RENO – Dr. Michael Lucia, a certified sleep disorder specialist, opened eyes during an STN EXPO panel Sunday on sleep apnea by dispelling "voodoo" he said is dominating the current conversation on one of the leading causes of motor crashes.
In fact, added Lucia, obstructive sleep apnea (OSA) results in an average of 50,000 fatalities in motor crashes each year compared to 8,000 in drunk-driving incidents.
The Federal Motor Carrier Safety Administration is poised to release guidelines this fall for commercial drivers and carriers regarding sleep apnea testing and diagnosis followed by proposed rulemaking. The school-bus industry, in general, has been opposed to federal regulation because of the purported high costs associated with testing and necessary sleep equipment that many school bus companies and school districts fear will fall on their shoulders.
Diagnosis and treatment can be expensive despite costs coming down and insurance coverage for procedures and equipment going up in recent years. But Dr. Lucia, an assistant professor at the University of Nevada School of Medicine and owner of the Sierra Pulmonary and Sleep Institute in nearby Sparks, pointed out that many of the costs being cited by organizations are outdated by 10 to 20 years. The National School Transportation Association opposes any federal sleep apnea rules for its member companies because of what it calls "a substantial additional burden." In a letter last fall to FMCSA Administrator Anne Ferro, NSTA pointed out that the potential cost to test 43,500 private-company school bus drivers for sleep apnea, based on their qualifying body mass index, would be $60.13 million. But "conservative estimates" by NSTA that also include screening, diagnosis and treatment ($1,300 each for CPAP machines and monthly monitoring costs of approximately $15 per month per individual) would total $103.63 million.
Lucia confirmed that sleep apnea testing in certified labs can cost about $1,300 not to mention the cost of CPAP machines prescribed to treat positive diagnoses but added that, most importantly, sleep apnea is a considerable health risk to all people, especially school bus drivers charged with ensuring the safety of some 24 million students nationwide. While the cost can still be significant to bus companies and school districts, he also said the total cost of certified testing, which does not have to be performed in a lab as long as the testing gauges actual airflow, can be as little as $400 per person with private insurance, Medicaid and Medicare. If no airflow is measured, he said a positive diagnosis of sleep apnea cannot be made. He also told audience members that only certified doctors who are members of the American Academy of Sleep Medicine should be diagnosing and treating sleep apnea and other sleep disorders rather than primary care physicians who have little or no training.
"There's a lot of voodoo out there," he added.
Lucia was joined on the panel "Asleep at the Wheel: Driving Home the Facts on Sleep Apnea" by Max Christensen, president of the National Association of State Directors of Pupil Transportation and the school transportation consultant at the Iowa Department of Education. Christensen has sat in on meetings with FMCSA representatives regarding the pending guidelines and proposed rulemaking as well as having undergone sleep-apnea testing. Other panelists were Ralph Knight, director of transportation at Napa Valley Unified School District north of San Francisco, and Charley Kennington, director of Innovative Transportation Solutions at the Region 4 Education Services Center in Houston.
Kennington, who is being treated for sleep apnea himself, told the audience that his discussion with school districts in the Houston area indicates little or no issues with drivers having sleep apnea. But Lucia said many people fail to correlate sleep apnea with other health issues such as heart attacks and stroke. In fact, Lucia continued, sleep apnea is as big of a risk factor for heart disease as is smoking. He also said that the effects of getting only two to four hours of uninterrupted sleep before driving is similar to consuming seven to 10 beers.
"(Having undiagnosed and untreated sleep apnea) is like know you have cholesterol (levels) of 300 and not doing anything about it," he added.
Lucia said 10 to 20 percent of the U.S. population suffers from sleep apnea, and 15 percent to as many as 40 percent of commercial drivers have the condition. Likewise, he said two-thirds of all Americans are overweight or obese, a figure that grows to as much as 80 percent for commercial drivers. Additionally, he said drivers with OSA are three to five times more likely of being in a motor vehicle crash.