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Trucks, Trains and Obstructive Sleep Apnea (OSA)

For many truck drivers and train operators, the adequate amount of sleep is vital not only for the effectiveness of their duties but to protect the lives of their other passengers. What is Obstructive Sleep Apnea and what are the current Federal regulations for OSA testing?

“Obstructive sleep apnea, or OSA, arises from what is basically a mechanical problem. During sleep the patient’s tongue falls back against his or her soft palate, and the soft palate and uvula fall back against the back of the throat, effectively closing the airway.  The result is when the sleeper expands the chest to inhale, no air enters the lungs.” –

The symptoms are serious especially if OSA is left untreated. It can lead to debilitating daytime sleepiness, morning headaches, depression, and a general sense of unwellness. This is especially worrisome for those whose jobs require precise mental alertness like truck drivers and train operators.  In time, OSA can lead to more serious health issues such as high blood pressure, heart disease, strokes, diabetes, and other life-threatening and life-shortening diseases.

What are the current regulations when it comes to OSA and transportation operators (for example truck drivers or train operators)? And what is being proposed?

Federal Motor Carrier Safety Administration’s (FMCSA) regulation, (49 CFR 392.3) that is  currently in force states that:

“No driver shall operate a commercial motor vehicle, and a motor carrier shall not require or permit a driver to operate a commercial motor vehicle, while the driver’s ability or alertness is so impaired, or so likely to become impaired, through fatigue, illness, or any other cause, as to make it unsafe for him/her to begin or continue to operate the commercial motor vehicle.”

But the National Transportation Safety Board (NTSB) does not feel this regulation is sufficient.  As a result, in March 2016, two Federal agencies within the Transportation Department proposed a rule that would have required truck drivers and train operators to be tested for obstructive sleep apnea. At that time, they concluded that when OSA goes undiagnosed or inadequately treated, it can cause unintended sleep episodes and resulting deficits in attention, concentration, situational awareness, and memory – and it would reduce the capacity to safely respond to hazards when performing safety sensitive duties. They further concluded that OSA has been linked to preventable accidents.

Federal Agencies Withdraw Proposed OSA Regulation Stating That Current Regulation is Sufficient

Unfortunately, the Federal Motor Carrier Safety Administration (FMCSA) and the Federal Railroad Administration (FRA) have since withdrawn that proposed rule, and concluded that “while OSA an on-going concern, the issue can be addressed through existing safety programs and rules“. The agencies stated that it should be up to railroads and trucking companies to decide whether to test employees. Surprisingly, one railroad already tests for OSA – the Metro-North in New York – and found that 11.6 percent of its engineers have sleep apnea!!

Why are New OSA Regulations being Proposed?

The decision to withdraw the proposed OSA Regulation was not well received by another Federal agency, the National Transportation Safety Board. The NTSB has been pushing for apnea screening and awareness, hence they publicly stated that it was disappointed by the move to withdraw.  Some recent studies and finding on the need for new regulation include:

  • Christopher O’Neil, NTSB Chief of Media Relations reported that medical fitness and fatigue, two of the NTSB’s 10 Most Wanted List of Transportation Safety Improvements for 2017 – 2018, are tied to obstructive sleep apnea. He further commented, “The need for this rulemaking is well documented.”
  • The NTSB board cited its own findings that obstructive sleep apnea has been linked to ten highway and rail accidents in the past 17 years.

Despite withdrawing the proposed regulation, just last spring the FMCSA and FRA themselves cited a number of cases of rail and trucking crashes that were linked to OSA in recent years including:

  • In 2001, there was an Arkansas train crash where the crew was “likely fatigued and asleep.”
  • In 2011, a railway collision near Red Oak, Iowa killed two crewmembers who were found to have been at risk of apnea – and prompted the NTSB to urge the Federal Railroad Administration to “require railroads to medically screen employees with safety sensitive duties for sleep apnea and other sleep disorders.”
  • In 2013, a derailment of a Metro-North Railroad passenger train that had been approaching the Spuyten Duyvil Station in New York City crashed, which was responsible for four passenger deaths and over 60 injuries. The engineer reported feeling dazed — and was later diagnosed with severe OSA. This 2013 derailment was also cited in the agencies’ initial proposal.

According to Dr. Stefanos Kales (Harvard School of Public Health), “Drivers with untreated obstructive sleep apnea who are non-compliant with treatment have a five-fold increase in the risk of serious preventable crashes.” Thus, both drivers and their companies have a legal responsibility to assure that anyone suspected of obstructive sleep apnea (OSA), or other similar condition, stays off of the road. It appears that for the transportation industry, the real question is if §392.3 is sufficient enough to protect the public – or if it will be enforced effectively. Stay tuned!

What’s Hot is OSA? ( Provides Answers)

Our online continuing education video course prepared for Sleep Technologists and Respiratory Therapists provides answers to new perspectives in the diagnosis and treatment of OSA, associated co-morbidities, impact on partner’s sleep, and effective treatment options such as auto PAP, and surgery.  Psychosocial issues will be reviewed and travel with OSA is also discussed. This course is presented as a video presentation that runs 47 minutes.

It is approved by the AAST for CEC credits, approved by BRPT for CSTEs, approved by the AARC for CECs, and approved by the CSRT for CPDs. Our courses are written by Sleep Medicine and Respiratory Care Industry Leaders with relevant topics that are engaging.  All Courses are Peer and/or Physician Reviewed! Our courses are simple to purchase – all you need is a credit card and the desire to get continuing education credits.




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