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Abstract: Sleep apnea among commercial drivers may increase the risk of fall-asleep crashes, which incur large expenses. Drivers of passenger cars whose apnea is treated experience lower crash risk. Among community-based holders of commercial driver''s licenses, we considered three methods for identifying sleep apnea syndrome: (1) in-lab polysomnography; (2) selective in-lab polysomnography for high-risk drivers, where high risk is first identified by body mass index, age and gender, followed by oximetry in a subset of drivers; (3) not screening. The costs for each of these three programs equaled the sum of the costs of testing, treatment of identified cases, and crashes. Assuming that treatment prevents apnea-related crashes, polysomnography is not cost-effective, because it was more expensive than the cost of crashes when no screening is done. Screening with BMI, age and gender, however, with confirmatory in-lab polysomnography only on high-risk drivers was cost-effective, as long as a high proportion (73.8%) of screened drivers accepts treatment. These findings indicate that strategies that reduce reliance on in-laboratory polysomnography may be more cost-effective than not screening, and that treatment acceptance may need to be a condition of employment for affected drivers. [Copyright &y& Elsevier]

Highlights: [•] Our study examines sleep duration relative to self-reported and objective cardiometabolic risk factors. [•] Very short sleep (<5h) was associated with self-reported hypertension, hyperlipidemia and diabetes mellitus (DM). [•] Very short sleep (<5h) was associated with objectively determined hyperlipidemia and obesity. [•] Short sleep (5–6h) was associated with self-reported hypertension and obesity, and objective obesity. [•] Race/ethnicity interactions are significant for self-reported and objective hypertension, hyperlipidemia, DM, and obesity. [Copyright &y& Elsevier]

Highlights: [•] Overall, more drowsy driving in short sleepers and less in long sleepers. [•] With 7 nights/wk insufficient sleep, more drowsy driving in both short and long sleepers. [•] With 0 nights/wk insufficient sleep, more drowsy driving in short sleepers. [•] Short sleepers at greater risk of drowsy driving, irrespective of sufficient sleep. [ABSTRACT FROM AUTHOR]