Nonadherence with Employer-Mandated Sleep Apnea Treatment and Increased Risk of Serious Truck Crashes

The objective of this study was to evaluate the effect of an employer-mandated obstructive sleep apnea (OSA) program on the risk of serious preventable truck crashes. The first large-scale, employer-mandated program to screen, diagnose, and monitor OSA treatment adherence in the US trucking industry was the source of the data used. Construction of a retrospective analysis of cohorts was as follows: polysomnogram-diagnosed drivers (OSA positive n = 1,613, OSA negative n = 403) were matched to control drivers unlikely to have OSA (n = 2,016) on two factors affecting crash risk, experience-at-hire and length of job tenure; tenure was matched on the date of each diagnosed driver’s polysomnogram. All cases (i.e., OSA positive drivers) were provided treatment by auto-adjusting positive airway pressure (APAP); there was objective monitoring of treatment. Cases were grouped by treatment adherence: “Full Adherence” (n = 682), “Partial Adherence” (n = 571), or “No Adherence” (n = 360). Preventable Department-of-Transportation-reportable crashes/100,000 miles were compared across study subgroups. There was assessment of robustness. Results showed that “No Adherence” cases had a preventable Department of Transportation-reportable crash rate that was fivefold greater (incidence rate ratio = 4.97, 95% confidence interval: 2.09, 10.63) than that of matched controls (0.070 versus 0.014 per 100,000 miles), after the matching date. The crash rate of “Full Adherence” cases was statistically similar to controls (incidence rate ratio = 1.02, 95% confidence interval: 0.48, 2.04; 0.014 per 100,000 miles). In conclusion, there was a fivefold greater risk of serious preventable crashes for nontreatment-adherent OSA-positive drivers, but were discharged or quit rapidly, being retained only one-third as long as other subjects. As a result, adherent drivers were retained at the study firm, while the mandated program removed risk nontreatment-adherent drivers. It is allowed by current regulations that if nonadherent OSA cases keep their diagnosis private, they can drive at another firm.


  • English

Media Info

  • Media Type: Digital/other
  • Features: Figures; References; Tables;
  • Pagination: pp 967-975
  • Serial:

Subject/Index Terms

Filing Info

  • Accession Number: 01606994
  • Record Type: Publication
  • Files: TRIS
  • Created Date: Jul 14 2016 11:32AM