The primary safety goal regarding OSA is to identify drivers with moderate-to severe
OSA to ensure these drivers are managing their condition to reduce to the
greatest extent practical the risk of drowsy driving. Moderate-to-severe OSA is
defined by an apnea-hypopnea index (AHI)1 of greater than or equal to 15.
• The Agency does not require that these drivers be considered unfit to continue them
driving careers; only that the medical examiner makes a determination whether they
need to be evaluated and, if warranted, demonstrate they are managing their OSA to
reduce the risk of drowsy driving.
• Screening: With regard to identifying drivers with undiagnosed OSA, FMCSA’s
regulations and advisory criteria do not include screening guidelines. Medical
examiners should consider common OSA symptoms such as loud snoring, witnessed
apneas, or sleepiness during the major wake periods, as well as risk factors, and
consider multiple risk factors such as body mass index (BMI), neck size,
involvement in a single-vehicle crash, etc.
• Diagnosis: Methods of diagnosis include in-laboratory polysomnography, at-home
polysomnography, or other limited channel ambulatory testing devices which
ensure chain of custody.
• Treatment: OSA is a treatable condition, and drivers with moderate-to-severe OSA
can manage the condition effectively to reduce the risk of drowsy driving.
Treatment options range from weight loss to dental appliances to Continuous
Positive Airway Pressure (CPAP) therapy, and combinations of these treatments.
The Agency’s regulations and advisory criteria do not include recommendations for
treatments for OSA and FMCSA believes the issue of treatment is best left to the
treating healthcare professional and the driver.