The FAA guidelines state …” In assessing airmen for groups 4 and 5, the AME is expected to use their own clinical judgment, using AASM information, when making the triage decision.”
Risk assessment for OSA is based on a combination of signs and symptoms. If symptoms are present, they can be very helpful in identifying those individuals at high risk, but the absence of symptoms in a population whose occupation may be dependent on this evaluation is notoriously unreliable. Therefore objective risk factors have to be relied in the absence of subjective symptoms.
If the Airman score positively for at least 3 items on the STOP BANG, the airman is determined to be at high risk for OSA.
AME should select Group 5 on the AME Action Tab and provide Specification Sheet B to the Airman. Be aware and explain to the Airman that even though 90 days is allowed for submission of all material to the FAA, once a sleep study is done and is positive for moderate to severe sleep apnea, the Airman can no longer exercise the privileges of the medical certificate until all compliance material is submitted to the FAA. This process can take many weeks if not handled in an expedited manner. The Zeeba Fly in Fly out program addresses this issue in detail. The airman should be provided options that do not jeopardize the continuity of the medical certificate.
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STOP BANG Questionnaire validation reference material