Obstructive Sleep Apnea (OSA) – Pilot – FAA Medical Exam

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Pilots are concerned about a new medical standard for Obstructive Sleep Apnea (OSA) by the Obstructive Sleep Apnea (OSA). The concern is that pilots with a serious weight problem will be adversely affected in their recertification. I would like to present my perspective as a senior AME. My thoughts are my own and not necessarily shared by the powers that be.

Obstructive sleep apnea may cause functional impairment for safe aircraft operations. OSA literally means that someone stops breathing during sleep or effectively loses the ability to oxygenate the blood stream. This is because the upper airway is partially or completely blocked during sleep. Therefore the chest muscles and diaphragm must work much harder to open the airway and maintain respiration.

Sometimes a spouse or significant other will notice that during sleep an individual has difficulty maintaining normal respiration or, in fact, there are long pauses between breaths. Patient will come to the office with this clear witnessed account of sleep apnea and we request that a sleep study be done.  This involves going to a sleep lab and spending the night while being monitored.

However doctors also should be looking for symptoms of daytime sleepiness, excessive fatigue, non-restorative sleep, difficulty concentrating, forgetfulness, snoring, and inability to stay awake during common activities during the day.

Overwhelmingly the patients at risk for this are not aware of the condition. Therefore, prospective screening is the best way to diagnose and manage patients with OSA.  There are estimated to be more than 12 million people in the United States at this time with sleep apnea. More than half of those individuals are overweight. It tends to occur in middle-age man and older woman.  The risk factors for obstructive sleep apnea include obesity, thick or large next, and smokers.

The FAA’s concerned that OSHA will result in impaired pilot performance. The FAA has published the Guidelines indicating that mild to moderate obstructive sleep apnea can show performance degradation equivalent to 0.06 to  0.08% blood alcohol levels which is the measure of legal intoxication in most states.  There’s also the increasing risk of hypertension and atherosclerosis with the resulting increasing the risk of heart attack and stroke.  In fact 30 to 50% of patients with heart disease and 60% of patients suffering strokes are found to have obstructive sleep apnea.

The FAA medical guidelines indicate that OSA is present in almost all obese individuals with a body mass index over 40 and the next circumference greater than 17 inches.  Untreated obstructive sleep apnea is a disqualifying condition for airmen and air traffic control specialists.

The next steps in the process will be for the pilot to have a BMI and neck circumference measured during the medical examination. Those airman with high BMI above 40 and neck circumference greater than 17 will be asked to undergo specialized evaluation by a sleep disorder specialist.

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Duration of FAA Pilot medical certificates

Many pilots ask if we could recap the duration for their medical certificates. and the frequency for the EKG for the first class airmen.

  1. First Class Medical Certificate: A first class medical certificate is valid for the remainder of the month of issue; plus

o    6 calendar months for operations requiring a first class medical certificate if the airman is age 40 or over on or before the date of the examination, or

o    12-calendar months for operations requiring a first-class medical certificate if the airman has not reached age 40 on or before the date of examination, or

o    12 calendar months for operations requiring a second class medical certificate, or

o    24 calendar months for operations requiring a third class medical certificate if the airman is age 40 or over on or before the date of the examination, or

o    60 calendar months for operations requiring a third class medical certificate if the airman has not reached age 40 on or before the date of examination. *

EKG is first done on the first medical exam after the airman’s 35th birthday.

The next EKG is done on the first medical exam after the airman’s 40th birthday.

After that one EKG is done every 12 months.

Please note that having the EKG in proper sequence with the medical is vital to maintaining the first class certificate.

After 12 months, an airman who does not have a current EKG will lose the first class certificate as it reverts to a Second class automatically.

    2. Second Class Medical Certificate: A second class medical certificate is valid for the remainder of the month of issue; plus

o    12 calendar months for operations requiring a second class medical certificate, or

o    24 calendar months for operations requiring a third class medical certificate, if the airman is age 40 or over on or before the date of the examination, or

o    60 calendar months for operations requiring a third class medical certificate if the airman has not reached age 40 on or before the date of examination. *

     3. Third Class Medical Certificate: A third-class medical certificate is valid for the remainder of the month of issue; plus

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