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      Commercial Driver Medical Examinations : Prevalence of Obesity, Comorbidities, and Certification Outcomes

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          The objective of this study was to assess relationships between body mass index (BMI) and comorbid conditions within a large sample of truck drivers.


          Commercial driver medical examination data from 88,246 commercial drivers between 2005 and 2012 were analyzed for associations between BMI, medical disorders, and driver certification.


          Most drivers were obese (53.3%, BMI >30.0 kg/m 2) and morbidly obese (26.6%, BMI >35.0 kg/m 2), higher than prior reports. Obese drivers were less likely to be certified for 2 years and more likely to report heart disease, hypertension, diabetes mellitus, nervous disorders, sleep disorders, and chronic low back pain (all P < 0.0001). There are relationships between multiple potentially disqualifying conditions and increasing obesity (P < 0.0001). Morbid obesity prevalence increased 8.9% and prevalence of three or more multiple conditions increased fourfold between 2005 and 2012.


          Obesity is related to multiple medical factors as well as increasing numbers of conditions that limit driving certification.

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          Most cited references 22

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          Obstructive sleep apnea and risk of motor vehicle crash: systematic review and meta-analysis.

          We performed a systematic review of the OSA-related risk of crash in commercial motor vehicle (CMV) drivers. The primary objective involved determining whether individuals with obstructive sleep apnea (OSA) are at an increased risk for a motor vehicle crash when compared to comparable individuals who do not have the disorder. A secondary objective involved determining what factors are associated with an increased motor vehicle crash risk among individuals with OSA. Seven electronic databases (MEDLINE, PubMed (PreMEDLINE), EMBASE, PsycINFO, CINAHL, TRIS, and the Cochrane library) were searched (through May 27, 2009), as well as the reference lists of all obtained articles. We included controlled studies (case-control or cohort) that evaluated crash risk in individuals with OSA. We evaluated the quality of each study and the interplay between the quality, quantity, robustness, and consistency of the body of evidence, and tested for publication bias. Data were extracted by 2 independent analysts. When appropriate, data from different studies were combined in a fixed- or random-effects meta-analysis. Individuals with OSA are clearly at increased risk for crash. The mean crash-rate ratio associated with OSA is likely to fall within the range of 1.21 to 4.89. Characteristics that may predict crash in drivers with OSA include BMI, apnea plus hypopnea index, oxygen saturation, and possibly daytime sleepiness. Untreated sleep apnea is a significant contributor to motor vehicle crashes.
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            Obesity and other risk factors: the national survey of U.S. long-haul truck driver health and injury.

            Drivers of heavy and tractor-trailer trucks accounted for 56% of all production and nonsupervisory employees in the truck transportation industry in 2011. There are limited data for illness and injury in long-haul truck drivers, which prompted a targeted national survey.
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              Systematic review of motor vehicle crash risk in persons with sleep apnea.

              To determine whether drivers with sleep apnea are at increased risk of motor vehicle crash; whether disease severity, daytime sleepiness, or both disease severity and daytime sleepiness affect this risk, and whether treatment of sleep apnea reduces crash risk. Systematic review of published literature. N/A. Patients with sleep apnea. N/A. Forty pertinent studies were identified. For studies investigating whether noncommercial drivers with sleep apnea have increased crash rates, the majority (23 of 27 studies and 18 of 19 studies with control groups) found a statistically significant increased risk, with many of the studies finding a 2 to 3 times increased risk. Methodologic quality of the studies did not influence this relationship (p = .22). For commercial drivers, only 1 of 3 studies found an increased crash rate, with this association being weak (odds ratio of 1.3). The evidence was mixed regarding whether the risk of crash involvement is proportional to the severity of the sleep apnea, with about half of the studies finding a statistically significant increased risk with increased severity. Correlation with subjective daytime sleepiness and crash risk was also found in only half of the studies reviewed. Treatment of sleep apnea consistently improved driver performance (including crashes) across all studies. Noncommercial drivers with sleep apnea are at a statistically significant increased risk of involvement in motor vehicle crashes. Studies did not consistently find that daytime sleepiness and the severity of sleep apnea were correlated with crash risk. Successful treatment of sleep apnea improves driver performance. Clinicians should educate their patients with sleep apnea about the importance of treatment adherence for driving safety.

                Author and article information

                From the Rocky Mountain Center for Occupational & Environment Health (Drs Thiese and Hegmann), Department of Family and Preventive Medicine, School of Medicine, University of Utah, Salt Lake City; Arkansas Occupational Health Clinic (Dr Moffitt), Springdale; Center for Truck and Bus Safety (Dr Hanowski), Virginia Tech Transportation Institute, Blacksburg; Department of Environmental Health (Dr Kales), School of Public Health, Harvard, Cambridge, Mass; and Utah Traffic Lab (Dr Porter), Department of Civil & Environmental Engineering, University of Utah, Salt Lake City.
                Author notes
                Address correspondence to: Matthew S. Thiese, PhD, Rocky Mountain Center for Occupational & Environment Health, Department of Family and Preventive Medicine, School of Medicine, University of Utah, 391 Chipeta Way, Ste C, Salt Lake City, UT 84108 ( matt.thiese@ ).
                J Occup Environ Med
                J. Occup. Environ. Med
                Journal of Occupational and Environmental Medicine
                American College of Occupational and Environmental Medicine
                June 2015
                06 September 2015
                : 57
                : 6
                : 659-665
                © 2015 by American College of Occupational and Environmental Medicine

                This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License, where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially.

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