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Obstructive Sleep Apnea

Source: FAA Safety Briefing, September/October 2018
By Penny Giovanetti, D.O.

Obstructive Sleep Apnea (OSA) has become very visible in the public eye over the last few years. It has been specifically mentioned in the National Transportation Safety Board’s (NTSB) Most Wanted List.

OSA is present in 2-4 percent of the adult population in the United States. It occurs when the upper airway repeatedly becomes blocked during sleep. This can reduce or even completely stop airflow to the lungs. If your brain realizes that you are not getting enough air, it will cause you to wake up and breathe. This could happen hundreds of times during the night resulting in poor sleep and daytime fatigue. Most people do not even realize they wake up. Risk factors for developing OSA include obesity, male gender, large neck circumference, large tonsils, and certain facial features such as a small lower jaw. OSA disrupts normal sleep causing fatigue and a variety of other problems that can result in pilot impairment.

Frequently Asked Questions

Why does the FAA care about OSA?

OSA is a known safety risk. It was cited by the NTSB as a contributing factor in the February 13, 2008 Mesa Airlines incident in which both the captain and the first officer fell asleep during the flight. They flew 26 miles past their destination and did not respond to air traffic control for more than 18 minutes. OSA has also been cited as a cause in rail mishaps in 2016 and 2017, in which one person was killed and 200 injured. Since 2001, the NTSB has identified OSA as a factor in at least nine accidents in four transportation modes.

Why should I care about OSA?

Untreated OSA increases the risk of hyperten-sion, heart disease, stroke, diabetes, and premature death. It is associated with chronic fatigue, excessive daytime sleepiness, problems with memory and concentration, and mood changes.

What should I do if I suspect I have OSA?

First you should discuss your symptoms with your primary care physician or your Aviation Medical Examiner (AME). He or she may then refer you for sleep studies to confirm the diagnosis, and start you on treatment if necessary. AMEs currently perform an OSA risk screening for all airmen at the time of their exam.

Can I get a medical certificate with OSA?

Yes. Once you are adequately treated and your symptoms have gone away, you can receive a special issuance. If your AME finds you are at significant risk for OSA, he or she can still issue you a medical certificate while you undergo diagnostic testing and initiate treatment. Renewal of your special issuance will require that you remain without symptoms, and that you give your AME a current assessment from your treating physician, along with a compliance printout from your continuous positive airway pressure (CPAP) machine, if you use one (more on that later).

Treatment

There are numerous methods to treat OSA. One of the best ways is to lose weight and maintain a healthy lifestyle including increasing physical activity and developing heathy sleeping habits. The first-choice treatment is a CPAP machine. The CPAP machine provides pressurized air through a mask to aid in breathing during sleep. In some individuals, oral appliances or simply a change in sleeping position may be sufficient. Depending on the severity of your OSA and your response to other treatment forms, surgery may be necessary. A newer treatment is a hypoglossal nerve stimulator. There are several possible procedures so be sure to discuss your options with your doctor.

Learn More

FAA Pilot safety brochure on OSA - www.faa.gov/pilots/safety/pilotsafetybrochures/media/Sleep_Apnea.pdf

Penny Giovanetti, D.O., received a bachelor’s degree from Stanford, a master’s in Environmental Health and Preventive Medicine from the University of Iowa and doctorate from Des Moines University. She completed a 27-year career as an Air Force flight surgeon. She is board certified in aerospace medicine, occupational medicine and physical medicine/rehabilitation. She is also a Fellow of the Aerospace Medical Association and a private pilot.