Railroad Worker Excessive Daytime Sleepiness Study Benjamin Gerson

Railroad Worker Excessive Daytime Sleepiness Study Benjamin Gerson M. D. University Services Philadelphia, PA 19154 benjamin@uservices. com

UNIVERSITY SERVICES WHO WE ARE MULTI-SPECIALTY MEDICAL SERVICES TOXICOLOGY FORENSIC: EMPLOYEE DRUG TESTING CLINICAL SLEEP DISORDERS / NEUROPHYSIOLOGY CLINICAL RESEARCH CONSULTING & LITIGATION SUPPORT

Goal of Study Assess the risk for excessive daytime sleepiness (EDS) and Sleep Apnea in selected workers in safety sensitive positions Demonstrate that a study can be executed successfully

Method Screen: Employees in selected safety sensitive positions due for re-certification were offered the opportunity to complete a [Epworth] Sleepiness Scale The survey was mailed, faxed, or completed on-line Scores of 10 or higher classified as “at risk” Confirm: Some of the at risk were tested by ambulatory device

Participant Method of Response 300 250 200 150 296 100 107 50 35 0 Fax Internet Mail

Sleepiness Score Distribution

Risk Percentage of EDS

Percentage of Subjects By Age 9% 14% 39% 18 - 30 31 - 44 45 - 55 56 and older 38%

Summary of Sleepiness Scores by Age Group n 18 -30 31 -44 45 -55 ≥ 56 39 168 163 62 Mean SS Score 8. 79 8. 85 9. 24 7. 50 Std. Dev. 4. 33 4. 40 4. 64 4. 53

Percentage of Subjects By Gender 3% male female 97%

Percentage of Subjects by Race 7. 19% 4. 90% 0. 50% 0. 20% 7. 19% White African American Hispanic Asian Other Didn't Report 80. 02%

Participants by Position 18 61 Engineer 34 Conductor Switchman/Brakeman Other 318

Participants by Position Other 18 Switchman/Brakeman 61 Conductor 34 Engineer 318 0 50 100 150 200 250 300 350

Number at Risk By Job Position Other 9 Switchman/Brakeman 22 Conductor 11 Engineer 130 0 50 100 150 200 250 300 350

Comparison Total Number by Job Position Other 18 Switchman/Brakeman 61 Conductor 34 Engineer 318 0 50 100 150 200 250 300 350

Follow-Up Survey A letter with a follow-up questionnaire was mailed to all participants who screened at risk Participant was asked to follow-up with physician and then complete the questions 17 [10%] returned the follow-up survey

Online Version of Follow-Up Survey

le hi or th w W ud y St en t at m tre le d d rte St a gu n he du Sc P PA C p -U Fo llo w io n ca t ed i M Be d er e rd O en t Tr ea tm g in er or d is D n at io al u Ev ep Sl e Te st ed ia gn os D ia n Ph ys ic Responses from Follow-Up Survey 14 12 10 8 6 4 2 Yes 0 No

Screening Results There is evidence that the true proportion of participating employees that are at risk (SS ≥ 10) is greater than 35%. We can say with 95% confidence that the true proportion is contained within the interval (35. 4%, 44. 8%). There is no evidence of a direct linear relationship between SS and age. There also is not enough evidence to show that age group was related to SS scores. It will be difficult to make any conclusions about gender or race due to the subjects being predominantly white males.

Confirmation Employees who scored 10 or greater on the Sleepiness Scale were offered the opportunity to wear a device to identify the presence of Obstructive Sleep Apnea The unit was shipped and worn for one night The unit was then shipped back to US for data interpretation

Confirmation Results 20 tests completed 18 confirmed positive for OSA All participants scoring 11 or higher on screening tested positive for sleep apnea

Confirmation Data AHI 60 57 54 51 48 45 42 39 36 33 30 27 24 21 18 15 12 9 6 3 0 8 9 10 11 12 13 14 15 Sleepiness Score 16 17 18 19 20 21

AHI vs BMI 65 60 55 50 45 40 35 AHI 30 25 20 15 10 5 0 20 25 30 BMI 35 40

Sleepiness Score vs BMI 24 22 20 18 Sleepiness Score 16 14 12 10 8 20 25 30 BMI 35 40