Federal Motor Carrier Safety Administration, Federal Railroad Administration. Evaluation of Safety Sensitive Personnel for Moderate-to-Severe Obstructive Sleep Apnea. Federal Register website. https://www.federalregister.gov/documents/2016/03/10/2016-05396/evaluation-of-safety-sensitive-personnel-for-moderate-to-severe-obstructive-sleep-apnea. Published March 10, 2016. Accessed March 9, 2017.
American Academy of Sleep Medicine. American Academy of Sleep Medicine - Comments. regulations.gov website. https://www.regulations.gov/document?D=FRA-2015-0111-0065. Published June 10, 2016. Accessed March 9, 2017.
Young T, Palta M, Dempsey J, Skatrud J, Weber S, Badr S. The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med. 1993;328(17):1230–1235. [PubMed]
Peppard PE, Young T, Barnet JH, Palta M, Hagen EW, Hla KM. Increased prevalence of sleep-disordered breathing in adults. Am J Epidemiol. 2013;177(9):1006–1014. [PubMed Central][PubMed]
Quan SF, Gillin JC, Littner M, Shepard J. Sleep-related breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clinical research. The report of an American Academy of Sleep Medicine Task Force. Sleep. 1999;22(5):667–689. [PubMed]
Berger M, Varvarigou V, Rielly A, Czeisler CA, Malhotra A, Kales SN. Employer-mandated sleep apnea screening and diagnosis in commercial drivers. J Occup Environ Med. 2012;54(8):1017–1025. [PubMed Central][PubMed]
Howard ME, Desai AV, Grunstein RR, et al. Sleepiness, sleep-disordered breathing, and accident risk factors in commercial vehicle drivers. Am J Respir Crit Care Med. 2004;170(9):1014–1021. [PubMed]
Pack A, Dinges D, Maislin G. A Study of Prevalence of Sleep Apnea among Commercial Truck Drivers. Publication no. DOT-RT-02-030. Washington, DC: Federal Motor Carrier Safety Administration; 2002. https://ntl.bts.gov/lib/55000/55400/55447/DOT-RT-02-030.pdf. Published May 2002. Accessed March 9, 2017.
Stoohs RA, Bingham LA, Itoi A, Guilleminault C, Dement WC. Sleep and sleep-disordered breathing in commercial long-haul truck drivers. Chest. 1995;107(5):1275–1282. [PubMed]
Platt AB, Wick LC, Hurley S, et al. Hits and misses: screening commercial drivers for obstructive sleep apnea using guidelines recommended by a joint task force. J Occup Environ Med. 2013;55(9):1035–1040. [PubMed]
Koyama RG, Esteves AM, Oliveira e Silva L, et al. Prevalence of and risk factors for obstructive sleep apnea syndrome in Brazilian railroad workers. Sleep Med. 2012;13(8):1028–1032. [PubMed]
McKay MP. Fatal consequences: obstructive sleep apnea in a train engineer. Ann Fam Med. 2015;13(6):583–586. [PubMed Central][PubMed]
Raslear TG. Prevalence and treatment of OSA in safety-critical railroad employees. J Sleep Disord Ther. 2014;3:179.
Tregear S, Reston J, Schoelles K, Phillips B. Obstructive sleep apnea and risk of motor vehicle crash: systematic review and meta-analysis. J Clin Sleep Med. 2009;5(6):573–581. [PubMed]
Tregear S, Reston J, Schoelles K, Phillips B. Continuous positive airway pressure reduces risk of motor vehicle crash among drivers with obstructive sleep apnea: systematic review and meta-analysis. Sleep. 2010;33(10):1373–1380. [PubMed Central][PubMed]
Burks SV, Anderson JE, Bombyk M, et al. Nonadherence with employer-mandated sleep apnea treatment and increased risk of serious truck crashes. Sleep. 2016;39(5):967–975. [PubMed Central][PubMed]
2015 Pocket Guide to Large Truck and Bus Statistics. Federal Motor Carrier Safety Administration website. https://www.fmcsa.dot.gov/safety/data-and-statistics/commercial-motor-vehicle-facts. Published April 2015. Accessed March 9, 2017.
Marshall NS, Wong KK, Cullen SR, Knuiman MW, Grunstein RR. Sleep apnea and 20-year follow-up for all-cause mortality, stroke, and cancer incidence and mortality in the Busselton Health Study cohort. J Clin Sleep Med. 2014;10(4):355–362. [PubMed Central][PubMed]
Young T, Finn L, Peppard PE, et al. Sleep disordered breathing and mortality: eighteen-year follow-up of the Wisconsin sleep cohort. Sleep. 2008;31(8):1071–1078. [PubMed Central][PubMed]
Wang X, Ouyang Y, Wang Z, Zhao G, Liu L, Bi Y. Obstructive sleep apnea and risk of cardiovascular disease and all-cause mortality: a meta-analysis of prospective cohort studies. Int J Cardiol. 2013;169(3):207–214. [PubMed]
Nieto FJ, Young TB, Lind BK, et al. Association of sleep-disordered breathing, sleep apnea, and hypertension in a large community-based study. Sleep Heart Health Study. JAMA. 2000;283(14):1829–1836. [PubMed]
Calhoun DA, Jones D, Textor S, et al. Resistant hypertension: diagnosis, evaluation, and treatment. A scientific statement from the American Heart Association Professional Education Committee of the Council for High Blood Pressure Research. Hypertension. 2008;51(6):1403–1419. [PubMed]
Botros N, Concato J, Mohsenin V, Selim B, Doctor K, Yaggi HK. Obstructive sleep apnea as a risk factor for type 2 diabetes. Am J Med. 2009;122(12):1122–1127. [PubMed Central][PubMed]
Arzt M, Young T, Finn L, Skatrud JB, Bradley TD. Association of sleep-disordered breathing and the occurrence of stroke. Am J Respir Crit Care Med. 2005;172(11):1447–1451. [PubMed Central][PubMed]
Redline S, Yenokyan G, Gottlieb DJ, et al. Obstructive sleep apnea-hypopnea and incident stroke: the sleep heart health study. Am J Respir Crit Care Med. 2010;182(2):269–277. [PubMed Central][PubMed]
Yaggi HK, Concato J, Kernan WN, Lichtman JH, Brass LM, Mohsenin V. Obstructive sleep apnea as a risk factor for stroke and death. N Engl J Med. 2005;353(19):2034–2041. [PubMed]
Yang EH, Hla KM, McHorney CA, Havighurst T, Badr MS, Weber S. Sleep apnea and quality of life. Sleep. 2000;23(4):535–541. [PubMed]
Akashiba T, Kawahara S, Akahoshi T, et al. Relationship between quality of life and mood or depression in patients with severe obstructive sleep apnea syndrome. Chest. 2002;122(3):861–865. [PubMed]
Durán-Cantolla J, Aizpuru F, Montserrat JM, et al. Continuous positive airway pressure as treatment for systemic hypertension in people with obstructive sleep apnoea: randomised controlled trial. BMJ. 2010;341:c5991[PubMed]
Martinez-Garcia MA, Capote F, Campos-Rodriguez F, et al. Effect of CPAP on blood pressure in patients with obstructive sleep apnea and resistant hypertension: the HIPARCO randomized clinical trial. JAMA. 2013;310(22):2407–2415. [PubMed]
Young T, Peppard PE, Gottlieb DJ. Epidemiology of obstructive sleep apnea: a population health perspective. Am J Respir Crit Care Med. 2002;165(9):1217–1239. [PubMed]
Martinez-Garcia MA, Soler-Cataluna JJ, Ejarque-Martinez L, et al. Continuous positive airway pressure treatment reduces mortality in patients with ischemic stroke and obstructive sleep apnea: a 5-year follow-up study. Am J Respir Crit Care Med. 2009;180(1):36–41. [PubMed]
Bolitschek J, Schmeiser-Rieder A, Schobersberger R, Rosenberger A, Kunze M, Aigner K. Impact of nasal continuous positive airway pressure treatment on quality of life in patients with obstructive sleep apnoea. Eur Respir J. 1998;11(4):890–894. [PubMed]
Marin JM, Carrizo SJ, Vicente E, Agusti AG. Long-term cardiovascular outcomes in men with obstructive sleep apnoea-hypopnoea with or without treatment with continuous positive airway pressure: an observational study. Lancet. 2005;365(9464):1046–1053. [PubMed]
Kanagala R, Murali NS, Friedman PA, et al. Obstructive sleep apnea and the recurrence of atrial fibrillation. Circulation. 2003;107(20):2589–2594. [PubMed]
Large Truck and Bus Crash Facts 2014. Federal Motor Carrier Safety Administration website. https://www.fmcsa.dot.gov/safety/data-and-statistics/large-truck-and-bus-crash-facts-2014. Published March 2016. Updated April 15, 2016. Accessed March 9, 2017.
Fatality Analysis Reporting System (FARS) Encyclopedia. National Highway Traffic Safety Administration website. https://www-fars.nhtsa.dot.gov/Main/index.aspx. Accessed March 9, 2017.
Hursh SR, Fanzone JF, Raslear TG. Analysis of the Relationship between Operator Effectiveness Measures and Economic Impacts of Rail Accidents. Federal Railroad Administration website. https://www.fra.dot.gov/eLib/details/L01301. Published May 2011. Accessed March 9, 2017.
National Cooperative Highway Research Program Report 755: Comprehensive Costs of Highway-Rail Grade Crossing Crashes. Transportation Research Board website. http://www.trb.org/Main/Blurbs/169061.aspx. Published 2013. Updated March 23, 2016. Accessed March 9, 2017.
Frost & Sullivan; American Academy of Sleep Medicine. Hidden health crisis costing America billions: underdiagnosing and undertreating obstructive sleep apnea draining health care system. American Academy of Sleep Medicine website. http://www.aasmnet.org/sleepapnea-economic-impact.aspx. Published August 8, 2016. Accessed March 9, 2017.
Gurubhagavatula I, Nkwuo JE, Maislin G, Pack AI. Estimated cost of crashes in commercial drivers supports screening and treatment of obstructive sleep apnea. Accid Anal Prev. 2008;40(1):104–115. [PubMed]
Tarasiuk A, Reuveni H. The economic impact of obstructive sleep apnea. Curr Opin Pulm Med. 2013;19(6):639–644. [PubMed]
Berger MB, Sullivan W, Owen R, Wu C. A Corporate Driven Sleep Apnea Detection and Treatment Program: Results and Challenges. Protecting Professional Drivers website. http://ppdsleep.com/sleep-dispoders-and-sleep-apnea-publications/. Published 2005. Accessed March 9, 2017.
Potts KJ, Butterfield DT, Sims P, Henderson M, Shames CB. Cost savings associated with an education campaign on the diagnosis and management of sleep-disordered breathing: a retrospective, claims-based US study. Popul Health Manag. 2013;16(1):7–13. [PubMed]
Hartenbaum N, Collop N, Rosen IM, et al. Sleep apnea and commercial motor vehicle operators: statement from the joint Task Force of the American College of Chest Physicians, American College of Occupational and Environmental Medicine, and the National Sleep Foundation. J Occup Environ Med. 2006;48 9Suppl:S4–S37. [PubMed]
Ancoli-Israel S, Czeisler CA, George CF, Guilleminault C, Pack AI. Expert Panel Recommendations: Obstructive Sleep Apnea and Commercial Motor Vehicle Driver Safety. Federal Motor Carrier Safety Administration website. https://cms.fmcsa.dot.gov/regulations/medical/expert-panel-recommendations-obstructive-sleep-apnea-and-commercial-motor. Published 2008. Accessed March 9, 2017.
January 28, 2008 MRB Meeting Summary. Federal Motor Carrier Safety Administration website. https://www.fmcsa.dot.gov/january-28-2008-mrb-meeting-summary. Published April 7, 2008. Updated November 24, 2009. Accessed March 9, 2017.
Proposed Recommendations on Obstructive Sleep Apnea. Federal Motor Carrier Safety Administration website. https://www.fmcsa.dot.gov/regulations/notices/2012-9555. Published April 20, 2012. Accessed March 9, 2017.
Final Report: OSA (MCSAC/MRB February 2012 meeting) (Task 11-05). Federal Motor Carrier Safety Administration website. https://www.fmcsa.dot.gov/advisory-committees/mcsac/final-report-osa-mcsacmrb-february-2012-meeting-task-11-05-0. Published February 21, 2012. Accessed March 9, 2017.
Colvin LJ, Collop NA. Commercial motor vehicle driver obstructive sleep apnea screening and treatment in the united states: an update and recommendation overview. J Clin Sleep Med. 2016;12(1):113–125. [PubMed Central][PubMed]
Dagan Y, Doljansky JT, Green A, Weiner A. Body mass index (BMI) as a first-line screening criterion for detection of excessive daytime sleepiness among professional drivers. Traffic Inj Prev. 2006;7(1):44–48. [PubMed]
Parks P, Durand G, Tsismenakis AJ, Vela-Bueno A, Kales S. Screening for obstructive sleep apnea during commercial driver medical examinations. J Occup Environ Med. 2009;51(3):275–282. [PubMed]
Talmage JB, Hudson TB, Hegmann KT, Thiese MS. Consensus criteria for screening commercial drivers for obstructive sleep apnea: evidence of efficacy. J Occup Environ Med. 2008;50(3):324–329. [PubMed]
National Standard for Health Assessment of Rail Safety Workers October 2012. National Transport Commission Australia website. https://www.ntc.gov.au/rail/safety/national-standard-for-health-assessment-of-rail-safety-workers/. Published October 2012. Updated March 16, 2013. Accessed March 9, 2017.
Xie W, Chakrabarty S, Levine R, Johnson R, Talmage JB. Factors associated with obstructive sleep apnea among commercial motor vehicle drivers. J Occup Environ Med. 2011;53(2):169–173. [PubMed]
Gurubhagavatula I. Does the rubber meet the road? Addressing sleep apnea in commercial truck drivers. Sleep. 2012;35(11):1443–1444. [PubMed Central][PubMed]
Zhang C, Berger M, Malhotra A, Kales SN. Portable diagnostic devices for identifying obstructive sleep apnea among commercial motor vehicle drivers: considerations and unanswered questions. Sleep. 2012;35(11):1481–1489. [PubMed Central][PubMed]
Aloia MS, Arnedt JT; Pack AI. Mechanisms of sleepiness in obstructive sleep apnea. Sleep Apnea: Pathogenesis, Diagnosis and Treatment. 2nd ed. New York, NY: Informa Healthcare; 2012.
Durmer JS, Dinges DF. Neurocognitive consequences of sleep deprivation. Semin Neurol. 2005;25(1):117–129. [PubMed]
Epstein LJ, Kristo D, Strollo PJ Jr, et al. Clinical guideline for the evaluation, management and long-term care of obstructive sleep apnea in adults. J Clin Sleep Med. 2009;5(3):263–276. [PubMed Central][PubMed]
Logan AG, Perlikowski SM, Mente A, et al. High prevalence of unrecognized sleep apnoea in drug-resistant hypertension. J Hypertens. 2001;19(12):2271–2277. [PubMed]
Pedrosa RP, Drager LF, Gonzaga CC, et al. Obstructive sleep apnea: the most common secondary cause of hypertension associated with resistant hypertension. Hypertension. 2011;58(5):811–817. [PubMed]
Foster GD, Sanders MH, Millman R, et al. Obstructive sleep apnea among obese patients with type 2 diabetes. Diabetes Care. 2009;32(6):1017–1019. [PubMed Central][PubMed]
Peppard PE, Young T, Palta M, Dempsey J, Skatrud J. Longitudinal study of moderate weight change and sleep-disordered breathing. JAMA. 2000;284(23):3015–3021. [PubMed]
Warsi A, Wang PS, LaValley MP, Avorn J, Solomon DH. Self-management education programs in chronic disease: a systematic review and methodological critique of the literature. Arch Intern Med. 2004;164(15):1641–1649. [PubMed]
Smith B, Phillips BA. Truckers drive their own assessment for obstructive sleep apnea: a collaborative approach to online self-assessment for obstructive sleep apnea. J Clin Sleep Med. 2011;7(3):241–245. [PubMed Central][PubMed]
Graber MA, Roller CM, Kaeble B. Readability levels of patient education material on the World Wide Web. J Fam Pract. 1999;48(1):58–61. [PubMed]
National Registry of Certified Medical Examiners website. https://nationalregistry.fmcsa.dot.gov/NRPublicUI/home.seam. Accessed March 9, 2017.
Parthasarathy S, Haynes PL, Budhiraja R, Habib MP, Quan SF. A national survey of the effect of sleep medicine specialists and American Academy of Sleep Medicine accreditation on management of obstructive sleep apnea. J Clin Sleep Med. 2006;2(2):133–142. [PubMed]
Parthasarathy S, Subramanian S, Quan SF. A multicenter prospective comparative effectiveness study of the effect of physician certification and center accreditation on patient-centered outcomes in obstructive sleep apnea. J Clin Sleep Med. 2014;10(3):243–249. [PubMed Central][PubMed]
DOT Rule 49 CFR Part 40 Section 40.21. United States Department of Transportation website. https://www.transportation.gov/odapc/part40/40_21. Accessed March 9, 2017.
Weaver TE, Chasens ER. Continuous positive airway pressure treatment for sleep apnea in older adults. Sleep Med Rev. 2007;11(2):99–111. [PubMed Central][PubMed]
Berry RB, Kushida CA, Kryger MH, Soto-Calderon H, Staley B, Kuna ST. Respiratory event detection by a positive airway pressure device. Sleep. 2012;35(3):361–367. [PubMed Central][PubMed]
Ramar K, Dort LC, Katz SG, et al. Clinical practice guideline for the treatment of obstructive sleep apnea and snoring with oral appliance therapy: an update for 2015. J Clin Sleep Med. 2015;11(7):773–827. [PubMed Central][PubMed]
Antic NA, Catcheside P, Buchan C, et al. The effect of CPAP in normalizing daytime sleepiness, quality of life, and neurocognitive function in patients with moderate to severe OSA. Sleep. 2011;34(1):111–119. [PubMed Central][PubMed]
Barbe F, Duran-Cantolla J, Sanchez-de-la-Torre M, et al. Effect of continuous positive airway pressure on the incidence of hypertension and cardiovascular events in nonsleepy patients with obstructive sleep apnea: a randomized controlled trial. JAMA. 2012;307(20):2161–2168. [PubMed]
Campos-Rodriguez F, Pena-Grinan N, Reyes-Nunez N, et al. Mortality in obstructive sleep apnea-hypopnea patients treated with positive airway pressure. Chest. 2005;128(2):624–633. [PubMed]
Johns MW. A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep. 1991;14(6):540–545. [PubMed]
Sassani A, Findley LJ, Kryger M, Goldlust E, George C, Davidson TM. Reducing motor-vehicle collisions, costs, and fatalities by treating obstructive sleep apnea syndrome. Sleep. 2004;27(3):453–458. [PubMed]
Bouloukaki I, Giannadaki K, Mermigkis C, et al. Intensive versus standard follow-up to improve continuous positive airway pressure compliance. Eur Respir J. 2014;44(5):1262–1274. [PubMed]
Colvin LJ, Dace GA, Colvin RM, Ojile J, Collop N. Commercial motor vehicle driver positive airway pressure therapy adherence in a sleep center. J Clin Sleep Med. 2016;12(4):477–485. [PubMed Central][PubMed]
Medical Examination Report For Commercial Driver Fitness Determination 649-F (6045). Federal Motor Carrier Safety Administration website. https://www.fmcsa.dot.gov/sites/fmcsa.dot.gov/files/docs/Medical_Examination_Report_for_Commercial_Driver_Fitness_Determination_649-F(6045).pdf. Accessed March 9, 2017.
MacLean AW, Davies DR, Thiele K. The hazards and prevention of driving while sleepy. Sleep Med Rev. 2003;7(6):507–521. [PubMed]
Hirshkowitz M, Whiton K, Albert SM, et al. National Sleep Foundation's updated sleep duration recommendations: final report. Sleep Health. 2015;1(4):233–243.
Bonato R, Bradley DC. Introducing a novel micro-recorder for the detection of oral appliance compliance: DentiTrac. Sleep Diagnosis and Therapy. 2013;8(3):12–15.