title: Hits and misses: screening commercial drivers for obstructive sleep apnea using guidelines recommended by a joint task force.
abstract: OBJECTIVE
  To evaluate joint task force criteria-based screening for severe obstructive sleep apnea (s-OSA) in commercial drivers.
  
  
  METHODS
  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.
  
  
  RESULTS
  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%).
  
  
  CONCLUSIONS
  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.
authors: Respiratory Specialists, Wyomissing, USA. alecplatt@gmail.com
authors: Alec B
authors: AB
authors: Platt
authors: Lindsay C
authors: LC
authors: Wick
authors: Sharon
authors: S
authors: Hurley
authors: Haideliza
authors: H
authors: Soto-Calderon
authors: Will
authors: W
authors: Wieland
authors: Beth
authors: B
authors: Staley
authors: Greg
authors: G
authors: Maislin
authors: Indira
authors: I
authors: Gurubhagavatula
mesh_terms: D000293:Adolescent; D000328:Adult; D026683:Advisory Committees; D000368:Aged; D001334:Automobile Driving; D015992:Body Mass Index; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D009765:Obesity / Q000150:complications / Q000175:diagnosis; D009784:Occupational Diseases / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D010414:Pennsylvania / Q000453:epidemiology; D010808:Physical Examination; D017286:Polysomnography; D017410:Practice Guidelines as Topic; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors; D057566:Self Report; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D016037:Single-Blind Method; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D055815:Young Adult