The AME has been instructed to identify those Airmen who are at high risk of having obstructive sleep apnea (OSA). Information has been provided to the AME by the FAA to help with this process. But no defined system to determine risk for OSA was provided. Populations targeted for screening include a category called ‘high risk driving populations’. It can be safely assumed that Airmen fall into this group. Another risk factor targets those individuals with a BMI of over 35. Other factors that increase risk that are recommended for evaluation include high blood pressure. The AME is also provided with risk assessment tools that include the STOP BANG questionnaire, that defines high risk of OSA as having 3 positive findings, that include: Age > 50, BMI > 35, Male, Neck Circumference of 16 inches or greater, High Blood Pressure, Snoring, Sleepiness and Breathing Pauses.
Some confusion exists as to whether the Airman must admit to symptoms like daytime sleepiness, snoring and breathing pauses to qualify as high risk . The FAA guidelines do however clearly allow the AME to use his or her own clinical judgement in determining final risk for OSA. Examiners are aware that airman may not willingly admit to specific symptoms that may suggest increased risk of OSA. Objective factors may be relied on to determine OSA risk.
If the airman believes that the chances of falling into the high risk OSA category at the time of the AME evaluation is increased then a decision should be made prior to the AME visit.
Decision A – Take a chance present for the AME evaluation and hope that the examiner does not determine the airman is at high risk for OSA. If this strategy succeeds then a certificate will be granted with no further requirements. If however the examiner determines that the risk of OSA is high, then the Airman will be provided with Spec Sheet B, that allows for 90 days in which a formal evaluation and possible treatment must occur. A medical certificate will be issued. But if the sleep study shows moderate to severe sleep apnea the airman may not exercise the privilege of the medical certificate until treatment compliance has been demonstrated. The gap between diagnosis and treatment compliance may be weeks if not months. However programs like the Fly in Fly out program provided by Zeeba Sleep Center can expedite these situations and assure very limited if any medical certificate lapses.
Decision B- Decide to be evaluated and possibly treated for OSA prior to the AME exam. Spec Sheet A will be issued and in this case as long as the sleep study has been performed prior to presenting to the AME , a medical certificate will be issues with the condition that all appropriate information pertaining to the diagnosis and treatment be provided within 90 days of the AME evaluation. Thus the course of action is predetermined, no risk exists of having lapses in medical certificate validity.
Either way The Fly-in Fly-out program, takes the uncertainty out of the entire process. From start to completion of the SI, you will be handled by experts in the process of SI for pilots with sleep apnea. In most cases no time off work will be required . The process of diagnosis, treatment and documentation of effective compliance is consolidated in a very short time span, making the risk and uncertainty of successful special issuance very low.
The process involves, flying into Las Vegas, sleeping overnight in the sleep facility, meeting with the physician the following morning. You will then be setup with the sleep equipment, educated on its usage. Return home with the equipment which will have data monitoring ability. Sleep will be remotely monitored for a short period, until criteria are met that will meet SI criteria. Support documentation for SI will be submitted to the RFS or AMCD. Once the appropriate documentation is submitted the airman may continue to exercise his medical certificate. Annual recertification will be required.
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