FAA Surgeon General Dr. Fred
Tilton M.D. has waged war on undiagnosed Obstructive Sleep Apnea (OSA). The research was actually done by Dr. Nick Lomangino over some
years (Tilton, F. 2014). The new OSA
rules were initially invoked as a simple FAA medical reinterpretation of the
existing regulations (ergo avoiding the notice of proposed rulemaking (NPRM)
process) but once the word got out, virtually every aviation organization
started screaming bloody murder. Organizations that are often at odds
with each other were in a united opposition to Dr. Tilton's reinterpretation of
the FAA's medical standards as it was seen as administrative overreach.
AOPA, ALPA, ATA, various aviation periodicals and many in the flying community were
activated. They were motivated by 3
things.
1. The biggest complaint was that the FAA was instituting what was
obviously a major rule change as a simple interpretation that required no
outside oversight. The attempt was thwarted by congress and the
entire thing went through the NPRM process.
2. Dr. Tilton's insistence that any pilot with a BMI
over 40 or neck size of 19 or higher were to be denied issuance of a
medical certificate until they had completed a sleep study (at their own
expense) and received FAA approved treatment (if it was deemed
required).
3. Some are arguing that it serves only a political purpose, not a
practical one and it doesn't cost the government money since the airmen have to
foot the bill. (Stanton, 2014).
After some changes made during the NPRM process the rule came into
effect. The main adjustment is that the FAA aviation medical examiners
(AMEs) can issue the medical certificate but airmen with BMIs over 40 will or
neck size over 19" have 90 days to do the sleep study and, if required,
receive treatment. The deadline can be extended another 90 days at
the airman's request.
Another change is that the airman can exercise the privileges of
his certificate until such time as the (and if) the sleep study requires treatment. As soon as the treatment begins and the
airman is content that the issue has been properly addressed, they may
self-release back to flying but the results of all tests must still be
submitted to the FAA by the 90 day deadline.
If the treatment is not working then the airman may not exercise the
privileges of their medical certificate until a satisfactory treatment is
underway.
An example is thus: The
airman has a 19 inch neck and the doctor says take a sleep study. The sleep study tells them they have severe
OSA. At this point the airman is
grounded (much the same as if they had a cold or any other temporary condition
that would ground them). A second sleep
test is done with a constant pressure air pump (CPAP) and the results show the
OSA is adequately addressed by its use.
The pilot gets their home CPAP unit and uses it for a few nights to make
sure all is well. The pilot may now self
release to resume flying but the doctor will want to see the results of longer
term use of the CPAP. The airman takes
the computer chip to the doctor who collects the data and from longer term use
(usually 30 days or so) and writes up a report that goes to FAA Aeromedical. Once they look at it and decide the OSA is
under control they will issue a waiver.
The pilot may have to have it renewed annually, possibly via a download
from the CPAP or just a declaration on the medical form.
FAA Aeromedical may continue to pursue more OSA requirements on
the aviation community possibly even making sleep studies a requirement for all
airmen certificates. This will be likely justified by the data showing
that 30% of all people have undiagnosed OSA.
This is on all of the associated documents and correspondence to AMEs (Tilton,
F. 2014).
Tilton, F. (2014). New obstructive sleep apnea policy. retrieved
from web
link. https://www.faa.gov/other_visit/aviation_industry/designees_delegations/designee_types/ ame/fasmb/media/201304_editorial.pdf
Stanton, B. (2014). Sleep apnea testing in transportation, it's
not medical guidance anymore, it's full
blown politics now. retrieved from web link.
http://www.sleepscholar.com/sleep-apnea-testing-in-transportation-its-not-medical- guidance-anymore-its-full-blown-politics-now/
