chunkyfrog wrote: . . . has apnea . . .
This is a phrase that is especially difficult to define, in practice. In some cases, naturally, it is very clear cut. In other cases, though, not so much. The gray areas make the issue problematic legally and ethically. Especially if we add words like "treated" or "untreated" to it.
Most all adult humans 'have apneas' in the sense of occasionally pausing in their breathing overnight. And at least for now anyway, we need humans, if we're gonna have big rigs on the road. Google is trying to fix that, I think.
So now we're left with the concept of where the line should be drawn for "diagnosing" and "treating" obstructive sleep apnea.
Generally speaking, an
asymptomatic person can have an AHI/RDI as high as 14 (on one night at one clinic) and still be considered NOT to have OSA. On the other hand, a person who subjectively reports daytime sleepiness (which, keep in mind, may or may not relate to the pauses in breathing overnight) and (on one night at one clinic) has an AHI/RDI above 5 can be diagnosed as 'having obstructive sleep apnea.' Why? This is to allow for people who are particularly sensitive to breathing disturbances at night to get their machine paid for by insurance.
The problem is that if we draw the line at 5 AHI/RDI to force insurance to pay when a person subjectively reports sleepiness, that implies to some authorities that that is where the line should be drawn for all professional drivers,
whether they subjectively report sleepiness or not. In other words, for milder cases, diagnosis is all about Epworth. Not Chicago. Now we have a situation ripe for an industry's ethical standard to be based on something totally, arbitrarily, subjective, or to be based on a misunderstanding of the objective criteria for clinical diagnosis.
OSA, as a syndrome, requires judgments of clinicians who differ in their interpretations and testing methods, no matter how "standardized" everything is supposed to be. That puts the clinician in the awkward position of judging the employability of a fellow human based on what are difficult judgment calls on things that vary night to night, that can be measured many ways, that can be interpreted many ways, etc.
It would be nice if OSA were as clear cut and matter-of-fact as some people make it out to be.
In my opinion, it just ain't so.
The reasons we want pilots, train conductors, and big rig operators to be held to a higher standard than the general population are all commendable. But once you do that, why not just make it against the law for any human to drive who has yawned after waking up in the morning, and then let the economy collapse? People with young children, noisy pets, loud neighbors, or who live near an airport can all be considered sleep-impaired to one degree or another. Will we make it against the law for them to drive?
Add to that the ambiguity of "treated" and we have a real mess on our hands. Can a trucker choose a dental appliance? surgery? sleep-position therapy? And what if a trucker's untreated RDI is above 100 but his treated RDI, with CPAP, is still above 5? Is he allowed to work? Do you consider him treated or untreated? And who decides? Based on what study?
Life just isn't that clear. If a trucker is found to have been drinking coffee before a crash, does that prove he must have been sleepy and thus guilty of negligence? or does it prove he was taking his wakefulness seriously? I don't know. Lawyers could make a case either way. And win.
I think we should be careful what we wish for. We can't decry the hair-splitting of doctors and lawyers and then demand that they do more hair-splitting for us. Sleepy driving is a complicated question without an easy fix in practice, no matter how clear it may seem to some minds. There is no breathalyzer-type sleepiness test that can print out the true state of someone's degree of impairment. So for me, instead of thinking of it all in terms of the extreme cases everyone would agree on, some problems
must be approached by thinking in terms of the gray areas and potential for abuses based on bad judgment and misunderstandings.
OSA diagnosis and treatment is mostly gray, not black and white.
In my opinion.
And goodness knows I have no shortage of those.