Nonadherence with employer-mandated sleep apnea treatment and increased risk of serious truck crashes

Stephen V. Burks, Jon E. Anderson, Matthew Bombyk, Rebecca Haider, Derek Ganzhorn, Xueyang Jiao, Connor Lewis, Andrew Lexvold, Hong Liu, Jiachen Ning, Alice Toll, Jeffrey S. Hickman, Erin Mabry, Mark Berger, Atul Malhotra, Charles A. Czeisler, Stefanos N. Kales

    Research output: Contribution to journalArticlepeer-review

    39 Scopus citations


    Study Objectives: To evaluate the effect of an employer-mandated obstructive sleep apnea (OSA) program on the risk of serious preventable truck crashes. Methods: Data are from the first large-scale, employer-mandated program to screen, diagnose, and monitor OSA treatment adherence in the US trucking industry. A retrospective analysis of cohorts was constructed: 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. Auto-adjusting positive airway pressure (APAP) treatment was provided to all cases (i.e. OSA positive drivers); treatment adherence was objectively monitored. 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. Robustness was assessed. Results: After the matching date, "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). 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). Conclusions: Nontreatment-adherent OSA-positive drivers had a fivefold greater risk of serious preventable crashes, but were discharged or quit rapidly, being retained only one-third as long as other subjects. Thus, the mandated program removed risky nontreatment-adherent drivers and retained adherent drivers at the study firm. Current regulations allow nonadherent OSA cases to drive at another firm by keeping their diagnosis private. Commentary: A commentary on this article appears in this issue on page 961.

    Original languageEnglish (US)
    Pages (from-to)967-975
    Number of pages9
    Issue number5
    StatePublished - May 1 2016

    Bibliographical note

    Funding Information:
    The research received support from Harvard Catalyst, The Harvard Clinical and Translational Science Center (NIH Award #UL1 RR 025758, financial contributions from Harvard University and its affiliated academic health care centers), and support from National Surface Transportation Safety Center for Excellence (Project# 12-UI-017). The content is solely the responsibility of the authors and does not necessarily represent the official views of any of the research sponsors.


    • APAP
    • CPAP
    • Commercial motor vehicle operator
    • Motor carrier
    • OSA
    • Obstructive sleep apnea
    • PSG
    • Preventable crash
    • Screening
    • Truckload

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