Aeromedical Forum: April 2015

Undoubtedly many of you have been following the Clash of the Titans — the FAA vs. AOPA — over the issue of Obstructive Sleep Apnea (OSA).

It all started back in late 2013 when Dr. Fred Tilton, the then Federal Air Surgeon announced that the FAA was going to adopt a new obstructive sleep apnea policy. He pointed out that OSA is “almost universal” in obese individuals with a Body Mass Index (BMI) over 40 and a neck circumference of 17 inches or more. Therefore he proposed that Aviation Medical Examiners be required to calculate the BMI for every airman examinee. In case you were wondering, you do this by dividing your weight in kilograms by the square of your height in meters. If the unlucky airman had a BMI of 40 or more, he would have to be evaluated by a board certified sleep specialist doc. If diagnosed with OSA he would have to be treated and then evaluated by the FAA for a Special Issuance to get his medical certificate.

Wow! Why was the FAA making such a big deal over this, you may ask? We talked about OSA in our September 2011 Aeromedical Forum. Those of you with the elephantine memories required of a pilot will remember that OSA happens when the upper airway is plugged, most commonly by fat deposits around the neck. They obstruct the airway when lying down. This can lead to snoring when the airway is partially occluded.

Things can worsen and the airway can close. The victim of OSA then struggles to breathe and is aroused from sleep. This process can repeat itself hundreds of times during the night. As you might imagine restorative sleep is pretty much abolished. Untreated OSA can cause daytime sleepiness, impairment of thinking, personality disturbances, high blood pressure, stroke, heart rhythm abnormalities which can lead to sudden death. Not so good in the cockpit!

Thus, OSA is a disqualifying medical condition requiring the airman to obtain treatment and demonstrate control of symptoms. What was new was the FAA’s aggressive policy to detect it. AOPA’s pushback on the policy was that it would cost obese airmen “$2,000 to more than $5,000 for testing and, if needed equipment for treatment, according to AOPA research.” That assumes the airman has no insurance. Be that as it may, the brouhaha generated enough political pressure to force the FAA to rework things. Over the last year they have been talking with industry representatives trying to hammer out a politically viable compromise. This January’s Federal Air Surgeon’s Bulletin summarized the new plan which went into effect March 2:

• No disqualification of pilots based on BMI alone.

• The OSA screening process will be completed by the AME.

• Pilots determined to be at significant OSA risk will be issued a medical certificate and referred for an evaluation.

• OSA evaluations may be completed by any physician, not just sleep specialists, using the American Academy of Sleep Medicine’s guidelines. (If your insurance supports it, I’d strongly recommend seeing a board certified sleep specialist.)

• Evaluations do not require a laboratory sleep study if the evaluating physician determines the airman does not require it. (If you insurance covers it, however get a sleep study!)

• Results of the evaluations can be given to the AME, forwarded to the Aerospace Medical Certification Division (AMCD), or sent to the Regional Flight Surgeon’s (RFS’s) office within 90 days of the FAA exam to satisfy the evaluation requirement. The pilot continues to fly during this period. (Let’s hope he stays awake!)

• If the pilot needs additional time beyond 90 days to complete the evaluation, a 30-day extension will be granted by the AMCD or the RFS on request.

• Pilots diagnosed with OSA can send documentation of effective treatment to the AMCD or the RFS’s office in order to receive consideration for a Special Issuance medical certificate.

• The FAA will send the pilot a Special Issuance letter documenting the follow-up tests required and timing of the reports.

• Most follow-up reports will only require usage data from the CPAP machine and a brief statement from a physician.

The new guidelines will require some more wok by the AME’s and some follow-through on the part of the pilots. Bottom line is that airmen with undiagnosed OSA will be stimulated to seek the medical care they need. I’ve worked with enough sleep apnea patients to know that bringing this disorder under control can be life-altering. After diagnosis and treatment, most guys tell me they never realized how bad they felt until they felt so good!

If you want to know more about OSA, the FAA has a very good pamphlet you can access on line: http://www.faa.gov/pilots/safety/pilotsafetybrochures/media/Sleep_Apnea.pdf

Fly wisely. See you next month!

As always, comments, questions and suggestions are welcome: jdlakin@mnallergyclinic.com.