Screening for Obstructive Sleep Apnea in DOT Commercial Drivers

Almost everyday I get confirmation that there are misconceptions and inconsistencies with how medical examiners are managing the screening, evaluation, and management of sleep apnea in commercial drivers.

We have had several trucking companies contact us to find out what our testing protocol is for sleep apnea during the DOT exam. There is an occupational clinic in our area that has recently begun to send every patient whose neck measures more than 17” for sleep apnea testing, which has been costing trucking companies a lot of money.  Is this something that we should also be automatically referring out for? Dr. Jonathon’s training course did not harp on sleep apnea besides questioning alertness, feeling resting when waking, snoring, trouble sleeping, etc.  He was not under the impression that he has to measure and refer every patient over 17”.  This doesn’t make sense to us as doctors because people of all shapes and sizes can have sleep apnea, regardless of their neck size.

sleep lab patient


This sort of arbitrary thinking that everyone with a certain neck size or BMI as a solitary criteria for ordering a sleep test is unsophisticated and plain nonsense.  There are multiple factors that should be looked at.
For screening, I recommend the “STOP-BANG” method:
Snoring-loud, as in heard easily in the next room
Tiredness during the normal waking hours
Observed Apneas
Pressure = HTN
BMI >=35 (some would argue 33 is the right number)
Age >=50
Neck Size > 17″ in males, 16″ in females
Gender – male or postmenopausal female.
A certain combination of these factors +/- other conditions would lead to a high risk of obstructive sleep apnea in the commercial driver and should be evaluated further.
OSA algoritm graphic
In our course we teach all the research available to date to give you confidence to assess and manage these drivers appropriately, including:
  • The impact obstructive sleep apnea has on large truck accidents, injuries and fatalities
  • How to use the right screening tools on every driver, every exam
  • How to order a sleep test, when to consider home sleep testing (HST) vs a polysomnography
  • Interpretation of the test in collaboration with a sleep specialist
  • How to determine when a driver needs treatment for sleep apnea
  • Recommended treatments
  • Certification or disqualification criteria and appropriate intervals
  • How to determine compliance with treatment and guide further certification/disqualfication
  • and more!

Managing Obstructive Sleep Apnea in Commercial Drivers