Occupational health experts are criticizing the U.S. Department of Transportation’s decision to withdraw a rule that would have required workers in safety sensitive jobs to be screened for a sleep disorder that could affect their work performance.

The American College of Occupational and Environmental Medicine (ACOEM) says that formal rulemaking is necessary to standardize the criteria used by medical examiners to evaluate the prevalence of Obstructive Sleep Apnea (OSA) among key workers in highway and rail transportation. Those who suffer from sleep apnea stop breathing repeatedly during their sleep, depriving the brain of sufficient oxygen.

Identifying at-risk workers

“The literature clearly shows that drivers with untreated OSA are at an increased risk of motor vehicle crash, but as there is no agreement on how to best identify these at-risk workers, it is essential that a starting point be identified – we had hoped this rulemaking would fulfill that purpose,” said ACOEM President Charles Yarborough, MD. The group said as in its comments last year about the DOT’s  Advanced Notice of Proposed Rulemaking (ANPRM) for the regulation.

The withdrawal of this proposed rulemaking also results in confusion for medical examiners, noted Natalie Hartenbaum, MD, chair of ACOEM’s Transportation Medicine Section. “What is being misunderstood is that while DOT and its agencies have withdrawn the ANPRM that would have required OSA screening, they have made it clear that this was not an intent to eliminate screening, diagnostic testing, treatment, and follow-up for those at risk of moderate to severe OSA or who have been diagnosed with OSA,” she said.

While rulemaking and specific requirements for evaluating transportation workers at risk of moderate to severe OSA is – for now – no longer on the regulatory docket, ACOEM urges medical examiners to avail themselves of the guidance issued by the agencies as well as in the medical literature in making an OSA determination. “As for any medical condition which could lead to sudden or gradual impairment or incapacitation where there are no specific requirements from DOT, the Federal Railroad Administration, or the Federal Motor Carrier Safety Administration, it is important that medical judgement and individual assessment be part of the decision-making process,” said Dr. Hartenbaum.


ACOEM is an international society of approximately 4,000 occupational and environmental physicians and other health care professionals. The College provides leadership to promote the health and safety of workers, stimulate research, enhancing education, and advance the specialty of OEM, the medical specialty devoted to the prevention and management of occupational and environmental injuries and illnesses. As such, ACOEM is the only medical specialty society uniquely involved in the matching of the worker’s capabilities to the job requirements.