If we start with the premise that a commercial driver can be both 100% compliant with HoS regulations and sound asleep at the wheel at the same time, then we have a starting point for healthy debate about the best way to design safety programs. To suggest otherwise and imply compliance to unsafe regulations equates to safer on road outcomes is misleading at best and fatal at worst.
We implore and even demand drivers be safe, yet fail to equip them with the flexibility or schedule to sleep when they need it. Sleep deprivation can be caused by inconsistent trip start/end times and those impossible 10-hour breaks that occur after sunrise.
Far too often we see veteran drivers survive millions of miles without incident only to end their career (and sometimes their lives) with just one major wreck as their aging body clock finally catches up with them.
Several studies have been done to evaluate the validity and usefulness of OPO in the screening of OSA [Table 1]. Hang et al. studied a total of 616 patients with nocturnal oximetry and PSG study and showed that OPO is a satisfactory diagnostic tool for patients with severe OSA.
OPO has a role in the screening of OSA in obese patients too. Morbid obesity (BMI >40 kg/m2) leads to a decreased basal nocturnal saturation due to the supine hypoventilation, hypoxemia, and hypercapnia during sleep secondary to a large abdomen, reduced diaphragmatic excursions, and low chest wall compliance. These factors result in increased susceptibility to SDB. The OPO shows a combination of low baseline oximetry (i.e., low T-90) and evidence of intermittent hypoxemia.
In a study by Elman et al., 87 nocturnal oximetry evaluations were done on 78 ALS patients symptomatic for SDB. These measurements were compared for those with forced vital capacity (FVC) >50% versus those with FVC of
Although OPO is not a substitute for PSG, the low cost and convenience of this technique has stimulated its application in ALS.[43,45,46] A mean nocturnal O2 saturation below 93% as detected by OPO is of prognostic value in ALS. Furthermore, NIV adapted to patients with early changes as registered by OPO permitted a longer survival compared with a group of patients who started NIV when FVC declined to 50% or less. 2b1af7f3a8