What Would You Do?

This recurring newsletter is designed to keep your mind sharp and 

well-informed about DOT regulations and guidelines. 

Stay informed! Stay compliant! 

Scenario:

A 48-year-old male presents for a DOT physical. Their medical history is positive for hypertension which is controlled with Lisinopril. He also has a 4-year history of sleep apnea. He was being treated with a CPAP machine but was unable to tolerate the mask, even after being properly fitted and trying multiple styles. Just over a year ago, he had an Inspire device implanted for the treatment of his sleep apnea. Significant exam findings include a blood pressure of 129/84, BMI of 42, and a neck size of 18.5”. There are no other significant findings.

What would you do?

Discussion:

Inspire is a device that is surgically implanted to treat obstructive sleep apnea (OSA). It works by delivering electrical impulses to keep the tongue forward, which helps maintain an open airway during sleep. 

An oral sleep apnea device, also called a mandibular advancement device (MAD), works by gently pushing the lower jaw forward during sleep, which prevents the tongue from collapsing backward and obstructing the airway, allowing for easier breathing and reducing sleep apnea symptoms. Oral devices are acceptable if the individual can demonstrate compliance. 

How do these devices measure compliance?

The Inspire device must be activated by a handheld remote before the individual falls asleep, allowing it to measure compliance based on the amount of usage. A downloadable mobile app allows users to track and share data.

Oral devices may have an implanted chip that will detect and record the change in temperature, thus logging the amount of time spent in the individual’s mouth.

FMCSA Medical Review Board (MRB) compliance recommendations for sleep apnea assistive devices:

Regardless of the device used, the driver must demonstrate that they are using the device for at least 4 hours per night on 70% of nights and report no excessive daytime sleepiness.

What length of time should be reported?

• Initial certification: The last 30 consecutive days

• Recertification: Documentation showing compliance from the time they were last certified (1 year)

The MRB also recommends that individuals with sleep apnea should only be certified for 1 year.

Conclusion:

On nearly every type of device, the process of creating a compliance report for any amount of time is the same. This driver has been using the Inspire device and should easily be able to pull up a report on their mobile device for whatever length of time is needed. The driver received the device just over a year ago, so the medical examiner should ask for a report for the last year. If the report shows that on average over the year, they have used the device 70% of nights for at least 4 hours per night, the driver can be certified for a year.

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