Sleep Disorders

 

Sleep Apnea

sleep apneaObstructive Sleep Apnea (OSA) 

Obstructive Sleep Apnea is a condition that, if undiagnosed, can have significant medical complications such as daytime hypersomnolence, also referred to as Excessive Daytime Sleepiness (EDS), heart rhythm disturbances, and elevated blood pressure.  In 2009, a National Transportation Safety Board (NTSB) Safety Recommendation to the FAA resulted in changes to the evaluation requirements for medical certification.

The FAA grants medical certification under a Special Issuance Authorization to pilots who report successful treatment and control of obstructive sleep apnea. However, medications that may be prescribed to treat symptoms are generally NOT allowed if used on a regular basis.

 

Initial evaluation must include:

  1. Sleep studies (overnight polysomnography).
  2. Maintenance of Wakefulness Test (MWT) after appropriate treatment has been initiated.
  3. Alternative to the MWT is a 30 day download of the programmable chip from the CPAP machine.  Satisfactory compliance generally means that CPAP is used at least 75% of the time, with at least 6 hours sleep per night.
  4. Current status letter from treating physician that includes present treatment and its effectiveness, specific comment should be made regarding any daytime sleepiness. If there is any question regarding compliance, intolerance to the CPAP, or persistence symptoms of excessive daytime sleepiness a MWT may be required.

Acceptable treatment includes:

  1. Surgery with documentation of satisfactory results. A post-op sleep study and MWT evaluation should be done as soon as surgical wounds have healed. A follow up status report will be required one year post-op. If the status report is favorable, further follow-up may not be required for continued certification.
  2. CPAP – A current MWT will be required following initial treatment to document satisfactory results; however, if the machine is equipped with an interrogation chip, a report of compliance will suffice.
  3. Oral mouthpiece- MWT will be required at first reporting.

Unacceptable treatment includes:

  1. Tennis balls in sleep shirt.
  2. Weight loss alone where BMI remains greater than 35, may be unacceptable treatment for moderate to severe sleep apnea.

Required Protocol for MWT:

  1. No dietary or medication manipulation is allowed. There must be a drug screen for stimulant drugs and caffeine.
  2. The MWT consists of four (4) forty- minute test periods at two hour intervals (e.g., 9:00 a.m., 11:00 a.m., 1:00 p.m., and 3:00 p.m.). NO napping is allowed between test periods.
  3. Patients should be monitored continuously during the nap test period. The standard polysomnographic monitoring (digastrics EMG, eye movement recorder, apnea recorder or ECG) may not be required; however, EEG monitoring will be required in order to detect the various stages of sleep.
  4. Patients should be dressed and sitting semi-recumbent on a bed in a dark room.
  5. Patients are asked to remain awake, but not to use extraordinary measures such as face slapping or singing.
  6. The endpoint of each test period is either sleep (three consecutive 30-s epochs of Stage I or any single 30-s epoch of Stages 2,3,4, or REM) or the end of the forty-minute time period. The patient is then asked to stay awake until the next test. The FAA considers the study “normal” if there is less than 90 seconds of combined sleep during the total test period.

AASI for Sleep Apnea:

After initial certification by FAA staff doctors, subsequent renewals qualify for AME Assisted Special Issuance (AASI), a process that provides examiners the ability to issue an airman medical certificate to an applicant who has a medical condition that is disqualifying under 14 CFR Part 67.

The authorization letter received from FAA, granted in accordance with part 67 (14 CFR Part 67.401), is accompanied by attachments that specify what information the treating physician(s) must provide for the renewal issuance.

Examiners may issue renewal of an airman medical certificate if the applicant provides the following:

  • An authorization granted by the FAA.
  • Current status letter from treating physician that includes present treatment and its effectiveness, and specific comments regarding daytime sleepiness.
  • A current download of the programmable chip (if applicable).

The examiner should defer to the AMCD or Region if:

  • There is question concerning adequacy of treatment or airman's compliancy.
  • The Maintenance of Wakefulness test shows evidence of daytime sleepiness.
  • There is evidence of new, associated illness, such as right-sided heart failure.

08/13