1. Truckers Drive Their Own Assessment for Obstructive Sleep Apnea: A Collaborative Approach to Online Self-Assessment for Obstructive Sleep Apnea Ben Smith, MS, North Carolina State University Gary Hull, TFAC/AWAKE Bob Stanton, TFAC/AWAKE Barbara Phillips, MD, MSPH, FCCP, University of Kentucky

2. Disclosures Benjamin Smith: –IBM PhD Fellowship –NSF Career Grant No. 0346903 Gary Hull-None Bob Stanton-None Barbara Phillips: –Department of Transportation, FMCSA –Cephalon –PriMed (funded by ResMed, Philips) –Barnwell, Whaley, LLC

3. Obstructive Sleep Apnea (OSA) and Commercial Motor Vehicle Drivers (CMVDs) Approximately 5,600 people are killed every year in crashes with commercial motor vehicles. Between 20 and 30% of crashes with CMVDs are sleep-related (Akerstedt T J Sleep Res 2000) At least 25% of CMVDs have OSA (Pack A AJRCCM 2006)

4. Commercial Drivers Carry Increased Risk for Crash They may operate larger vehicles transport hazardous materials carry multiple passengers operate for longer stretches of time have an economic incentive to continue driving when private drivers may choose to stop for a medical reason or road conditions.

5. The Federal Motor Carrier Safety Administration (FMCSA) Regulates CMVD’s

6. Background/Rationale Based on an evidence review The FMCSA Medical Expert Panel recommended that CMVDs undergo testing for OSA if –they have a positive Berlin Questionnaire and/or –BMI > 33 kg/m 2. The FMCSA Medical Review Board recommended that CMVDs undergo testing for OSA if –they have a positive Berlin Questionnaire and/or –BMI > 30 kg/m 2.

7. Development of Collaboration Truckers for a Cause- Alert, Well, And Keeping Energetic (TFAC- AWAKE), responding to requests from participants, desired to host a screener for OSA on its website. TFAC-AWAKE leader sought help with website screener development. Collaborators agreed to publish the anonymous results. The study was exempted by UK IRB.

8. Methods We adapted the Berlin Questionnaire ( Netzer NC Ann Intern Med 1999) to be taken online. TFAC-AWAKE hosted the survey on their website. TFAC’s XM radio, word of mouth and trucking industry press contacts offered promotion. We collected IP addresses to ensure that each participant only took the survey once, but we collected no other identifying data.

10. Not all word of mouth was good…

11. The Berlin Questionnaire (Netzer NC Annals 1999) 1.Do you snore? 2.How loud do you snore? 3.How often do you snore? 4.Has your snoring ever bothered other people? 5.Has anyone noticed that you quit breathing during your sleep? 6.How often do you feel tired or fatigued after your sleep? 7.During your waking time, do you feel fatigued, or not up to par? 8.Have you ever nodded off or fallen asleep while driving a vehicle? 9.Do you have high blood pressure? 10.What is your BMI? I: Snoring II: Sleepiness III: Objective

12. The Berlin Questionnaire (Netzer NC Annals 1999) 1.Do you snore? 2.How loud do you snore? 3.How often do you snore? 4.Has your snoring ever bothered other people? 5.Has anyone noticed that you quit breathing during your sleep? 6.How often do you feel tired or fatigued after your sleep? 7.During your waking time, do you feel fatigued, or not up to par? 8.Have you ever nodded off or fallen asleep while driving a vehicle? 9.Do you have high blood pressure? 10.What is your BMI?

13. Aims and Hypotheses Aims –to determine if truckers would assess their OSA risk online. –to collect demographic data from self-selected truckers. Hypotheses –those with OSA symptoms (snoring, sleepiness) would be more likely to report drowsy driving, but –objective data (BMI, hypertension history) would predict sleepy driving better than would subjective data.

14. Data analysis The website was active to collect data from January 11, 2010 until September 24, 2010. We performed Logistic Regression Analyses using the R statistical package.

15. Results 595 of CMVDs took the survey 55.9% positive on overall Berlin –78.3% positive on objective (BMI, bp) part 69.6% had a BMI > 30 Kg/m 2 47.6% had BMI > 33 Kg/m 2 20.5% reported falling asleep while driving (on Berlin)

16. Sleepy Driving Associated with… QuestionSignificance (Logit. Regression p -value) Overall Berlin Score0.00 Do you snore?< 0.01 How loud is your snoring?< 0.0001 Does your snoring bother other people?< 0.01 How often do you snore?< 0.0001 How often has someone noticed that you quit breathing during your sleep? < 0.0001 How often do you feel tired or fatigued after your sleep? 0.00 During your wake time, how often do you feel fatigued, or not up to par? 0.00 What kind of commercial vehicle do you drive? < 0.05 (Commercial Vehicles the highest)

17. Witnessed Apneas Associated with… QuestionSignificance (Logit. Regression p-value) Overall Berlin Score0.00 Do you snore?Yes (p=0.00), Maybe (p=0.09) How loud is your snoring?0.00 Does your snoring bother other people?< 0.01 How often do you snore?0.00 How often has someone noticed that you quit breathing during your sleep? 0.00 During your wake time, how often do you feel fatigued, or not up to par? 0.00 What kind of commercial vehicle do you drive? < 0.05 (Commercial Vehicles the lowest)

18. Conclusions This was a unique and interesting collaboration! Truckers willingly assess their OSA risk online. The rate of obesity is high in this group. More than two-thirds of those who do so would be required to undergo polysomnography (PSG) if suggested guidelines become regulation. Subjective symptoms were associated with sleepy driving, but objective findings were not. Sleep health professionals need to develop expedient, non- punitive tools to keep CMVDs healthy and driving.

20. OSA Increases the Risk of Crash (FMCSA, 2007, Tregear S, JCSM 2009)