title: Estimated cost of crashes in commercial drivers supports screening and treatment of obstructive sleep apnea.
abstract: Sleep apnea among commercial drivers may increase the risk of fall-asleep crashes, which incur large expenses. Drivers of passenger cars whose apnea is treated experience lower crash risk. Among community-based holders of commercial driver's licenses, we considered three methods for identifying sleep apnea syndrome: (1) in-lab polysomnography; (2) selective in-lab polysomnography for high-risk drivers, where high risk is first identified by body mass index, age and gender, followed by oximetry in a subset of drivers; (3) not screening. The costs for each of these three programs equaled the sum of the costs of testing, treatment of identified cases, and crashes. Assuming that treatment prevents apnea-related crashes, polysomnography is not cost-effective, because it was more expensive than the cost of crashes when no screening is done. Screening with BMI, age and gender, however, with confirmatory in-lab polysomnography only on high-risk drivers was cost-effective, as long as a high proportion (73.8%) of screened drivers accepts treatment. These findings indicate that strategies that reduce reliance on in-laboratory polysomnography may be more cost-effective than not screening, and that treatment acceptance may need to be a condition of employment for affected drivers.
authors.affiliation: Center for Sleep and Respiratory Neurobiology, Division of Sleep Medicine, Department of Medicine, University of Pennsylvania Medical Center, Philadelphia, PA 19104, United States. gurubhag@mail.med.upenn.edu
authors.forename: Indira
authors.initials: I
authors.lastname: Gurubhagavatula
authors.forename: Jonathan E
authors.initials: JE
authors.lastname: Nkwuo
authors.forename: Greg
authors.initials: G
authors.lastname: Maislin
authors.forename: Allan I
authors.initials: AI
authors.lastname: Pack
mesh_terms: D000062:Accidents, Occupational / Q000191:economics*; D000063:Accidents, Traffic / Q000191:economics*; D000328:Adult; D045422:Continuous Positive Airway Pressure / Q000191:economics; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010092:Oximetry / Q000191:economics; D017286:Polysomnography / Q000191:economics* / Q000379:methods; D011237:Predictive Value of Tests; D012307:Risk Factors; D020181:Sleep Apnea, Obstructive / Q000150:complications / Q000175:diagnosis* / Q000628:therapy*; D014186:Transportation