Obesity, male gender, and middle age, the typical demographic features of the commercial driver, are also the three strongest risk factors for obstructive sleep apnea. While sleep apnea afflicts 2-4% of all middle aged employed adults, as many as 60-80% of commercial drivers may have the condition, and most of them are unaware that they have it. The driver with sleep apnea experiences repetitive airway closure during sleep, subsequent fall in oxygen saturation and arousal from sleep. Morbidity from this condition is substantial, and includes hypertension, myocardial infarction, stroke, insulin resistance, and fall-asleep crashes. A safe and effective therapy for sleep apnea is available in the form of continuous positive airway pressure, a pneumatic splint that prevents airway collapse during sleep. This therapy confers benefits such as reduction in blood pressure, insulin resistance and sleepiness and may attenuate the risk of cardiovascular disease and crashes. The morbidity of sleep apnea and the availability of effective therapy argue strongly for the development of effective screening strategies for sleep apnea in commercial drivers. An in-laboratory, full overnight sleep study is the current diagnostic gold standard, but is expensive, inconvenient and inaccessible. Simpler techniques may be applied within minutes during occupational health screening, and may be combined with technologies self-assembled in the home by the driver. However, the usefulness or cost of these strategies has not been evaluated in occupational screening. Therefore, our specific aims are to: 1) Evaluate how well self-assembled technologies used in the home setting identify sleep apnea in commercial drivers, 2) Determine whether an occupational screening evaluation can be combined with home diagnostic technologies to reduce the number of patients that need testing 3) Determine the relative economic costs of these screening strategies
