1. Sleep Disorders & the Commercial Driver: Schneider National’s Screening Program Wake Up Michigan! Symposium Darrel Drobnich Chief Program Officer – Policy, Education & Research National Sleep Foundation 1522 K Street, NW, Suite 500 Washington, DC 20005 www.sleepfoundation.org

2. Obstructive Sleep Apnea, Drowsy Driving & the Commercial Driver Best Practices

3. NSF’s 2007 Healthy Sleep Community Award to Schneider National, Inc.

4. Sleep Apnea and Truck Drivers  FMCSA study of 4,826 commercial truck drivers  17.6% had mild sleep apnea  5.8% had moderate sleep apnea  4.7% had severe sleep apnea  Prevalence was closely linked with age and degree of obesity  Prevalence also depends on the average duration of sleep over consecutive nights at home.

5. Health Effects of OSA

6. Prevalence of SDB Compared to Other Chronic Disorders In U.S.  High Blood Pressure25 – 30 million  Asthma 15 – 17 million  COPD 14 – 16 million  Diabetes 14 – 16 million  SDB: 12-18 million  4% of middle-aged men, 2% of middle-aged women  10% or more in geriatric populations  Heart Failure4 – 6 million

7. Sleep Apnea Risk Factors & Co-morbidities 58% of patients that suffer from diabetes have sleep apnea 35% of Hypertension patients have OSA (80% of all drug resistant hypertensive patients) 50% of Congestive Heart Failure patients have OSA Obesity is the most important risk factor for OSA 58% of patients that suffer from diabetes have sleep apnea 35% of Hypertension patients have OSA (80% of all drug resistant hypertensive patients) 50% of Congestive Heart Failure patients have OSA Obesity is the most important risk factor for OSA Co-morbidities Obesity Male gender Increasing age Family history Alcohol or sedative use Anatomic abnormalities of the upper airway Smoking Endocrine and metabolic disorders Risk Factors

8. Three of the Top Healthcare Expenditures in the Trucking Industry Hypertension Diabetes Cardiovascular Disease

9. Prevalence of Sleep Apnea Co-morbidities Sjostrom et al. Thorax 2002 Logan et al. J. Hypertension 2001 Javaheri et al. Circulation 1999 O’Keefe, Patterson. Obes Sugery 2004 Einhorn et al. Amer Diab 2005 Somers et al. ATS Pres. 2004

10. Safety Effects of OSA

11. Risk of Motor Vehicle Crashes in OSA (2x –7Xs)

12. Jackson, Tennessee, July 26, 2000 Tennessee State Trooper Killed Driver of Chevy Blazer Seriously Injured

13.  Driver stated he may have fallen asleep  Involved in similar accident in Utah 3 years prior  Prior diagnoses of obstructive sleep apnea and hypothyroidism NTSB Findings

14. Schneider National OSA Screening Program - Education  First ever fleet-wide screening of drivers for sleep apnea  Started by educating leadership (!) and special personnel – Training engineers – effect first line screen in classroom and cab – Disease management vendors responsible for chronic disease management – Physical therapists at operating centers – Loss prevention teams throughout company – Medical review teams at time of hire

15. Schneider National OSA Screening Program - Education  Monthly newsletters sent to drivers homes (spousal recognition of symptoms crucial)  Text messages are sent to drivers in their trucks regarding setting up sleep study or follow up appointments  Driver handbooks have been updated  “Drive-time tapes” are provided to diagnosed drivers to help educate them about their disorder and proper management.

16. Schneider National OSA Screening Program - Medical Screening  They screen applicants once they complete driver training for those at risk  Worked with drivers to develop system to keep them out of service for only 12 hours for diagnosis and first treatment.  Makes testing mandatory if the driver screens at high risk  They use data on DOT long form physicals to determine who is at risk also  Pharmaceutical claims data is reviewed for certain meds including sleep aides and Modofinal

17. Schneider National OSA Screening Program – Medical Screening  They use a screening tool developed with Precision Pulmonary Diagnostics  Uses objective and subjective data that are supported by research to predict OSA  BMI, Heavy snoring, hypertension  Objective data is important since drivers may feel pressure to deny symptoms out of fear of being put out of service.  Boasts a predictive value of 85% among a high at-risk group such as commercial drivers.

18. Schneider National OSA Screening Program – Compliance  Only data base of its size that have all been screened- close to 12,000  Over 1000 diagnosed and treated in 2006--- averaging about 50 a month this year SNI is making testing mandatory if you screen at high risk.  Compliance with CPAP treatment is KEY for safety and Return on Investment

19. Schneider National Sleep Apnea Screening Program  30% accident reduction in this group  $500-$700 per driver per month health care savings 12 months post CPAP as compared to 12 months pre CPAP in this cohort depending on time with SNI 4.  Retention in this group at the time of the study (done 2x) shows twice the retention as in regular fleet. (important in a high turnover industry)

20. Sleep Apnea and Special Populations – NFL Lineman  2002 study involving more than 300 players from 8 randomly selected teams  Sleep apnea was found in 14% of players overall, 5xs higher than similar aged adults  OSA was found in 34% of linemen  Sleep apnea present in young, physically fit men who are in top condition otherwise George, C. et al, NEJM, Han 23, 2003

21. New DOT Guidelines Coming An industry “Joint Statement” issued in September 2006 recommends that all CMV drivers with typical signs of sleep apnea be tested and treated, including: – Body Mass Index > 35 – Neck size > 17 – Hypertension that is uncontrolled – Snoring, excessive daytime fatigue or witnessed apneas – A positive Epworth Sleepiness Scale score >10 The “Joint Statement” is expected to influence an updated DOT guideline in the future

22. Get on the Road to Better HealthRecognize the Dangers of Sleep Apnea A joint program of the Federal Motor Carrier Safety Administration and the National Sleep Foundation

23. Get on the Road to Better HealthRecognize the Dangers of Sleep Apnea Campaign Goals Increase driver and industry awareness about sleep apnea and other sleep disorders including associated dangers, risk factors, symptoms and treatments. Encourage drivers and others in the trucking and motorcoach industries to seek medical help if they are experiencing symptoms of sleep apnea or other sleep disorders. Ease driver and industry fears around sleep apnea by communicating that treatment will help reduce crash risk and by clarifying guidelines regarding fitness for duty.

24. Get on the Road to Better HealthRecognize the Dangers of Sleep Apnea For More Information, Visit www.fmcsa.gov www.drowsydriving.org www.sleepfoundation.org

25. Summary  28.1% of truck drivers have sleep apnea  2-7x increased risk for crash  OSA is co-morbid with other major and costly chronic diseases.  Treatment can not only improve safety and driving performance, but other health outcomes.  Treating all US drivers suffering from apnea would save $11.1B in collision costs and save 980 lives annually (  Treating all US drivers suffering from apnea would save $11.1B in collision costs and save 980 lives annually (Sassanai, et al. SLEEP 2004)