All railway workers in safety sensitive positions should be routinely tested for sleep apnea and impaired function using objective measures. Sleep apnea in railway drivers represents a potentially reversible cause of a large number of railway incidents. Screening for sleep apnea needs to be comprehensive, focusing on identification of sleep apnea as well as an evaluation for signs of functional impairment. Education and other technological advances can also help support improving railway safety. Railway workers bear an awesome responsibility and many lives depend upon their ability to drive a train while fully functional, at any time, whether it be at 4 PM or at 4 AM. Research has demonstrated that self-reported symptoms of sleep apnea in transportation workers are often unreliable.
Those certified to drive a train should:
- Have no sign of sleep apnea on Home Sleep Testing, Polysomnography (PSG) or provide evidence of successful sleep apnea treatment.
- Pass a driving simulator test that mimics nighttime conditions and/or a maintenance of wakefulness test, demonstrating that they do not have a high likelihood of falling asleep when they need to be alert.
Those found to have sleep apnea need to be monitored to ensure compliance with treatment. Individuals without apnea should also be able to demonstrate that they are able to drive and maintain their level of alertness. Additionally, they should be tested at regular intervals to identify apnea that can develop at any time.
Implementation of these recommendations can be accomplished in a cost effective manner that will reduce fatigue related collisions, benefit the health and longevity of railway workers and reduce healthcare costs over time.