I have sleep apnea... What next?
November 5, 2014
Many airman are not aware that sleep apnea is a serious medical condition that is disqualifying for flight duties. Even mild cases of sleep apnea requires a FAA granted waiver or special issuance.
Sleep Apnea is a condition that occurs when airway obstruction occurs during sleep. Typically, with this condition, tissues surround the opening to the lungs deep in the neck close off this opening, During sleep this closure may be incomplete resulting in loud snoring, this may be followed by complete airway closure which results in increasing carbon dioxide and decreasing oxygen in the blood stream. As the oxygen level in the blood decreases to a critical threshold a the brain sends a wake-up signal resulting in a loud gasp as sleep process in interrupted. This process may be repeated several hundred times a night. In addition to not being well rested and suffering from daytime sleepiness the condition, by virtue of the consequences of prolonged hypoxia (decreased blood oxygen) and hypercapnea (increased blood carbon dioxide) may, over time, result in hypertension, abnormal cardiac rhythms (arrhythmias) and heart failure.
To obtain a special issuance for sleep apnea aircrew and controllers need to document thattheir condition does not present a problem with daytime hypersomnolence also known as Excessive Daytime Sleepiness (EDS), cardiac arrhythmias, changes in cognition or significant hypertension.
The FAA requires the following:
Initial work-up should include:
- Sleep studies (overnight polysomnography) before and after treatment.
- Maintenance of Wakefulness Test (MWT) after appropriate treatment – May be Requested - see protocol below.
- Status report form the sleep doctor
Acceptable treatment includes:
Surgery with documentation of satisfactory results. A post-op sleep study or MWT evaluation should be done as soon as practical.
Continuous Positive Airway Pressure, typically called CPAP. This consists of a mask or nasal pads that provide continuous pressure to the airway thus preventing complete obstruction of the airway during sleep
More about the Maintenance of Wakefulness Test (MWT)
The MWT is typically not performed unless specifically requested. In most cases this will not be required but may be requested after review of you case by an FAA flight surgeon. If you are asked for a MWT the FAA requires a drug screen to ensure no stimulants are utilized & this screen should be addressed in the MWT report (include results of laboratory testing).
The MWT consists of four forty-minute test periods typically at two hour intervals.
Patients are monitored in the standard polysomnographic manner (central and occipital EEG, digastric EMG, and eye movement recorder).The endpoint of each test period is either a sleep or the end of the forty-minute time period. The patient is then asked to stay awake until the next test period.
The Status Report
Your sleep doctor will need to provide a status report which is a letter summarizing your case and required treatment.
This status report should be current within the last 60 days once all evaluations completed.
It should clearly address your initial presentation, evaluation, results of sleep study and MWT, treatments including medications and dosages, response to treatment, current physical status with specific mention of any physical limitations, presence or absence of any excessive daytime fatigue, presence or absence of any obvious cognitive deficits, and future prognosis with emphasis on potential for sudden or subtle incapacitation. If CPAP was required the doctor should, comment on compliance
All elements of the above paragraph need to be included in the doctors status report.
Once granted a special issuance for sleep apnea a yearly letter from your sleep doctor will be required that indicates that your treatment continues to be successful and that you are compliant with the treatment. No further sleep studies are generally required unless warranted by a change in your condition.
Here is a case report form a 2013 issue of the Federal Air Surgeon's Medical Bullitin, see page 8 on the below pdf file link.
This link will take you to the Sleep Study center here in Ashland, Ohio that has additional information regarding sleep studies and sleep apnea
http://www.samaritanhospital.org/departments-services/sleep-center
Any Questions give me a call
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