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Hello. Welcome to this update on
Obstructive Sleep Apnea screening guidance
for Aviation Medical Examiners.
According to the Federal Air Surgeon,
the new guidance will significantly improve the
safety of the National Airspace System while
simultaneously improving pilot health and career longevity.
Today, I'll walk you through a triage function
resulting in six possible determinations.
But first, a little history on this topic:
In 2008 the NTSB provided recommendations to the FAA
to mitigate the safety risk of Obstructive Sleep Apnea.
In response to these recommendations,
the FAA developed lectures on sleep-related disorders -
and in particular Obstructive Sleep Apnea,
to be delivered at all training events.
Unfortunately, after five years of awareness training,
the number of pilots identified with OSA
was virtually unchanged.
It's important to note that the NTSB has recently placed
OSA on their "Most Wanted" list for transportation safety
improvements for 2015.
As a result, the FAA has developed new guidance
to address this growing concern.
This video outlines the process that AMEs are expected
to perform at each pilot examination.
The process is a result of input
given by industry stakeholders and
medical practice guidelines established by the
American Academy of Sleep Medicine, or AASM.
AMEs will perform what is essentially a triage function -
screening and assigning pilots into one of six
OSA groups while entering exam results into AMCS.
We do not expect the AME to perform a
sleep medicine evaluation, nor do we encourage it.
When performing the triage, it is important to keep in mind
two principles. Number one: A pilot should not be denied or
deferred unless the AME believes he or she represents
an immediate safety hazard.
This should be rare regarding OSA.
And number two: No pilot will be deferred based on
Body Mass Index alone.
Let's go over how an AME will assign pilots
to the OSA groups.
When examining pilots for OSA, AMEs should apply clinical
judgment using criteria developed by the AASM.
Risk assessment is determined through evaluation of history,
symptoms, and physical findings, including questions about OSA
that should be part of a routine health maintenance evaluation
according to the AASM.
Pilots determined to be at risk for OSA will be issued a
medical certificate and referred for an evaluation.
This evaluation will not require a laboratory sleep study,
or even a home study if the evaluating physician
determines it is not required.
Included in the new guidance is a decision tool that will
guide you through the six possible determinations.
Let's look at each of the six groups individually.
Group one is for those pilots who have already been
diagnosed and are currently on an AME
Assisted Special Issuance.
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Group two is for pilots who have had a sleep evaluation
but did not report the findings, regardless if found
positive or negative for a sleep disorder.
The AME must give the pilot a copy of Specification Sheet A
which outlines the information the pilot will need to provide
to the FAA.
An official request from the Federal Air Surgeon
will follow by mail.
The pilot will have 90 days to comply,
but may request an additional 30 days, if needed.
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Group three is for those pilots who do not have any
risk factors of OSA as outlined by the AASM.
No further reporting or evaluations are needed.
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Group four is for pilots who may meet some criteria for
OSA, but do not have any clinical signs or symptoms.
The AME is encouraged to provide the pilot with FAA
educational material, and suggest the pilot follow up
with their personal physician.
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Group five is for pilots who have overt signs and symptoms
of OSA and will need an evaluation.
The AME must give the pilot a copy of Specification Sheet B.
An official request from the Federal Air Surgeon
will follow by mail.
The pilot will have 90 days to comply but may request an
additional 30 days, if needed.
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Group six is where the AME determines that the pilot's
risk for OSA is significantly high,
and is an immediate risk to aviation safety.
We expect this to be extremely rare.
For example, the AME enters the exam room and finds a
pilot sleeping and witnesses prolonged apneas.
In these cases, pilots should be deferred.
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Note that deferral only applies to Group 6.
In summary, the result of your clinical decision making using
FAA OSA guidance will correlate directly to the AMCS
notation you make at the conclusion of the examination.
Today, we've covered OSA screening guidance,
the six OSA groups, and documentation
requirements in AMCS.
Our goal was to make this OSA "screen and detect" process
standards-based and straightforward for our
Aviation Medical Examiners.
Going forward, keep these two guiding principles in mind:
No pilot will be deferred or denied unless there is an
immediate safety hazard, and no pilot will be deferred
based on Body Mass Index alone.
For more information and additional reference material,
refer to the new section in the Guide for
Aviation Medical Examiners at the link provided.
Thanks for watching!
We appreciate the job you do keeping our skies safe.
See you next time.
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