REVIEW: PORTABLE DIAGNOSTIC DEVICES FOR IDENTIFYING OSA IN CMV DRIVERS
Portable Diagnostic Devices for Identifying Obstructive Sleep Apnea among Commercial Motor Vehicle Drivers: Considerations and Unanswered Questions
Chunbai Zhang, MD, MPH1,3,4; Mark Berger, MD2; Atul Malhotra, MD3,4; Stefanos N. Kales, MD, MPH1,4,5
1Environmental and Occupational Medicine and Epidemiology, Harvard School of Public Health, Boston, MA; 2Precision Pulmonary Diagnostics, 8275 El Rio Street, Houston, TX; 3Division of Sleep Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA; 4Division of Sleep Medicine, Harvard Medical School, Boston, MA; 5Employee and Industrial Medicine, Cambridge Health Alliance, Cambridge, MA
Obstructive sleep apnea (OSA), a syndrome defined by breathing abnormalities during sleep, can lead to fatigue and excessive daytime sleepiness (EDS) with an increased risk of motor vehicle crashes. Identifying commercial motor vehicle operators with unrecognized OSA is a major public health priority. Portable monitors (PMs) are being actively marketed to trucking firms as potentially lower-cost and more accessible alternatives to the reference standard of in-laboratory polysomnography (PSG) in the diagnosis of OSA among commercial motor vehicle operators. Several factors regarding PMs remain uncertain in this unique patient population: their sensitivity and specificity; the cost-benefit ratio of the PMs versus PSG; potential barriers from human factors; and evolving technologic advancement. Human factors that alter test accuracy are a major concern among commercial drivers motivated to gain/maintain employment. Current available data using PMs as a diagnostic tool among CMV operators indicate relatively high data loss and high loss to follow-up. Loss to follow-up has also been an issue using PSG in commercial motor vehicle operators. Furthermore, PM testing and PM results interpretation protocols may have no sleep specialist oversight, and sometimes minimal physician oversight and involvement. Additional studies comparing unattended and unmonitored PMs directly against full in-laboratory PSG are needed to provide evidence for their efficacy among commercial motor vehicle operators.
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.