Washington takes wrong turn on sleep apnea
Four died in Metro-North's Bronx derailment in 2013. Engineer William Rockefeller, inset, was later diagnosed with sleep apnea. Credit: Charles Eckert
Maybe the federal government is asleep on the job?
The Federal Motor Carrier Safety Association and the Federal Railroad Administration last week withdrew a nascent proposal requiring screening and treatment of commercial drivers and train operators with sleep apnea. Sleep apnea — snoring and gaps in breathing during sleep — prevents the brain from proper rest. If untreated, it can lead to lethal consequences: It increases sevenfold the risk of collision.
Sadly, I know this well. As a sleep specialist, I see sometimes see patients after a collision has occurred. At NYU-Winthrop Hospital Sleep Disorders Center, we see thousands of sleep-disordered patients a year, many of whom are professional drivers and pilots. They are worried about their sleepiness and fatigue, and want to be safe.
Unsurprisingly, the decision to nix lifesaving screening has rightly triggered an uproar. Sleep apnea has been implicated in a fatal 2000 tractor-trailer crash in Tennessee, a 2013 Metro-North derailment in the Bronx that killed four people, and a NJ Transit crash in Hoboken in September that killed a woman.
America’s train operators are especially unprotected. Federal law subjects commercial drivers and commercial pilots to comprehensive medical examinations which can uncover the need for sleep evaluations. But outside of drug and alcohol testing, train operators receive only hearing and vision tests. They are the only transport personnel for whom the federal government does not mandate a comprehensive exam, let alone a vital sleep apnea evaluation.
The federal government’s decision to abandon the screening plan unfairly burdens individual train engineers and commercial drivers who must decide on their own to seek evaluation and treatment and incur the costs while the public is at risk. Worse, if collisions related to sleep apnea occur, the federal government is powerless to cite irresponsible transport operators.
Yet, treating sleep apnea is only part of the story. My patients are worried about performing difficult and dangerous jobs on rotating shifts too often as they cover for sick or vacationing colleagues in a short-staffed workforce. When I educate them on sleep, I have found that these same patients are devoted to public safety and eager to learn healthy behaviors and driving safety when tiredness might strike. In more than 12 years, I have never encountered a patient who refuses advice or resists treatment. Quite the opposite, commercial drivers and transport workers are among the most willing sleep patients.
But what’s the big deal, you may ask? Some of the world’s most notable disasters were sleep-related: Chernobyl, Three-Mile Island, the Exxon Valdez and the Space Shuttle Challenger disaster were all linked to sleep loss and sleep disorders in critical personnel. All of these accidents caused incalculable public health and environmental damage — sometimes permanently devastating industries. When it comes to New York, Sen. Chuck Schumer was candid about the implications. He’s right: It shouldn’t take a Long Island Rail Road crash for the MTA to test and treat LIRR engineers for sleep disorders, like sleep apnea.
On this, sleep medicine evidence supports the need for screening. The feds’ decision to deny mandated sleep apnea screening of some of our most vital workers, who are moving millions of New Yorkers around the region, fails to protect passengers and the dedicated workers who keep New York running. New York must provide our train engineers and commercial drivers the best sleep medicine there is to offer. It’s the least we can do.
Dr. Qanta A. Ahmed is an attending physician at NYU-Winthrop Hospital Sleep Disorders Center.
