1. Railroad Worker Excessive Daytime Sleepiness Study Benjamin Gerson M.D. University Services Philadelphia, PA 19154 benjamin@uservices.com

2. UNIVERSITY SERVICES WHO WE ARE MULTI-SPECIALTY MEDICAL SERVICES TOXICOLOGY FORENSIC: EMPLOYEE DRUG TESTING CLINICAL SLEEP DISORDERS / NEUROPHYSIOLOGY CLINICAL RESEARCH CONSULTING & LITIGATION SUPPORT

3. Goal of Study Assess the risk for excessive daytime sleepiness (EDS) and Sleep Apnea in selected workers in safety sensitive positions Demonstrate that a study can be executed successfully

4. Method Screen: Employees in selected safety sensitive positions due for re-certification were offered the opportunity to complete a [Epworth ] Sleepiness Scale The survey was mailed, faxed, or completed on-line Scores of 10 or higher classified as “at risk” Confirm: Some of the at risk were tested by ambulatory device

5. Participant Method of Response

6. Sleepiness Score Distribution

7. Risk Percentage of EDS

8. Percentage of Subjects By Age

9. Summary of Sleepiness Scores by Age Age GroupnMean SS Score Std. Dev. 18-30398.794.33 31-441688.854.40 45-551639.244.64 ≥ 56627.504.53

10. Percentage of Subjects By Gender

11. Percentage of Subjects by Race

12. Participants by Position

14. Number at Risk By Job Position

15. Comparison

16. Follow-Up Survey A letter with a follow-up questionnaire was mailed to all participants who screened at risk Participant was asked to follow-up with physician and then complete the questions 17 [10%] returned the follow-up survey

17. Online Version of Follow-Up Survey

18. Responses from Follow-Up Survey

19. Screening Results There is evidence that the true proportion of participating employees that are at risk (SS ≥10) is greater than 35%. We can say with 95% confidence that the true proportion is contained within the interval (35.4%, 44.8%). There is no evidence of a direct linear relationship between SS and age. There also is not enough evidence to show that age group was related to SS scores. It will be difficult to make any conclusions about gender or race due to the subjects being predominantly white males.

20. Confirmation Employees who scored 10 or greater on the Sleepiness Scale were offered the opportunity to wear a device to identify the presence of Obstructive Sleep Apnea The unit was shipped and worn for one night The unit was then shipped back to US for data interpretation

21. Confirmation Results 20 tests completed 18 confirmed positive for OSA All participants scoring 11 or higher on screening tested positive for sleep apnea

22. Confirmation Data

23. AHI vs BMI

24. Sleepiness Score vs BMI