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.
From: Raymond Basri <xxxxxxxxxxxxxxxxx >
Date: June 24, 2014 11:03:41 AM EDT
Subject: Re: LASIK
That is very good news indeed. I’m happy you are satisfied with the results. You should bring the report from the eye specialist as well as completing your Medxpress online application listing it as a surgical procedure.
I look forward to seeing you on your next visit and removing your vision restriction from your certificate.
On Jun 24, 2014, at 09:14 AM, < xxxxxxxxxxxxxxxxxxx > wrote:
Hey Dr. Basri – how’s things? Hope your summer is off to a good start.
aymond Basri, MD, FACP
236 Crystal Run Rd, Ste. 2
Middletown, NY 10941
June 18, 2014
Coronary Artery Disease and Your Medical Certification
Pilots can have coronary artery disease and not be retired on disability. Here is a case where the pilot regained his Class 1 Medical Certificate exactly 6 months after having a mycardial infarction and coronary artery stent.
The FAA mandates a 6 month medical furlough after any cardiac incident or procedure including coronary artery bypass surgery (CABG). Although the 6 Months is a minimum, many airmen are never returned to duty sometimes becasue they did not seek out the proper medical advice.
In order to return to full duty with the least time off, pilots should work with their Senior AME to plan the testing and reporting needed to satisfy the FAA.
We are experienced with these issues and have successfully returned scores of airmen to work and recreational flying. Here is an example of how we approach the return to duty.
Ray Basri, MD, FACP
Senior Aviation Medical Examiner
Manager, Aeromedical Certification Division
PO Box 26080
Oklahoma City, OK 73126
Dear Dr. XXXX at FAA,
I performed the cardiovascular exam as per protocol for the first request for Authorization for Special Issuance of a First Class Medical Certificate.
This airman has a history of MI in March 2013 followed by successful PTCA and stenting of the distal circumflex artery on March 28 using a Resolute drug eluting stent. He made an excellent recovery and underwent nuclear exercise stress testing on August 29 with normal exercise capacity (Bruce stage 4, 10 minutes) and normal scans. This airman also had transthoracic echocardiography done on the same date, which showed normal wall motion and LVEF.
Furthermore, after these tests were done and reported as normal, this pilot underwent another cardiac catheterization which showed normal flow through the stent and excellent perfusion to all areas of the myocardium.
I am pleased to report that his health continues to be good, free of cardiovascular symptoms of chest discomfort, shortness of breath, palpitations, dizziness, or side effects from his medications. He is currently taking Lisinopril 5 mg per day, Dexilant 60 mg per day, Crestor 10 mg per day, Plavix 75 mg per day and ASA 81 mg per day. His metoprolol was discontinued after the normal stress test and catherization. He has no side-effects from these medications. He does not use tobacco, family history is negative for CVD, and his weight has come down from 232 to 225 lbs. He runs a couple of miles daily.
This airman has normal blood pressure 120/80 in each arm on 3 separate visits, and physical exam shows:
HEENT- Anicteric, PERLA, EOMI, Fundi nl
Neck- supple, JVD neg , no bruits
Lungs- clear to A & P, well healed midline CABG scar
COR- RSR no murmurs, gallops or rubs, PMI is not displaced
Abd- soft, no organomegaly, no CVAT
Ext- no clubbing cyanosis or edema
Neuro- A & O X 3, Cr Nerves II-XII intact, Motor intact
MyFlightMD Offices and Contact Info for your Next Medical.
uestions & Answers:
- What is a medical certificate?
- How do I obtain a medical certificate?
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- What class of medical certificate must I hold and how long is it valid?
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