title: Nonadherence with Employer-Mandated Sleep Apnea Treatment and Increased Risk of Serious Truck Crashes.
abstract: To evaluate the effect of an employer-mandated obstructive sleep apnea (OSA) program on the risk of serious preventable truck crashes.
  
  
  
  Data are from the first large-scale, employer-mandated program to screen, diagnose, and monitor OSA treatment adherence in the US trucking industry. A retrospective analysis of cohorts was constructed: polysomnogram-diagnosed drivers (OSA positive n = 1,613, OSA negative n = 403) were matched to control drivers unlikely to have OSA (n = 2,016) on two factors affecting crash risk, experience-at-hire and length of job tenure; tenure was matched on the date of each diagnosed driver's polysomnogram. Auto-adjusting positive airway pressure (APAP) treatment was provided to all cases (i.e. OSA positive drivers); treatment adherence was objectively monitored. Cases were grouped by treatment adherence: "Full Adherence" (n = 682), "Partial Adherence" (n = 571), or "No Adherence" (n = 360). Preventable Department-of-Transportation-reportable crashes/100,000 miles were compared across study subgroups. Robustness was assessed.
  
  
  
  After the matching date, "No Adherence" cases had a preventable Department of Transportation-reportable crash rate that was fivefold greater (incidence rate ratio = 4.97, 95% confidence interval: 2.09, 10.63) than that of matched controls (0.070 versus 0.014 per 100,000 miles). The crash rate of "Full Adherence" cases was statistically similar to controls (incidence rate ratio = 1.02, 95% confidence interval: 0.48, 2.04; 0.014 per 100,000 miles).
  
  
  
  Nontreatment-adherent OSA-positive drivers had a fivefold greater risk of serious preventable crashes, but were discharged or quit rapidly, being retained only one-third as long as other subjects. Thus, the mandated program removed risky nontreatment-adherent drivers and retained adherent drivers at the study firm. Current regulations allow nonadherent OSA cases to drive at another firm by keeping their diagnosis private.
  
  
  
  A commentary on this article appears in this issue on page 961.
authors.affiliation: Division of Social Science, University of Minnesota, Morris, MN.|Center for Transportation Studies, University of Minnesota, Morris, MN.|Institute for the Study of Labor (IZA), Bonn, DE.
authors.forename: Stephen V
authors.initials: SV
authors.lastname: Burks
authors.affiliation: Division of Science and Math, University of Minnesota, Morris, MN.
authors.forename: Jon E
authors.initials: JE
authors.lastname: Anderson
authors.affiliation: Division of Social Science, University of Minnesota, Morris, MN.
authors.forename: Matthew
authors.initials: M
authors.lastname: Bombyk
authors.affiliation: Division of Social Science, University of Minnesota, Morris, MN.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Haider
authors.affiliation: Division of Social Science, University of Minnesota, Morris, MN.
authors.forename: Derek
authors.initials: D
authors.lastname: Ganzhorn
authors.affiliation: Division of Social Science, University of Minnesota, Morris, MN.
authors.forename: Xueyang
authors.initials: X
authors.lastname: Jiao
authors.affiliation: Division of Science and Math, University of Minnesota, Morris, MN.
authors.forename: Connor
authors.initials: C
authors.lastname: Lewis
authors.affiliation: Division of Science and Math, University of Minnesota, Morris, MN.
authors.forename: Andrew
authors.initials: A
authors.lastname: Lexvold
authors.affiliation: Division of Social Science, University of Minnesota, Morris, MN.
authors.forename: Hong
authors.initials: H
authors.lastname: Liu
authors.affiliation: Division of Social Science, University of Minnesota, Morris, MN.
authors.forename: Jiachen
authors.initials: J
authors.lastname: Ning
authors.affiliation: Division of Science and Math, University of Minnesota, Morris, MN.
authors.forename: Alice
authors.initials: A
authors.lastname: Toll
authors.affiliation: Virginia Tech Transportation Institute, Blacksburg, VA.
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Hickman
authors.affiliation: Virginia Tech Transportation Institute, Blacksburg, VA.
authors.forename: Erin
authors.initials: E
authors.lastname: Mabry
authors.affiliation: Precision Pulmonary Diagnostics, Houston, TX.
authors.forename: Mark
authors.initials: M
authors.lastname: Berger
authors.affiliation: Division of Pulmonary and Critical Care Medicine, School of Medicine, University of California, San Diego, San Diego, CA.
authors.forename: Atul
authors.initials: A
authors.lastname: Malhotra
authors.affiliation: Division of Sleep Medicine and Circadian Disorders, Department of Medicine and Neurology, Brigham and Women's Hospital, Boston, MA.|Division of Sleep Medicine, Harvard Medical School, Boston, MA.
authors.forename: Charles A
authors.initials: CA
authors.lastname: Czeisler
authors.affiliation: Division of Sleep Medicine, Harvard Medical School, Boston, MA.|Department of Environmental and Occupational Medicine and Epidemiology, Harvard TH Chan School of Public Health, Boston, MA.|Occupational Medicine, Cambridge Health Alliance, Harvard Medical School, Cambridge, MA.
authors.forename: Stefanos N
authors.initials: SN
authors.lastname: Kales
mesh_terms: D000063:Accidents, Traffic / Q000517:prevention & control / Q000706:statistics & numerical data*; D000328:Adult; D001334:Automobile Driving; D005260:Female; D006801:Humans; D008297:Male; D037141:Mandatory Programs; D008403:Mass Screening; D008875:Middle Aged; D018986:Motor Vehicles; D009786:Occupational Health Services / Q000706:statistics & numerical data; D010349:Patient Compliance / Q000706:statistics & numerical data*; D017286:Polysomnography; D012189:Retrospective Studies; D012307:Risk Factors; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis* / Q000523:psychology / Q000628:therapy*; D055815:Young Adult
keywords: APAP; CPAP; OSA; PSG; commercial motor vehicle operator; motor carrier; obstructive sleep apnea; preventable crash; screening; truckload