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Indications for commercial drivers to be evaluated by a sleep medicine physician

Indications for commercial drivers to be evaluated by a sleep medicine physician
Primary criteria Secondary criteria
  1. BMI ≥40 kg/m2 or
  2. BMI ≥33 kg/m2 and either
    1. Hypertension requiring ≥2 medications for control or
    2. Type 2 diabetes
  3. Sleepiness-related crash or accident, off-road deviation, or rear-ending another vehicle by report or observation
  4. Fatigue or sleepiness during the duty period
  1. Symptoms of OSA, which include but are not limited to:
    • Loud, habitual snoring
    • Witnessed apneas
    • Sleepiness during the major wake period*
  2. BMI 28 to 33 kg/m2 with any of the following risk factors of OSA
    • Small or recessed jaw
    • Small airway (modified Mallampati classification of 3 or 4)
    • Neck size ≥17 inches (males), ≥15.5 inches (females)
    • Hypertension (especially if resistant)
    • Type 2 diabetes, particularly if accompanied by obesity
    • Cardiovascular disease
    • Hypothyroidism (untreated)
    • Age 42 years or older
    • Family history of OSA
    • Male, or postmenopausal female

BMI: body mass index; OSA: obstructive sleep apnea.

* Absence of reported symptoms is less useful than the presence of symptoms.

¶ Combination of factors has greater risk than a single risk factor.
Republished with permission of the American Academy of Sleep Medicine, from: Gurubhagavatula I, Sullivan S, Meoli A, et al. Management of obstructive sleep apnea in commercial motor vehicle operators: Recommendations of the AASM Sleep and Transportation Safety Awareness Task Force. J Clin Sleep Med 2017; 13:745; permission conveyed through Copyright Clearance Center, Inc. Copyright © 2017.
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