US relents on sleeps tests for fat controllers

The United States Federal Aviation Administration (FAA) last week sent draft guidance for Aviation Medical Examiners (AMEs) on Obstructive Sleep Apnea (OSA) for key industry medical representatives to review in response to concerns from the medical community.

The condition inhibits restorative sleep and can have significant safety implications because it can cause excessive daytime sleepiness, cognitive impairment, cardiac dysrthythmias, sudden cardiac death, personality disturbances, and hypertension. OSA is nearly universal in obese people who have a Body Mass Index (BMI) over 40.

The FAA announced in November the new regulation requiring pilots and air traffic controllers undergo testing for sleep disorders if they’re overweight. The requirement said that any pilot or controller with a body mass index of 40 or greater and a neck circumference of 17 inches should be tested, adding it would also look at those with lower BMIs “until we have identified and assured treatment for every airman”.

The FAA said this new rule is in line with a National Transportation Safety Board recommendation and is “designed to help airmen and aviation safety by improving the diagnosis of unrecognized or untreated obstructive sleep apnea.”

“Untreated OSA has always been and will continue to be a disqualifying medical condition,” said the FAA in its latest statement although it said its revised guidance aims to improve safety and pilot health by reducing the burdens and disincentives that ‘may have prevented some pilots from getting an OSA evaluation and treatment’. Highlights include:

  • Workers will not be disqualified based on Body Mass Index (BMI) alone. AMEs will consider all of the OSA risk factors and make a recommendation regarding an OSA evaluation. AMEs will issue medical certificates to workers regardless of BMI if they are otherwise qualified.
  • Workers with significant risk will be referred for an evaluation for possible OSA. OSA evaluations may be completed by any physician, not just sleep specialists, using standard criteria. Evaluations may not require a laboratory sleep study or even a home study if the certifying physician does not feel the pilot requires it.
  • Reports from physicians may be given to the AME within 90 days of the FAA exam and forwarded to the FAA to satisfy the evaluation requirement. The person continues to work during this period.
  • Workers diagnosed with sleep apnea can bring documentation of effective treatment to the AME who will call the Regional Flight Surgeon or the Aeromedical Certification Division for assistance in order to continue flying on the previously issued medical certificate.

The FAA will send the worker 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 Continuous Positive Airway Pressure (CPAP) machine and a brief statement from a physician.


Posted in CAAs/ANSPs, News, Safety

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