Study: Low-cost screening test may lead to fewer fatigue-related crashes

More than 5,000 people are killed and another 100,000 injured annually in the U.S. in accidents involving large trucks and buses. Nearly one-third of the accidents are attributable to fatigue.

With that in mind, researchers set out to determine whether a simple, 10-minute test administered during routine exams could better identify people susceptible to daytime sleepiness. Their study, published the Journal of Occupational and Environmental Medicine, shows promising results.

The most common cause of excessive daytime sleepiness is obstructive sleep apnea, a sleep disorder that also may cause fatigue, lack of concentration/attention, and difficulty remaining alert. Left untreated, OSA is associated with a two to sevenfold increase in motor vehicle crashes, according to the researchers.

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Among commercial drivers, the prevalence of OSA ranges from 12 to 28 percent. But the lack of a federal mandate for medical examiners and trucking companies to screen drivers for OSA makes detection difficult.

The study involved the use of psychomotor vigilance testing on 193 commercial drivers during employment mandated exams at an occupational health clinic between July 2009 and November 2010. PVT is a 10-minute test which rapidly assesses attention, reaction time, and abnormal vigilance. They concluded psychomotor vigilance testing may be an adjunct to screening drivers for high-risk obstructive sleep apnea/excessive daytime sleepiness.

Findings. The researchers found that the vigilance test was particularly noteworthy in detecting OSA in a subset of males who might otherwise have been overlooked. These drivers were identified as microsleepers, meaning they had higher reaction times.

Obese participants were significantly more likely to be at or above the 95th percentile for what the researchers called "super lapses," and the mean slowest 10 percent of reaction times than normal weight and overweight subjects. A subset of these obese workers are excluded from other OSA screening tests because their body mass index was between 30 and 35.

"Given a prevalence of obesity as high as 50 percent among commercial drivers and a prevalence of OSA as high as 12 to 28 percent, the PVT may be a promising adjunct which would allow the rapid identification of a smaller driver subset," the researchers wrote. "We do not see the PVT as replacing traditional, anthropometric OSA screening, but serving as an important added functional screen."

The researchers said their results showed the feasibility of using the test as a potentially effective point of care screening instrument within a commercial driver medical exam at an occupational health clinic. "Further studies in representative clinical and occupational populations are necessary to validate whether the PVT is adequately sensitive and specific to predict EDS related to OSA and most importantly, crash risk."

Read more at the WorkersComp Forum homepage.

September 8, 2011

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