Sleep Apnea: Why Everyone Who Travels Is at Risk

By Mark Rosekind, PhD

A man asleep while drivingThe NTSB has long sounded the alarm on the subject of obstructive sleep apnea (OSA), its adverse effect on sleep quality, and the significant safety risks associated with human fatigue in transportation operations. For over 40 years, the NTSB has identified fatigue as a problem and OSA as one of its several causes. It is a common fatigue-inducing medical disorder that affects pilots, drivers, captains, and conductors. This stealth impairment affects transportation safety in every mode and it often remains undiagnosed. It places everyone in the traveling public at risk and I recently had the opportunity to discuss sleep apnea and transportation safety on ABC’s Nightline.

The NTSB has issued more than 200 safety recommendations on fatigue and it was on our Most Wanted List of critical transportation safety issues from 1990 to 2011. Take, for example, NTSB recommendations with extensive background on OSA resulting from a 2008 incident in which a go! Airlines captain and first officer fell asleep and flew past their destination airport in Hilo, Hawaii. Excessive daytime sleepiness due to fatigue resulting from the captain’s undiagnosed sleep apnea contributed to the incident.

Three of the NTSB recommendations apply specifically to OSA, and the critical issue of diagnosis and treatment. Although these particular recommendations are specific to this aviation incident, they have tremendous applicability to every other form of transportation and call for:

  1. getting at an early stage specific information about any previous diagnosis of obstructive sleep apnea and the presence of specific risk factors for that disorder;
  2. implementing a program to identify those at high risk for obstructive sleep apnea and requiring that high risk individuals provide evidence of having been appropriately evaluated and, if treatment is needed, effectively treated for that disorder before being granted permission to operate; and
  3. developing and disseminating guidance for operators, employers, and physicians regarding the identification and treatment of individuals at high risk of obstructive sleep apnea, emphasizing that operators who have obstructive sleep apnea – effectively treated – are routinely approved to continue their job.

The problem of undiagnosed sleep disorders such as OSA has received some attention in aviation as well as commercial trucking, but the chronic issue has applicability throughout transportation.

Because sleep apnea leads to excessive daytime fatigue, increases the risk of accidents, impairs cognitive skills, substantially elevates the likelihood of critical errors and falling asleep, and because many individuals who have the disorder do not know they have it, the NTSB has been eminently clear in specific recommendations on identifying and treating the disorder to ensure the safety of the traveling public. With treatment, sleep can be improved, OSA symptoms reduced, and adverse effects reversed, leading to a return to normal and safe operations. It is a priority that this agency cannot ignore.


Mark Rosekind, Ph.D., is a Member of the National Transportation Safety Board. He is a frequent contributor to the NTSB blog.

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