Assessment and policy for commercial driver license referrals.
This report describes experiences, subsequent action, and policy recommendations regarding sleep disorders assessment of veterans in relation to a commercial driver medical examiner referral. A series of 6 veterans were seen in our sleep clinic, presenting with an order from a commercial driver medical examiner (CDME) for polysomnography and/or Multiple Sleep Latency Testing (PSG/MSLT). We searched the literature for an evidence-based justification for handling this referral, and we concluded that there is neither federal policy nor current evidence to suggest that any current diagnostic test, including PSG/MSLT and/or MWT, is capable of predicting which individual drivers are at risk for fall-asleep crashes. The best indicator of risk is self-reported sleepiness, regardless of cause. Thus, we concluded that an administrative request for a "PSGIMSLT" is not a rational use of VA resources. Procedures and a policy for the Cleveland VA system were developed to respond to the request for evaluation, recognizing that sleep problems and disorders other than sleep apnea may be present in this population. An educational component was an important feature of this response. We suspect that this approach may be appropriate for managed care systems in general.
Miller
Christopher M
CM
Louis Stokes DVA Medical Center, Division of Pulmonary and Critical Care Medicine, Department ofFamily Medicine, Case Western Reserve University, Cleveland, OH 44107, USA. chrismandelmiller@yahoo.com
Khanna
Amit
A
Strohl
Kingman P
KP
D001333:Automobile Driver Examination; D006266:Health Education / Q000379:methods; D006291:Health Policy; D006801:Humans; D008297:Male; D009820:Ohio; D017286:Polysomnography / Q000379:methods; D011237:Predictive Value of Tests; D012017:Referral and Consultation / Q000592:standards*; D012307:Risk Factors; D012891:Sleep Apnea Syndromes / Q000150:complications / Q000175:diagnosis; D012893:Sleep Wake Disorders / Q000150:complications* / Q000175:diagnosis; D014481:United States; D014493:United States Department of Veterans Affairs; D014728:Veterans
Eur Respir J. 1996 Dec;9(12):2606-11
8980976
Sleep. 1995 Nov;18(9):787-96
8638073
N Engl J Med. 1997 Sep 11;337(11):755-61
9287232
Sleep. 1997 Oct;20(10):835-43
9415942
JAMA. 1998 Jun 17;279(23):1908-13
9634264
N Engl J Med. 1999 Mar 18;340(11):881-3
10080854
Sleep. 1999 Sep 15;22(6):790-5
10505825
Behav Sleep Med. 2003;1(3):171-83
15600220
Sleep Med. 2005 Mar;6(2):155-62
15716219
JAMA. 2005 Sep 7;294(9):1025-33
16145022
Chest. 2006 Sep;130(3):902-5
16963693
Psychophysiology. 2000 Mar;37(2):251-6
10731775
Accid Anal Prev. 2000 Jul;32(4):493-504
10868752
Am J Respir Crit Care Med. 2004 Mar 15;169(6):668-72
15003950
Sleep. 2004 May 1;27(3):369-70
15164885
Sleep. 2004 May 1;27(3):453-8
15164898
Sleep. 1991 Dec;14(6):540-5
1798888
Am J Respir Crit Care Med. 1994 Nov;150(5 Pt 1):1463-73
7952578
Accid Anal Prev. 1997 Jul;29(4):541-53
9248513