Barbara Phillips, MD: How Doctors Can Prevent Commercial Vehicle Crashes

Barbara Phillips, MD:

Most commercial drivers who are referred to be tested and treated for sleep apnea are not referred by the commercial driving medical examiner. There are several reasons for that, including that when a driver goes in for an exam, he's unlikely to admit to a symptom that's gonna result in loss of time and money to be tested.

I'm not talking out of school here - this has been studied and published in the peer-reviewed literature. Commercial drivers deny classic symptoms of sleep apnea like snoring, stopping breathing during sleep, and daytime sleepiness when they fill out their paperwork for the commercial driving medical exam.

The commercial driving medical examiners, for reasons of their own, maybe don't press as hard on this as they would if they were focused on the patient's health, rather than keeping the patient's employer happy with their service.

But the patient's primary care doctor, ostensibly is focused on their health, and the patient feels more comfortable telling his or her primary care doctor about symptoms of sleep apnea.

So here's the role that any physician can have: ask about sleep apnea. If a patient has a body mass index over 32 or 33 and it's a male, he very likely is at risk for sleep apnea. If the patient is on 3 anti-hypertensives, she very likely has obstructive sleep apnea. If the patient's neck circumference is more than 17 inches in a man or 16 in a woman, that individual very likely has sleep apnea.

So the primary care doctor, really is going to be better able, probably, to pick up sleep apnea in commercial drivers than the medical examiner, which is unfortunate, but I think it's probably reality.