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One of the more common sleep disorders is sleep apnea, affecting as many as 18 million Americans


Riportiamo un importante documento riguardante gli Effetti causati da alcune Patologie del Sonno nell'ambito della Sicurezza nel Settore del Trasporto in questo caso quello ferroviario.
Il documento risale al 4 Ottobre 2004, ma č, purtroppo, di attuale e importante attualitą.

Courtesy by gpo.gov

[Federal Register: October 1, 2004 (Volume 69, Number 190)]
[Page 58995-58996]
From the Federal Register Online via GPO Access [wais.access.gpo.gov]


Federal Railroad Administration

Notice of Safety Advisory 2004-04; Effect of Sleep Disorders on
Safety of Railroad Operations

AGENCY: Federal Railroad Administration (FRA), DOT.

ACTION: Notice of Safety Advisory.


SUMMARY: FRA is issuing Safety Advisory 2004-04 to alert the railroad
community, and especially those employees occupying safety-sensitive
positions, to the danger associated with degradation of performance
resulting from sleep disorders that are undiagnosed or not successfully
treated. Alertness (vigilance) and unimpaired cognitive functions are
important to the safety of railroad operations. Of particular concern
to FRA are those employees who dispatch or operate trains or who
inspect and maintain signal systems. Many of these employees work
unpredictable schedules and long hours, making it difficult for them to
achieve adequate rest even if otherwise healthy. This advisory contains
suggested measures that railroads and employees should utilize to
prevent work-related errors and on-the-job accidents as a result of
sleep disorders.

4, Mail Stop 25, Federal Railroad Administration, U.S. Department of
Transportation, 1120 Vermont Avenue, NW., Washington, DC 20590.
Telephone 202-493-6303.


Factual Background

On November 15, 2001, Canadian National Railway Company/Illinois
Central Railroad Company (CN/IC) southbound Train 533 and northbound
Train 243 collided near Clarkston, Michigan. Both crewmembers of Train
243 were fatally injured, and both crewmembers of Train 533 sustained
serious injuries. The track and equipment damaged in the accident was
valued at approximately $1.4 million. The National Transportation
Safety Board (NTSB) determined that the probable cause of the accident
was crewmembers' fatigue, which was primarily due to the engineer's
untreated, and the conductor's insufficiently treated, obstructive
sleep apnea. NTSB Report No. RAR/02/04. Sleep apnea is a sleep disorder
characterized by cessations of breathing during sleep, and therefore
partial awakenings during a sleep period.
Sleep disorders represent a serious health problem in American
society and a significant economic concern. Moreover, untreated sleep
disorders can result in impaired work performance, including possible
loss of alertness and situational awareness, which could in turn
present an imminent threat to transportation safety. In general terms,
sleep disorders range from fairly common disorders, such as insomnia
(the inability to initiate or maintain sleep) to relatively rare sleep
disorders such as narcolepsy (inappropriate and uncontrollable sleep
episodes). Railroad employees who typically work on-call are especially
vulnerable to sleep disorders such as circadian rhythm disorders,\1\
and shift work sleep disorder,\2\ a relatively recent addition to sleep
disorders listed in the Diagnostic and Statistical Manual of Mental
Disorders published in 1994 by the American Psychiatric Association
(better known as the DSM IV), which cuts across all types of shift work
jobs. Studies of on-call work schedules that lead to alterations in the
timing or duration of sleep and the sleep-wake cycle have also been
shown to lead to significant sleep and circadian rhythm disturbances in
railroad workers.\3\

\1\ Elshaug, A. Reid, K. and Damson, D. 1998, The circadian
effects of irregular work schedules on sleep. In W.P. Colquhoun
(ed.), Aspects of Human Efficiency (London: English Universities),
\2\ 2004, National Sleep Foundation Workshop on Shift Work Sleep
Disorder, March 4-5, Washington, DC.
\3\ Pilcher, J. and Coplen, M. 2000, Work/Rest Cycles in
railroad operations: effects of shorter than 24-hour shift work
schedules and on-call schedules on sleep. Ergonomics, Vol. 43, No.
5, 573-588.

One of the more common sleep disorders is sleep apnea, affecting as
many as 18 million Americans. Researchers estimate that the prevalence
of sleep apnea in the general population is between 8-12%, depending on
the measure used (mild, moderate or severe). Some researchers have also
estimated the prevalence of severe sleep apnea in the general
population between 3-5%, about 90% of whom are still undiagnosed,
clearly demonstrating a significant problem. Obstructive sleep apnea,
circadian rhythm disorders, and rotating shifts, have been found to be
significant predictors of work-related accidents.\4\ Although severe
sleep apnea is considered one of the more debilitating sleep disorders
and is a significant risk factor for on-the-job accidents, it is also
one of the most easily diagnosed and treated of all sleep disorders.

\4\ Ohayton, M, Lermoine, P., Arnaud-Briant, V., and Dreyfus,
M., 2002, Prevalence and consequences of sleep disorders in a shift
worker population. Journal of Psychosomatic Research, 53, 577-583.

According to the National Sleep Foundation, untreated sleep
disorder sufferers are three times more likely to have automobile
accidents. The National Highway Traffic Safety Administration estimates
that more than 100,000 auto crashes annually may be fatigue-related.
These incidents result in an estimated 1,500 deaths and tens of
thousands of injuries and lasting disabilities. Sleep disorders also
tend to be more prevalent in an aging population. The average age for a
railroad operating employee is now approaching 50.
While the impact of sleep disorders is unique to each individual
and can be related to a variety of other factors and medical conditions
such as obesity, depression, age and gender, evidence is clear that
significant risks exist for those with undiagnosed and untreated sleep
disorders. Some of these risks include excessive daytime sleepiness,
greater risk of cardiovascular disease, memory loss, and increased risk
of accidents to name a few. For these and other reasons, the NTSB has
been concerned about the impact of sleep disorders and other medical
conditions on railroad safety.
Following its investigation into the collision near Clarkston,
Michigan, the NTSB issued three recommendations to FRA:

[[Page 58996]]

``Develop a standard medical examination form that includes
questions regarding sleep problems and requires that the form be
used, pursuant to 49 CFR part 240, to determine the medical fitness
of locomotive engineers; the form should also be available for use
to determine the medical fitness of other employees in safety-
sensitive positions.'' (R-02-24).
``Require that any medical condition that could incapacitate, or
seriously impair the performance of, an employee in a safety-
sensitive position be reported to the railroad in a timely manner.''
``Require that, when a railroad becomes aware that an employee
in a safety-sensitive position has a potentially incapacitating or
performance-impairing medical condition, the railroad prohibit that
employee from performing any safety-sensitive duties until the
railroad's designated physician determines that the employee can
continue to work safely in a safety-sensitive position.'' (R-02-26).

FRA agrees with the safety concerns as expressed by the NTSB. This
Safety Advisory, which has been developed after consultation with
industry parties participating in the North American Rail Alertness
Partnership, is an initial step in addressing the concerns identified
by the NTSB.
However, in evaluating the recommendations, FRA has noted the
importance of addressing these needs within a proper framework of
accountability, scientific credibility, professional discipline, and
fairness. Further, FRA notes that conditions that could threaten
employee fitness for duty are not limited to sleep disorders.
Accordingly, in the fall of 2003, FRA awarded a contract for a
comprehensive study to determine the need for, and options for
implementing, medical standards for railroad employees in safety-
critical occupations. Upon receipt of a final report from that study,
FRA will evaluate the appropriate framework for addressing in greater
detail the NTSB's recommendations.
While FRA has regulations that address the fitness of employees,
the regulations are limited to hearing and vision requirements for
locomotive engineers (49 CFR part 240) and the control of alcohol/drug
use (49 CFR part 219). FRA also enforces the hours of service law (49
U.S.C. 21101-21108), which specifies the maximum hours of duty and
minimum periods of release for certain safety-critical employees.\5\

\5\ The hours of service law is an important defense against
excessively long hours of work. However, it was enacted prior to
completion of the major body of fatigue research. Although FRA may
not vary the terms of the statute, FRA is empowered to authorize
pilot projects directed at fatigue mitigation upon joint petition of
the railroad and employees affected. FRA continues to encourage
development of approaches to fatigue prevention and mitigation,
especially with regard to providing predictable work schedules that
do not induce fatigue and that offer ample opportunity for rest.

Need for Action Now

The FRA and NTSB have investigated numerous human factor accidents
that were the result of errors caused by loss of alertness or loss of
situational awareness. While there are no existing data to justify the
inference that undetected or untreated sleep disorders were a causal
factor, several factors, including the Clarkston, Michigan collision,
data extrapolated from other modes of transportation, and the
prevalence of sleep disorders within the general population, clearly
demonstrate that there is a threat to railroad operations from
undiagnosed or incompletely treated sleep disorders.
This threat exists, not only in train operations, train
dispatching, and signal maintenance, but also in the operation of motor
vehicles, on-track equipment, and other machinery. Approximately 35% of
all train accidents reported to FRA are attributed to human factors, of
which fatigue, and more particularly, sleep disorders, play an
undetermined role. Most employee casualties in train incidents and non-
train incidents also involve a human factor component.

Recommended Actions

Therefore, FRA recommends that railroads and representatives of
employees, working together, take the following actions to promote the
fitness of employees in safety-sensitive positions:
(1) Establish training and educational programs to inform employees
of the potential for performance impairment as a result of fatigue,
sleep loss, sleep deprivation, inadequate sleep quality, and working at
odd hours, and document when employees have received the training.
Incorporate elements that encourage self-assessment, peer-to-peer
communication, and co-worker identification accompanied by policies
consistent with these recommendations.
(2) Ensure that employees' medical examinations include assessment
and screening for possible sleep disorders and other associated medical
conditions (including use of appropriate checklists and records).
Develop standardized screening tools, or a good practices guide, for
the diagnosis, referral and treatment of sleep disorders (especially
sleep apnea) and other related medical conditions to be used by company
paid or recommended physicians during routine medical examinations; and
provide an appropriate list of certified sleep disorder centers and
related specialists for referral when necessary.
(3) Develop and implement rules that request employees in safety-
sensitive positions to voluntarily report any sleep disorder that could
incapacitate, or seriously impair, their performance.
(4) Develop and implement policies such that, when a railroad
becomes aware that an employee in a safety-sensitive position has an
incapacitating or performance-impairing medical condition related to
sleep, the railroad prohibits that employee from performing any safety-
sensitive duties until that medical condition appropriately responds to
(5) Implement policies, procedures, and any necessary agreements
(a) Promote self-reporting of sleep-related medical conditions by
protecting the medical confidentiality of that information and
protecting the employment relationship, provided that the employee
complies with the recommended course of treatment;
(b) Encourage employees with diagnosed sleep disorders to
participate in recommended evaluation and treatment; and
(c) Establish dispute resolution mechanisms that rapidly resolve
any issues regarding the current fitness of employees who have reported
sleep-related medical conditions and have cooperated in evaluation and
prescribed treatment.
FRA acknowledges that some of the above recommendations may have
already been institutionalized in one form or another by various
segments of the industry; in this case, FRA suggests a review of
current policies and procedures for relevancy.
FRA believes that the recommendations set forth above, if
implemented by industry parties, could advance the successful
management of sleep disorders. Taken together with the results of FRA's
broader study of potentially impairing medical conditions, lessons
learned could provide a sound foundation for more formal action by
industry, government, or both.

Issued in Washington, DC, on September 21, 2004.
Grady C. Cothen, Jr.,
Acting Associate Administrator for Safety.
[FR Doc. 04-22025 Filed 9-30-04; 8:45 am]


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