Med Sleep Apnea Screening

---
name: med-sleep-apnea-screening
description: |
  Use this skill when a driver is being screened for sleep apnea. Covers FMCSA Medical Review Board (MRB) recommendations, BMI thresholds, sleep study referrals, and continued certification.
---

# Sleep Apnea Screening Standards for CMV Drivers

FMCSA does not have a specific sleep apnea regulation, but Medical Examiners are required to assess sleep-related conditions per § 391.43. Industry standards from the Medical Review Board (MRB) guide examiner decisions.

## When examiner considers sleep apnea
- BMI 33+ (Medical Review Board recommends screening)
- BMI 40+ (MRB recommends mandatory sleep study)
- Daytime sleepiness reported
- Self-reported snoring or witnessed apnea
- History of motor vehicle crash with sleepiness component
- Hypertension at certain levels
- Type 2 diabetes
- Other risk indicators

## Sleep study (polysomnogram)
If indicated:
- Driver gets sleep study (overnight) at a clinic or in-home test
- Apnea-Hypopnea Index (AHI) calculated
- AHI < 5: no apnea
- AHI 5-14: mild apnea (driver may continue if compliance with treatment is good)
- AHI 15-29: moderate apnea (treatment required)
- AHI 30+: severe apnea (treatment required for continued certification)

## Treatment options
1. **CPAP (continuous positive airway pressure)** — most common; driver wears mask at night
2. **Oral appliance** — for mild-moderate cases
3. **Surgery** — last resort
4. **Weight loss** — recommended in conjunction

## Continued certification post-diagnosis
- Driver must demonstrate compliance with CPAP (typical: ≥4 hours/night for 70%+ of nights)
- Reduced AHI on follow-up (typically AHI < 5 with treatment)
- Continued examination every 12 months (vs. 24-month default) — common
- Self-reported daytime sleepiness reviewed at each exam

## Driver pushback
Sleep apnea diagnosis is sensitive — drivers fear losing certification. Reality:
- Treated apnea = certification CONTINUES
- Untreated apnea = potential DOWNGRADING to shorter cert windows or non-cert

## What the carrier sees
Compass medical tracking shows:
- Each driver's current cert expiration
- Drivers flagged by examiner for sleep apnea screening
- CPAP compliance documentation (when driver shares)
- Risk flag if compliance lapses

## Common pitfall
A driver who tests positive for apnea but never starts treatment is at risk. The medical examiner has authority to NOT issue cert at next visit. Carrier must monitor.

## CFR citations
- **49 CFR § 391.43**
- **FMCSA Medical Review Board Recommendations**

## How Compass surfaces this
This skill is searchable in Compass Ask and runs against the carrier's actual fleet data when invoked from the relevant tracker. Read-only; no actions taken without explicit user approval.


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## Built by X3 Compass

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*This skill is published under the X3 Compass open skills initiative. Contributions welcome at https://github.com/x3fleetsafety/skills*