From the Guidelines
A sleep study is likely needed for this DOT examination. Based on the information provided, this 39-year-old male has multiple risk factors for obstructive sleep apnea (OSA), including a large neck circumference of 18 inches, obesity (BMI of approximately 39.6, which is class II obesity), and male gender. According to the American Academy of Sleep Medicine clinical practice guideline for diagnostic testing for adult obstructive sleep apnea 1, one study incorporated neck circumference in the determination of high risk of OSA.
Key Risk Factors
- Large neck circumference of 18 inches
- Obesity (BMI of approximately 39.6)
- Male gender The Federal Motor Carrier Safety Administration (FMCSA) guidelines recommend screening commercial drivers with these risk factors for sleep apnea, as untreated OSA significantly increases the risk of drowsy driving and accidents.
Recommended Course of Action
- The examining physician would likely issue a temporary medical certificate (typically 90 days) pending completion of a sleep study
- If OSA is diagnosed, the driver would need to demonstrate effective treatment compliance (usually with CPAP therapy) before receiving a longer-term medical certificate This requirement exists because untreated sleep apnea impairs alertness and reaction time, creating safety concerns for commercial drivers who operate large vehicles for extended periods, as indicated by the clinical practice guideline 1.
From the Research
Sleep Study Requirements
To determine if a sleep study is needed for a DOT examination, we must consider the individual's risk factors for sleep apnea. The given information includes:
- Age: 39
- Neck circumference: 18 inches
- Weight: 276 pounds
- Height: 70 inches
Risk Factors for Sleep Apnea
According to the provided studies, risk factors for sleep apnea include:
- Obesity, which is defined as a body mass index (BMI) of 30 or higher 2
- Large neck circumference, which can be an indicator of sleep apnea 3
- Given the individual's weight and height, their BMI can be calculated to determine if they are at risk for sleep apnea
Calculation of BMI
To calculate the individual's BMI, we use the formula: BMI = weight (in kg) / height (in meters) squared First, we convert the individual's weight and height to metric units:
- Weight: 276 pounds = approximately 125 kg
- Height: 70 inches = approximately 1.78 meters Then, we calculate the BMI:
- BMI = 125 kg / (1.78 m) squared = approximately 39.5
Determining the Need for a Sleep Study
Based on the calculated BMI, the individual is considered obese, which puts them at risk for sleep apnea. Additionally, their large neck circumference is also a risk factor. Therefore, a sleep study may be necessary to diagnose sleep apnea. The American Academy of Sleep Medicine (AASM) recommends the use of polysomnography (PSG) or home sleep apnea tests (HSATs) for the diagnosis of sleep apnea 4, 5, 3
Recommendations for Sleep Studies
The AASM provides guidance on the use of PSG and HSATs for the diagnosis and treatment of sleep apnea:
- PSG is the gold standard for diagnosing sleep apnea, but HSATs are a viable alternative for increasing access to diagnosis and treatment 5, 3
- HSATs may be used for patients with a high probability of moderate to severe sleep apnea, such as those with a large neck circumference and obesity 6, 2
In this case, given the individual's risk factors, a sleep study, either PSG or HSAT, may be necessary to determine if they have sleep apnea. The decision to use PSG or HSAT should be made by a clinician, taking into account the individual's specific circumstances and available diagnostic tools 4