FAA Moves to Ease Medical Guidance on Pilots’ Sleep Apnea
January 26, 2015
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  • Federal air-safety regulators have drafted new standards for identifying and testing commercial and private pilots suspected of suffering from sleep disorders, easing earlier proposals criticized as too rigid by many aviators.

    The Federal Aviation Administration said the revised guidance, slated to go into effect in early March, will give designated medical examiners greater leeway to approve unrestricted licenses even for some seriously overweight or obese pilots without first requiring detailed screening tests. According an agency summary, that decision is to be based on an assessment of an aviator’s personal “history, symptom and physical/clinical findings.”

    The previous guidance, which prompted controversy when it was proposed last November, envisioned automatically grounding some overweight pilots most at risk for sleep disorders—based solely on their body-mass index—until they passed elaborate tests administered by sleep specialists or were treated successfully for sleep apnea. The index compares height and weight to provide a numerical measure, or BMI, of the proportion of fat in an individual’s body. Under the initial proposal, a BMI of 40 or more would have triggered special screening exams and other measures.

    A major shift will allow pilots to continue flying while they are being evaluated for potential sleep disorders, according to the FAA’s announcement, or as they begin treatment, if needed. Pilots diagnosed with such disorders will be eligible for a special medical certificate, once they have undergone successful treatment.

    Sometimes called obstructive sleep apnea, or OSA, the sleep disorder restricts an individual’s airway, prevents normal oxygenation of the blood and typically results in fitful sleep. Experts say the disrupted sleep patterns can cause excessive daytime sleepiness, memory lapses, heart or lung damage, reduced problem-solving skills and inattention to detail.

    Concern about the U.S. obesity epidemic prompted FAA officials to step up medical scrutiny of overweight pilots with the goal of identifying undiagnosed sleep apnea. Some studies indicate that roughly 7% of the general population experience sleep apnea.

    The revised guidelines mean that a high BMI alone “will not disqualify a pilot or require an OSA evaluation,” according to the FAA. If an evaluation for possible sleep apnea is required, it can be done by any physician and won’t necessarily have to be performed by a specialist or involve a laboratory sleep study. Pilots will have 90 days to complete the evaluation and forward the results to FAA officials.

    In releasing specifics of the new guidance last Friday, the FAA said a database compiled by U.S. crash investigators lists a total of 32 fatal plane crashes in which sleep apnea was mentioned in the pilot’s medical history. The crashes involved a wide range of aircraft, but sleep apnea wasn’t explicitly identified as a cause or contributing factor in any of the accidents.

    The impact of sleep apnea in the cockpit first attracted heightened public attention in 2008, when a commuter jet carrying 40 passengers between a pair of Hawaiian islands flew some 26 miles past its destination and lost radio contact with air-traffic controllers for more than 18 minutes. The plane landed safely, but “the captain was found to have undiagnosed severe OSA,” according to the FAA.

    When the FAA unveiled its original proposals, groups representing airline and private pilots complained that the blanket requirement for extensive testing based on the BMI index was arbitrary, expensive and intrusive. They helped persuade the House of Representatives to pass a bill requiring the FAA to go through formal rule-making procedures—a process that often takes years—before imposing any new policy on testing for sleep disorders.

    Within weeks of the FAA’s November announcement, the agency reversed course and pledged to consult more closely with pilot and industry representatives. The Air Line Pilots Association, the largest North American pilots union, has argued against mandatory testing of all aviators based entirely on BMI.

    The Aircraft Owners and Pilots Association, the largest group representing private pilots, responded to the latest FAA move by noting that it closely tracks draft guidelines released last April. AOPA urged its members to spread information about their experiences. “The effectiveness of the new policy will depend on how aviation medical examiners implement it,” according to the association.

    Write to Andy Pasztor at