FAA Revises Sleep Apnea Guidance

In April, the FAA announced that it will ask aviation medical examiners (AMEs) to review new draft guidance that would require pilots at risk for obstructive sleep apnea (OSA) to undergo testing and treatment, if necessary.

According to the National Sleep Foundation, more than 18 million American adults suffer from sleep apnea. The FAA says that the new 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” and comes “in response to concerns from the aviation medical community.”

But in December, the draft guidance received vocal opposition from both general aviation and commercial pilots, specifically regarding the FAA’s plans to require all pilots with a BMI of 40 or more to undergo testing and potential treatment for OSA.

OSA is a potentially deadly condition that occurs during sleep when the throat or tongue obstructs the airway, causing the airway to close and the person to struggle for breath. Due to snoring and pauses in breath, some sufferers end up breathing less than half as often as they should. The daytime fatigue caused by apnea events can be very dangerous especially for those that need to be alert while piloting or driving. Since apnea events happen during sleep, many sufferers have this condition for years and are unaware of it. OSA is very common in overweight and obese patients.

The Air Line Pilots Association, Aircraft Owners and Pilots Association and the National Business Aviation Association all questioned the draft’s safety justification, and requested the FAA undergo a formal rulemaking process before announcing a new mandatory testing policy.

The FAA has since agreed to revise the draft guidance, and has asked aviation medical examiners to review the draft revisions by late April. The revised draft guidance also comes as both House and Senate lawmakers introduced legislation that would require such a rulemaking for any mandatory OSA testing. The House passed its version of the bill last February.

Under the latest draft

According to the latest draft guidance, while AMEs will consider all OSA risk factors, pilots will not be disqualified based solely on BMI. The FAA says that, “AMEs will issue medical certificates to pilots regardless of BMI if they are otherwise qualified.”

However, pilots deemed to be of “significant risk” will be referred for OSA evaluation, but the FAA says the testing can be completed by any physician. Also, this evaluation many not require laboratory sleep study or home study if the physician does not believe it necessary.

The FAA is providing a 90-day window for the physician report to be furnished to the AME, so that pilots would be able to continue flying during this period. Pilots diagnosed with OSA must provide documentation of effective treatment and then obtain a special issuance letter.

While the revised draft guidance eliminates the BMI threshold, the FAA’s statement on the guidance reiterates the belief that OSA is nearly universal in obese people with a BMI of 40 or more, and that untreated OSA has always been and will continue to be a disqualifying medical condition.

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