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FAA set to issue medical guidance on sleep apnea

OSA inhibits restorative sleep. Untreated OSA always has been a disqualifying medical condition and will continue to be disqualifying. The FAA is not changing its medical standards related to OSA; however, it is revising the screening approach to help AMEs find undiagnosed and untreated OSA. The new guidance will improve safety and pilot health by reducing the burdens and disincentives that may have prevented some pilots from seeking an OSA evaluation and treatment. Pilots will be able to continue flying while they are evaluated and as they begin treatment, if needed. Pilots diagnosed with OSA may send documentation of effective treatment to the FAA to arrange for a Special Issuance medical certificate to replace the regular issuance medical certificate.

Based on feedback from industry on the FAA’s draft guidance, the new guidance does not rely on BMI and allows a pilot to keep flying during evaluation and treatment. The FAA plans to publish the new guidance in the FAA Guide for Aviation Medical Examiners on March 2, 2015.

The FAA policy on sleep apnea responds to many of the concerns raised by the U.S. Aircraft Owners and Pilots Association (AOPA) and the general aviation community.

The new policy will not disqualify pilots from receiving a medical certificate based solely on body mass index (BMI). Pilots believed to be at significant risk for the condition will receive a regular medical certificate and be required to undergo a follow-up assessment. Those who are diagnosed with the condition must receive treatment to continue flying.

“We appreciate the FAA’s decision to work with the aviation community to address concerns regarding sleep apnea,” said AOPA president Mark Baker. “The new policy combines a focus on safety with a common sense approach that lets pilots who haven’t been diagnosed with an illness keep flying.”

The issue of sleep apnea came to the forefront in 2013 when the federal air surgeon described a planned policy change in an FAA medical bulletin. Under the original FAA proposal, pilots with a BMI of 40 or greater would have been required to undergo testing for sleep apnea by a board certified sleep specialist. The FAA said it planned to expand the policy to include all pilots with a BMI of 30 or greater.

But AOPA strongly objected to requiring thousands of pilots to go through expensive and intrusive testing based exclusively on BMI. The association and other aviation groups turned to Congress for assistance, and the U.S. House of Representatives passed a bill that would have required the FAA to go through the rule making process before introducing any new policy on sleep disorders.

In December 2013, the FAA stepped back from its initial policy announcement and began working with stakeholders, including AOPA, to address concerns about sleep apnea.

Under the new policy, the risk of obstructive sleep apnea will be determined through an integrated assessment of the pilot’s medical history and symptoms as well as physical and clinical findings. Aviation medical examiners will be provided with guidance from the American Academy of Sleep Medicine to assist them in determining each pilot’s risk.

“The effectiveness of the new policy will depend on how aviation medical examiners implement it,” said Rob Hackman, AOPA vice president of regulatory affairs. “We continue to be engaged in this issue and we encourage AOPA members to tell us about their experiences once the policy takes effect.”

Pilots who are determined to be at significant risk will receive a regular medical certificate and undergo a sleep apnea evaluation. That evaluation can be performed by any physician, including the aviation medical examiner, and does not require a sleep study unless the physician believes one is needed. Pilots will have 90 days to complete the evaluation and forward the results to the FAA’s Aerospace Medicine Certification Division (AMCD), the Regional Flight Surgeon’s office, or the aviation medical examiner. Thirty-day extensions will be available to pilots who need more time to complete the process.

If the evaluation does not lead to a diagnosis of obstructive sleep apnea, no further action will be required. Pilots who are diagnosed with the condition can send documentation of effective treatment to the AMCD or regional flight surgeon to arrange for a special issuance medical certificate to replace the regular medical certificate issued previously.