Hits and misses: screening commercial drivers for obstructive sleep apnea using guidelines recommended by a joint task force.

Abstract

To evaluate joint task force criteria-based screening for severe obstructive sleep apnea (s-OSA) in commercial drivers. Among a community-based cohort of licensed commercial vehicle drivers, we assessed utility of the joint task force criteria. We conducted full, 14-channel overnight polysomnography in all drivers, defining s-OSA as an apnea-hypopnea index of 30 or more per hour. One hundred of 104 drivers with successful polysomnography studies were predominantly obese (median body mass index = 32.8 kg/m; interquartile range = 26.8 to 37.4) and had a median apnea-hypopnea index of 20.6 per hour (interquartile range = 10.0 to 34.2). Examination-based criteria were more effective (sensitivity = 80%; negative posttest probability [nPTP] = 17%) than symptom-based criteria (sensitivity = 63%; nPTP = 23%). Examination and symptom-based criteria combined had high sensitivity (97%) and low nPTP (7%), but poor specificity (19%). Examination-based criteria missed 20% of s-OSA cases. Combining examination with confidentially reported symptoms improved sensitivity but required confirmatory polysomnography in 86%, supporting universal screening of all drivers.