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PuttingSleepApneatotheTest: Onesleepprogramsdrivetodiagnoseandtreatcommercialtruckdrivers

Houston,TXJuly14,2011Whenacommercialtruckisstationary,thedriverislosingmoney.Soits nowondercommercialtruckdriversarebehindthewheelsoftheirbigrigsforupto14hourseveryday sedentary.Coupleitwithfastfoodontheroad,stressfuldeadlinesandunfamiliarsleepenvironments andyouhavetherecipeforavarietyofhealthissues,includingsleepapnea. Recentresearchandmediaattentionhasbroughtobstructivesleepapnea(OSA)anddriversleepiness intothelimelight,revealingjusthowprevalenttheconditionisamongcommercialdrivers. Itisestimatedthat28percentorhigherofanycommercialfleetisatriskforobstructivesleepapnea. Why?Thisisademographicofpredominantlymiddleagedmales,manywithBMIsof30orgreater,with associatedcomorbiditieslikehypertension,diabetes,gastricrefluxorheartdisease.Thiscombination putsoneatrisk,especiallywhencoupledwithaneckof17inchesorgreater. Legislativeprogress TheattentionhaspromptedtheFederalMotorCarrierSafetyAdministration(FMCSA)toreviewthe issuebuthasyettoputastandardintoplaceregardingdriversafety. TheMedicalReviewBoard(MRB)totheFMCSAvotedonrecommendationsinJanuary2008inSaltLake City.ThesewereguidelinesforDOTexaminerstousewhenreviewingadriveratthepointofaDOT medicalexam.AMRBmaymeetonthesubjectofsleepapneaagaininAugust2011. Companiestakeaction Butthathasntstoppedsometruckingcompaniesfromsettingtheirownstandardbeforeregulation hits.Manycompaniessolicittheuseofsurveysorquestionnairesfromathirdpartytocollectdata regardingadriversalertnessontheroad.However,thesetoolshavedisadvantageswhenworkingwith areluctantpatient. Theaveragetruckdriverisnotgoingtovolunteersymptomsrelatedtodaytimefatigue,daytime sleepiness,orinattentivenesswhiledriving,saidMarkBerger,MD,CEOofPrecisionPulmonary Diagnostics(PPD)inHouston. Surveysays ThatswhyBerger,alongwithcolleagueWendySullivan,RN,VicePresidentofprojectimplementation andhealthandsafetyconsultativeservicesatPPD,developedtheSomniSageQuestionnaireasleep focusedquestionnaire,whichdeterminessleepissuesamongthemostreluctantofdrivers. TheSomniSageQuestionnaire,nowpatented,wasdevelopedbasedonresearchcollectedsolelyfrom commercialdrivers.Theresearch,collectedoverthepastfouryears,concludeddrivershaveatendency

tobereluctantduetofearofnotbeingabletodrive,beingputoutofserviceornotbeingableto adheretoCPAPtreatmentforsleepapnea.(Bergerandhisteamarecurrentlypreparingthedatafor publication.) TheSomniSageQuestionnaireisadministeredthroughasecureHIPAAcompliantWebportaland featuresabout35questionsadrivercanusuallyanswerinlessthan15minutes. "It'srunningahighpositivepredictivevalueforthepresenceofsleepapneainatruckdriver,"Berger said.PPDusesthesurveyduringitsscreeningprocesstodeterminewhichdriversaremostatriskfor OSA. "Wewantedamethodtoidentifywhichtruckdriversinafleetwouldbeatriskforhavingsleepapnea becauseyouobviouslydon'twanttodoanovernightsleeptest,evenwithanovernightlimitedchannel monitor,oneverysingletruckdriverjustbecausethey'reatruckdriver,"Bergersaid. Instead,Bergerbelievesitismoretimeandcosteffectivetodosubsequenttestingonthosewhoscore highonthequestionnaire,andthereforemaybemoreatriskforOSA. Partneringforacause Whilediagnostictestingmaybetrickyonsuchamobilepopulation,PPDsubcontractsindependent diagnostictestingfacilities,accredited(orpendingaccreditation)witheithertheAmericanAcademyof SleepMedicineorTheJointCommission.The30sleeplabsinPPDsnationalnetworkprovidethe diagnostictestingcomponentofitscomprehensivesleepapneamanagementprogram. Driversaretestedovernightonsitewithatype1polysomnogram.AlthoughPPDisexploringtheuseof limitedchannelmonitors,Bergercitesareducedneedtobringdriversbackasadistinctadvantageofan attendeddiagnostictest. "Ifthereisatechnicaldifficulty,itcanberemediedimmediately,hesaid.Sothechanceofhavingto bringadriverbackbecauseofatechnicalissuerelatedtothediagnostictestisalmostzero.Inaddition, itisthereferencestandardandthemostcomprehensivetest. Thescopeisanotheradvantageintermsofliabilityconcerns. "Thelegalimplicationsofadiagnosisoramisdiagnosisofsleepapneainacommercialdriverare potentiallyhuge,sowefeelstronglythatthemostcomprehensivestudyoughttobetheoneusedin thispatientpopulationtoruleoutthepresenceofsleepapneaortoassessitsseverity,"Bergersaid. Driversupport Criticaltothesuccessofasleepapneaprogramisthemonitoring,supportandeducationoncetherapy isprescribed.Over50percentofCPAPmachinessitonshelves.PPDhasatollfreehotlinedriverscan call24hoursaday,7daysaweek,iftheyhaveconcernsaboutequipmentneeds;careandmaintenance ofCPAPequipment;CPAPtroubleshootingandcommonquestions;datacardquestions;compliance questions;orsleeplab/studyinformation.

PPDhasaDriverSupportblog,www.CPAPCrossCountry.com,wheredriverscanreadaboutsleep specifictopicsandconnectwithotherdriverssufferingfromOSA. Itsimportanttosupportthedrivers,Sullivansaid.Improvementinhealth,safetyandproductivity dependonit. AboutPrecisionPulmonaryDiagnostics Foundedin2005bysleepspecialist,MarkB.Berger,M.D.,PrecisionPulmonaryDiagnostics(PPD)is committedtothediagnosisandtreatmentofsleepapneaincommercialdrivers/operators,resultingin improveddriverhealthandsafetyandsignificantreturnoninvestmentfortheiremployer. HeadquarteredinHouston,TXPPDspatentpendingprogramsallowadministrationof employerdrivensleepapneaprogramsthatincludewebbasedscreeningtools,diagnosis,treatment andmonitoringofthishighlyprevalentcondition.Formoreinformationgoto:wwwPPDsleep.com