Impact of rail medical standard on obstructive sleep apnoea prevalence

The 2004 edition of the National Standard for Health Assessment of Rail Safety Workers (the standard) used the Epworth Sleepiness Scale (ESS) to screen for excessive daytime sleepiness related to obstructive sleep apnoea (OSA). The 2012 edition of the standard expanded the OSA screening matrix to in...

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Bibliographic Details
Published in:	Occupational medicine (Oxford) Vol. 66; no. 1; pp. 62 - 68
Main Authors:	Colquhoun, C P, Casolin, A
Format:	Journal Article
Language:	English
Published:	England Oxford University Press 01-01-2016
Subjects:	Accident Prevention Adult Aged Body Mass Index Diabetes Mellitus, Type 2 - complications Female Humans Hypertension - complications Male Mass Screening - standards Middle Aged Occupations Original Paper Outcome Assessment (Health Care) Prevalence Railroads Reference Values Risk Factors Safety Sleep Sleep Apnea, Obstructive - diagnosis Sleep Apnea, Obstructive - epidemiology Wakefulness Work Work Capacity Evaluation Young Adult screening Medical standards obstructive sleep apnoea safety critical work rail
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Summary:	The 2004 edition of the National Standard for Health Assessment of Rail Safety Workers (the standard) used the Epworth Sleepiness Scale (ESS) to screen for excessive daytime sleepiness related to obstructive sleep apnoea (OSA). The 2012 edition of the standard expanded the OSA screening matrix to include body mass index, comorbid hypertension and type 2 diabetes as triggers requiring a sleep study to be undertaken irrespective of the ESS. To assess the impact of the new standard on the estimated prevalence of OSA in railway workers. An analysis of data on safety critical employees referred for rail safety health assessment during the 2013 calendar year and meeting the criteria for sleep study referral. Sleep study outcomes were used to assess the predictive value of screening under the new standard. A total of 200/4311 workers were investigated with a sleep study. One hundred and ninety-three met the new risk factor criteria and 182 (91%) were newly diagnosed with OSA. The prevalence of OSA in the study population was 7%, compared with 2% in 2009. No worker reported an elevated ESS. The false positive to true positive ratio was 0.1 (95% CI 0.06-0.16). The new medical standard has resulted in an increased estimate of the prevalence of OSA in rail workers. This study supports the use of objective clinical risk factors to select workers for further investigation, aiming to minimize the risk of accidents associated with excessive daytime sleepiness and other comorbid conditions of OSA.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0962-7480 1471-8405
DOI:	10.1093/occmed/kqv101