By Sandy Long
On February 6, 2012, a meeting was held between the FMCSA Medical Review Board and the Motor Carrier Safety Advisory Committee to discuss, once again, sleep apnea, BMI and truck drivers. The upshot of that meeting, citing the possibility of fatigue related accidents, is that drivers with a BMI (body mass index) of 35 or more will have to have a mandatory sleep study done if the FMCSA takes the recommendations to regulation. This though studies and statistics show that fatigue is related to approximately 1.4% of all truck related crashes. What is really going on?
It is a fact that Americans are growing larger in both height and weight. Three of the major factors in an increase of weight are availability of food, decrease of physical activity and a prevalence of car usage. However, there are other factors; (from wikidpedia.com) “(1) insufficient sleep, (2) endocrine disruptors (environmental pollutants that interfere with lipid metabolism), (3) decreased variability in ambient temperature, (4) decreased rates of smoking, because smoking suppresses appetite, (5) increased use of medications that can cause weight gain (e.g., atypical antipsychotics)…” Then there is stress.
Stress causes an increase in a hormone called cortisol that can cause obesity. People’s bodies, those who experience high levels of work related stress, release cortisol in response to the ‘flight or fight’ factors found in the brain. Cortisol causes excess belly fat. A study done on the difference between regular shift workers and irregular shift truck drivers shows a marked increase in cortisol production for irregular shift truck drivers.
Sleep apnea is the current disease du jour and much has been written on this condition. While obese people are perhaps more susceptible to developing sleep apnea, it is not only fat people who do get it; many are susceptible. “According to the American Sleep Apnea Association (quoted at yahoo voices), people who are at a “normal” weight (with a BMI of less than 25) are at a 16.4 percent risk of sleep apnea. People who are “overweight” (with a BMI of 25 to 30) are at a 38.1 percent risk of sleep apnea, while those who are “obese” (with a BMI of more than 30) are at a 45.5 percent risk of sleep apnea. Other factors that can cause sleep apnea are high blood pressure, being over the age of 65, being male, a large neck circumference, alcohol, tranquilizer and sedative use, smoking, sitting for long periods of time, stroke, brain tumor or heart disorders.”
In a webinar presented by Ralph Craft, Ph.D., Senior Transportation Specialist, FMCSA Office of Analysis, Research, and Technology (ART) with Kirse Kelly, Web Conference Host, FMCSA ART, Kelly spoke about misconceptions involved in large truck crash statistics. In the presentation, Kelly stated, “Being unable to perform the task of driving means you are asleep, you are in diabetic shock so you can’t drive, or you have had a heart attack, or passed out, or any other medical condition that hits you and now you are no longer able to perform the task of driving.” Notice that being obese was not mentioned.
Finland did a study on truck crash causation as did the FMCSA using statistics from the Michigan State Patrol, neither showed a predominance of fatigue as factors causing the accidents cited. Finland 2%, Michigan 2.4%. Overall, accidents involving commercial vehicles has gone down and stayed relatively flat over the last 3 years.
Sleep apnea is a big business ticket. NPR reports, “Medicare payments for sleep testing increased from $62 million in 2001 to $235 million in 2009, according to the Office of the Inspector General.” In the same report, “Dr. Fred Holt, an expert on fraud and abuse and a medical director of Blue Cross Blue Shield in North Carolina, says some patients aren’t having basic exams done first and are therefore being prescribed expensive tests they don’t need. Not everyone who snores has a chronic disorder, he says. In other cases, Holt says, the labs prescribe CPAP machines right away without first suggesting other strategies that could reduce apnea, such as losing weight or sleeping on your side.”
Sleep apnea became an issue under the first head of the FMCSA’s Medical Review Board Barbara Phillips, M.D. who was also the Chair of the National Sleep Foundation (NSF). NSF receives funding from sources including foundations, corporations and federal agencies. Dr. Phillips has also been affiliated with Astra Zeneca, Boehringer-Ingelheim, GlaxoSmithKline, ResMed, and Sanofi-Aventis; has participated as a consultant for Ogden, Newell & Welch, PLLC; has received speaking honoraria from Boehringer-Ingelheim, GlaxoSmithKline, Cephalon, JewishHeart Lung Institutes, Orphan Medical, Pfizer, ResMed, St. Joseph’s Hospital, Swedish Medical Center, and Sepracor.
Today’s head of the Medical Review Board is Benjamin H. Hoffman, M.D. M.P.H. (Texas) who is the Global Chief Medical Officer at GE Energy. GE Energy develops and markets sleep apnea aid parts.
A sleep study costs between $2,000-3,000.00. A C-PAP machine, the only corrective device suggested by the Medical Review Board, can cost over $5,000.00. Some insurance companies pay for the studies and machines, some do not.
It is true that obesity is on the rise overall in America. It is true that there are many factors that cause a truck driver and others to be obese. It is true that obesity can cause health issues such as sleep apnea. It is true that many who are not obese may suffer from sleep apnea. It is untrue that sleep apnea or fatigue causes a substantial amount of unsafe driving among truck drivers. It is very true that there is a huge amount of money to be made from the promotion of regulations requiring truck drivers to have to take mandatory sleep studies using BMI as an indicator. Therefore, it is true that it is about money.