NEW YORK — Federal regulators who concluded that an engineer's sleep apnea caused a deadly train derailment in New York adopted several recommendations Wednesday for better screening of such disorders, including a call for improved physician training.

The National Transportation Safety Board, meeting in Washington, approved all the conclusions and recommendations in a staff report that examined five Metro-North Railroad accidents in New York and Connecticut in 2013 and 2014.

"We noted a rising trend of accidents and incidents in passenger rail," said Christopher Hart, acting chairman of the NTSB. "Today's recommendations ... have the potential to reverse this trend."

Among the Metro-North accidents was a Dec. 1 derailment that killed four people in the Bronx. The NTSB said last month that the engineer had fallen asleep at the controls because he had a severe, undiagnosed case of sleep apnea.

Apnea robs its victims of rest because they are repeatedly awakened as their airway closes and their breathing stops. Rockefeller told investigators he felt strangely "dazed" right before the crash, which occurred as he sped through a 30 mph curve at 82 mph.

Two of the recommendations went to the American College of Physicians and the American Academy of Family Physicians, asking the doctors' groups to enhance training so physicians can better "identify the risk factors for, evaluate and effectively treat obstructive sleep apnea."

The groups said they expected to comment later.

In addition, the NTSB issued recommendations urging Metro-North and the Long Island Rail Road to routinely screen "safety-sensitive" employees for sleep disorders. It urged other railroads and rail unions to support such screening.

The NTSB cannot require screening, and it repeated a call to the Federal Railroad Administration, which can, to impose sleep-disorder screening on all railroads.

"Only the FRA can provide the regulatory basis to improve passenger rail safety nationwide and we urge the FRA to do so," Hart said as the meeting ended.

Much of the discussion during the meeting repeated earlier findings, including that Metro-North had developed a "culture" that sacrificed safety for the sake of on-time performance.

During Wednesday's meeting, NTSB members and investigators praised Metro-North's response, noting that safety was now top priority and that a sleep-disorder program is now in place. But they noted that screening for engineers in the New York City subway — also part of Metro-North's parent agency, the Metropolitan Transportation Authority — was in place before the Bronx wreck.

Other recommendations in Wednesday's report urge Metro-North to improve communication among its various divisions and to implement a "non-punitive safety reporting system" so employees feel free to report problems.

Metro-North President Joseph Giulietti said the railroad already has taken action on each of the NTSB recommendations.

"We will continue to work on improvements — such as installing cameras on trains, fatigue management programs, and vastly improved track inspections," he said.

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Associated Press Writer Joan Lowy contributed to this report from Washington.