomed-earns-fda-clearance-oral-appliance-compliance-microrecorder/

 

 

Sleep apnea and commercial motor vehicle operators: Statement from the joint task force of the American College of Chest Physicians, the American College of Occupational and Environmental Medicine, and the National Sleep Foundation.

Hartenbaum N1, Collop N, Rosen IM, Phillips B, George CF, Rowley JA, Freedman N, Weaver TE, Gurubhagavatula I, Strohl K, Leaman HM, Moffitt GL; American College of Chest Physicians; American College of Occupational and Environmental Medicine; National Sleep Foundation.   Chest. 2006 Sep;130(3):902-5.

http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.683.3627&rep=rep1&type=pdf