Document Type

Dissertation

Degree

Doctor of Nursing Practice

Major

Nursing

Date of Defense

8-4-2015

Graduate Advisor

Susann Farberman, DNP

Committee

Miles Patterson

Richard Yakimo

Loretta Colvin

Abstract

Abstract The transportation industry has the third highest occupational risk for death and disability (BLS, 2010) with 7% of Commercial Motor Vehicle Drivers (CMVD) falling asleep while driving (NHTSA, 2006). One contributing factor may be undiagnosed Obstructive Sleep Apnea (OSA) (Tregear et al, 2009). In 2006, a Joint Task Force (JTF) published screening recommendations for OSA, which led to a change in the Department of Transportation screening practices within a local Occupational Medicine clinic. The purpose of this study was to: (a) determine what percentage of drivers having had a positive clinical screening examination (met two of three objective measures) tested positive for a diagnosis of OSA (b) determine what percentage of drivers diagnosed with OSA had an Apnea-Hypopnea-Index (AHI) greater than or equal to 20 abnormal breaths per hour, meeting the threshold for mandatory treatment, (c) determine the relationship between Body Mass Index (BMI), hypertension and neck circumference with a diagnosis of OSA. The electronic medical records of 182 drivers were reviewed. Of these, 143 were found eligible for the study with the following findings: 63% (n = 90) clinically screened positive and underwent confirmatory testing by Polysomnography (PSG). Of these, 92% (n = 83) were found to have OSA, and 48% (n = 43) met the threshold for mandatory treatment. The study found no correlation between a diagnosis of OSA and BMI. Hypertension was found to have an inverse relationship. Neck circumference was found to have a significant positive correlation. No drivers self-reported daytime sleepiness and would have been missed using the current recommendations. Screening the CMVD for OSA with self-reported symptoms of sleepiness is not adequate. This study shows the importance of neck circumference as the best predictor of identifying OSA.

Included in

Nursing Commons

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