OSA is particularly common among HGV drivers – up to 15% of HGV drivers are believed to have the condition, compared with 5% of the general population in the UK. However we also know that vocational drivers are worried about coming forward for treatment, as they fear losing their licence and therefore their livelihood.
We have worked closely with our membership within the transport sector to develop a voluntary screening process for HGV drivers which has the support and backing of the fleet operator.
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With the support of the Road Haulage Association, we introduced a pilot screening process to employees at Nagel Langdons. Nagel is a leading logistics provider for chilled and frozen food industry with a fleet of c. 800 vehicles. The business has 10 depots operating across the UK from Bodmin to Motherwell.
The aim of the screening was to improve both safety in the workplace and the individual’s quality of life. However, so drivers did not feel unduly singled out, we opted to screen all employees at the depot.
Working closely with the company’s HR and transport team, we came up with a two-part process to screen 200 drivers at their Bridgewater Express depot.
- Stage 1 employed a simple subjective screening questionnaire (incorporating the ESS and the STOPBANG which was sent by post to everyone). If high scores were found, then the employee entered the second stage.
- Stage 2 consists of a fuller questionnaire, and a simple home sleep study using the ApneaLink Air device (sent by post to high risk individuals identified in stage 1).
- The sleep study and a fuller questionnaire were interpreted with recommendations as to the appropriate follow-up.
- Clinical expertise was made available for Continuous Positive Airway Pressure (CPAP) therapy if appropriate
Any screening system cannot be perfect, but should be able to identify the majority of individuals with significant and symptomatic OSA. The proposed two-stage screening programme was based on published studies and expert opinion. The screening questionnaires used were the ESS and the STOPBANG . Used in isolation, such questionnaires do not have adequate sensitivity or specificity but, in combination with a simple sleep study, they are reasonably effective .
 (Canadian anaesthetists, Anesthesiology 2008;108:812 and Can J Anaesth 2010;57:423). Screening questionnaires and their limitations were reviewed by Josephs and Ramachandran, (Anesthesiology 2009;110:928-9); Abrishami et al, (Can J Anest 2010;57:423-38); and Fedson et al, (Sleep Med Rev 2012;16:529-37).
 (Gurubhagavatula et al, Am J RespCrit Care Med 2004;170:371-6).
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Results and interpretation
Approximately 200 questionnaires were sent out
23 returned, therefore about an 11% return rate
22 male, 1 female
Average BMI = 29.3 (range 26.3 to 37.0)
Average STOPBANG = 3 (range 1-5)
Average ESS = 4.8 (range 0-15)
STOPBANG Categories LOW(0-2), n=7 INT(3-4), n=13 HIGH(5-8), n=2
3/23 reached threshold and screened with the ApneaLink (2 qualified via STOPBANG, 1 via ESS)
3 screened with sleep study
BMIs 32.1 30.0 37.0
ESSs 15 10 8 (repeated ESS) 13 8 6
No significant OSA found
High ESS (15) patient had significant other issues explaining his situation.
We were disappointed with the response rate, but we believe that this is because, despite reassurances, there is a fear that if an individual comes forward and is found to have OSA, they will lose their licence, and if they are a driver they believe this means losing their job.
However, despite the results, Nagel expressed a commitment to continue with the screening and roll out to other depots.
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The programme will roll out across the rest of the company from 1st January 2018 starting with the main Bridgewater and Liverpool depots.
In order to address the issue of driver concern, we have developed a support programme, that Nagel has signed up to, which gives the driver or staff member with guarantees for their job security. This might include private treatment if NHS care cannot be delivered within the Four Week Wait period. In addition, we have set up meetings with the employee representatives and the managers to engage them in the process and to encourage them to become ambassadors for the campaign.
We believe that the result of the pilot underlines the need for the introduction of fast tracking for vocational drivers through the OSA Partnership Group’s Four Week Wait.
For more information about this pilot please contact Gillian Gibbons or visit the OSA Partnership's website: http://osapartnershipgroup.co.uk/campaign3-four-week-campaign.html
You can also download a poster to raise awareness of OSA and its symptoms.
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