FAA Brochure - Obstructive Sleep Apnea

Obstructive

Sleep Apnea

(OSA)

Overview for the

Aerospace CommunityTreating OSA

Once recognized and identified, OSA is

highly treatable, either with surgery or nonsurgical approaches.

Obviously, non-surgical methods should

be tried first –

Behavioral changes

• Change sleeping position

(sleep on side or stomach).

• Change sleeping environment

(mattress, light level, temperature, etc.).

• A 10% weight loss will decrease the OSA

Apnea-Hypopnea Index (AHI) by 25%.

Dental appliances

Dentists specialized in sleep medicine

(American Academy of Dental Sleep Medicine) are trained the use of oral appliance therapy for the treatment of obstructive sleep apnea and snoring.

• Oral appliances (OA) using mandibular

repositioning are highly effective for mild

to moderate OSA and snoring.

The FAA’s medical certification guidance is based upon recommendations and criteria established by the American

Academy of Sleep Medicine (AASM) ( http://www.aasmnet.org/).Continuous positive airway pressure

(CPAP) machine

• Probably the best, non-surgical treatment

for reducing AHI when used consistently

over six hours a night

• Uses air pressure to hold the tissues open

during sleep

• Decreases daytime

sleepiness, as

measured by

surveys and

objective tests

• Improves cognitive

functioning on

tests

Surgical Methods

These can be very significant surgeries that

don’t always succeed and can lead to side

effects. They should be used only after non-

surgical methods have failed.

• Nasal airway surgery: Corrects for swelling

of the turbinates, septal deviation, and

nasal polyps.

• Palate implants: Stiffen the palate to prevent

it from collapsing.

• Uvulopalatopharyngoplasty (UPPP):

Prevents collapse of the palate, tonsils,and pharynx.

• Tongue reduction surgery: Decreases the

size of the base of the tongue.

• Genioglossus advancement: Pulls the

tongue forward to enlarge the airway.

• Maxillomandibular Advancement (MMA),

Moves the upper jaw (maxilla) and lowerjaw (mandible) forward.

The Bottom Line

If you experience one or more symptoms of

obstructive sleep apnea, it is recommended that

you consult a doctor, since treatment for OSA is

effective for decreasing fatigue and increasing

aviation safety.

What about your medical certificate? If your

OSA is treatable, you can maintain your airman

medical certificate and continue to enjoy your

aviation career.

However, flying with untreated OSA constitutes

an unnecessary risk and can become a safety-

of-flight issue.

Publication No. AM-400-10/2 (rev. 11/27/16)

Provided by

Aerospace Medical Education Division, AAM-400

To request copies of this brochure online:

http://www.faa.gov/pilots/safety/pilotsafetybrochures/

or contact:

Federal Aviation Administration

Civil Aerospace Medical Institute

AAM-400

P .O. Box 25082

Oklahoma City, OK 73125

(405) 954-4831

More information on OSA is available Online at:

www.faa.gov/go/ame

OK-16-2037

Asleep at the controls

On a daytime flight in 2008, a commercial

aircraft with three crewmembers and 40 passengers flew past its destination airport after both the captain and first officer fell asleep.

The pilot awoke and turned back to the destination airport, where all deplaned safely-- but behind schedule.

The National Transportation Safety Board

(NTSB) determined that contributing factors to the incident were the captain’s undiagnosed obstructive sleep apnea (OSA) and the flight crew’s recent work schedules, which included several days of early-morning start times.

Up to that time, OSA was relatively unknown

outside the medical community.

Today, OSA is recognized as the primary

source of sleep-disordered breathing (SD) and a major contributor to many possible health-related chronic health conditions.

The NTSB listed OSA on its “Most Wanted”

list of Transportation Safety Improvements for 2015 in North America:

• 10-15% of females and 20-30% of males

have OSA

• 15% of males and 5% of females are

confirmed through diagnosis

OSA affects:

• 70% of morbid obese patients

• 70% of patients with T ype II diabetes

• 40% of patients with hyper tension

• 30% of patients with morning headache

• 20% of veter ansThe pathophysiology of OSA

Apnea means “being without respiration.”

Obstructive sleep apnea is characterized

as a repetitive upper airway obstruction during sleep, as a result of narrowing of the respiratory passages.

Mild OSA is defined as an Apnea-Hypopnea

Index (AHI) of 5-15/hr and severe OSA as an AHI > 30/hr. Moderate OSA would fall between these ranges.

Most people with this disorder are o

verweight

and have higher deposits of adipose (fatty) tissue in their respiratory passages, and the size of their soft palates and tongues are larger than average.

These conditions decrease the size of the

upper airway and decrease airway muscle tone, especially when sleeping in the supine (back down and horizontal) position.

Gravity can pull tissue down and over the

airway, further decreasing its size, impeding air flow to the lungs during inhalation.

The major impact of OSA

Snoring can result when the airway becomes partially obstructed. With further tissue obstruction of the airway, there may be complete occlusion. Whether the obstruction is partial (hypopnea) or total (apnea), the patient struggles to breathe and is aroused from sleep.

Often, these sleep interruptions are

unrecognized, even if they occur hundreds of times a night. The real danger is that the OSA sufferers may not realize the condition and are only aware that they typically awaken feeling sleepy and tired.

Losing sleep is more than a simple

inconvenience. Good, sound sleep is essential for good health and clear mental and emotional functioning.

Additionally, OSA is associated with a

reduction in blood oxygen levels feeding the brain, which, of course, is a major health concern for neurocognitive deficit.

Repetitive decreases in blood oxygen le

vels associated with OSA may eventually

increase:

• Blood pressure

• Strain on the cardiovascular system

• Risk of heart attac k

• Risk of stroke

• Risk of neurocognitive decline

• DiabetesA potential problem in flight?

The implications for pilots and crewmembers are significant.

It has been suggested that people with mild-

to-moderate OSA can show performance degradation equivalent to 0.06 to 0.08% blood alcohol levels, which is the measure of legal intoxication in most states.

Most pilots will not fly intoxicated, but OSA

sleep deprivation may be causing the equivalent effects! Further exacerbating the problem are time zone changes and post-flight alcohol consumption, which can inhibit wakefulness.

The NTSB reported a six fold increase in the

risk of aviation crashes for pilots with OSA.

Normally, when you stop breathing while

asleep, the brain automatically sends a wake-up call after about 10 seconds, and you wake up, gasping for air.

Multiple time zone changes and alcohol

consumption inhibit arousal mechanisms and may result in oxygen deprivation of 30 seconds or longer before you heed the wake-up call. When you add up the oxygen starvation resulting from many occurrences per night, along with the subsequent arousals, the effect is significant fatigue.

Recognizing OSA

Typically, a person suffering from OSA is not

aware of the condition.

The only way it can be objectively detected

is through various forms of sleep studies. A complaint of loud and excessive snoring may be an important clue, since that is characteristically the first sign of OSA.

Other symptoms suggesting OSA include:

• Difficulty in concentrating, thinking,

or remembering

• Daytime sleepiness, fatigue, and the need

to take frequent naps

• Headaches

• Irritability

• Short attention span

Complications

of Sleep ApneaMemory LossLung

Hypertension

Stroke

Headache

Heart

Attack

Arrhythmia

Diabetes

Fatigue

Drowsiness

Hy

pertension Obesity