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

doi:10.5665/sleep.5734

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 journal › Article › peer-review

77 Scopus citations

Abstract

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 language	English (US)
Pages (from-to)	967-975
Number of pages	9
Journal	Sleep
Volume	39
Issue number	5
DOIs	https://doi.org/10.5665/sleep.5734
State	Published - 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.

Keywords

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

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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Burks, S. V., Anderson, J. E., Bombyk, M., Haider, R., Ganzhorn, D., Jiao, X., Lewis, C., Lexvold, A., Liu, H., Ning, J., Toll, A., Hickman, J. S., Mabry, E., Berger, M., Malhotra, A., Czeisler, C. A., & Kales, S. N. (2016). Nonadherence with employer-mandated sleep apnea treatment and increased risk of serious truck crashes. Sleep, 39(5), 967-975. https://doi.org/10.5665/sleep.5734

Burks, SV, Anderson, JE, Bombyk, M, Haider, R, Ganzhorn, D, Jiao, X, Lewis, C, Lexvold, A, Liu, H, Ning, J, Toll, A, Hickman, JS, Mabry, E, Berger, M, Malhotra, A, Czeisler, CA & Kales, SN 2016, 'Nonadherence with employer-mandated sleep apnea treatment and increased risk of serious truck crashes', Sleep, vol. 39, no. 5, pp. 967-975. https://doi.org/10.5665/sleep.5734

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abstract = "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.",

keywords = "APAP, CPAP, Commercial motor vehicle operator, Motor carrier, OSA, Obstructive sleep apnea, PSG, Preventable crash, Screening, Truckload",

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

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.",

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doi = "10.5665/sleep.5734",

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AU - Burks, Stephen V.

AU - Anderson, Jon E.

AU - Bombyk, Matthew

AU - Haider, Rebecca

AU - Ganzhorn, Derek

AU - Jiao, Xueyang

AU - Lewis, Connor

AU - Lexvold, Andrew

AU - Liu, Hong

AU - Ning, Jiachen

AU - Toll, Alice

AU - Hickman, Jeffrey S.

AU - Mabry, Erin

AU - Berger, Mark

AU - Malhotra, Atul

AU - Czeisler, Charles A.

AU - Kales, Stefanos N.

N1 - 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.

PY - 2016/5/1

Y1 - 2016/5/1

N2 - 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.

AB - 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.

KW - APAP

KW - CPAP

KW - Commercial motor vehicle operator

KW - Motor carrier

KW - OSA

KW - Obstructive sleep apnea

KW - PSG

KW - Preventable crash

KW - Screening

KW - Truckload

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

Abstract

Bibliographical note

Keywords

UN SDGs

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