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FAA will move forward with sleep apnea policy

B

Barnstormer

Federal Air Surgeon says agency will not go through rulemaking process
December 12, 2013
By Elizabeth A Tennyson


During a hastily organized webinar held Dec. 12, the Federal Air Surgeon said the FAA will move forward with implementing mandatory screening and testing for obstructive sleep apnea despite opposition from the pilot and aviation medical communities.

The FAA recently announced that it would require aviation medical examiners to calculate body mass index (BMI) for all pilots. Those with a BMI of 40 or greater would have to be screened and, if necessary, treated for obstructive sleep apnea (OSA). The AME may issue a medical certificate at the time of the examination; however, the FAA will follow up with a request for additional evaluations, including a sleep study and evaluation by a board-certified sleep specialist. Pilots who don’t undertake the evaluation within 60 days would face receiving a letter of disqualification. Over time, the FAA would lower the BMI requirement, compelling more pilots to be screened by a sleep specialist. The FAA currently lists 5,000 pilots with a BMI of 40 or greater and more than 120,000 who qualify as obese with a BMI of 30 or higher.


AOPA and others have objected to the new testing requirements, saying they force AMEs to venture into predictive medicine, rather than focusing on their mandate of determining the likelihood that a pilot will be medically incapacitated at some point in the duration of the medical certificate. The association also has argued that such a significant change needs to go through the rulemaking process to allow public input and the opportunity to explore less intrusive and less costly methods for addressing concerns about sleep disorders.

But during the nearly two-hour webinar, Dr. Fred Tilton, who was joined by Dr. Mark Rosekind of the NTSB and Dr. Mark Ivey, a board-certified sleep specialist, characterized the sleep apnea screening requirements as a “process enhancement” rather than a policy change. As a result, Tilton said, the FAA does not need to, and won’t, go through the rulemaking process. He added that the policy will be implemented in early January when AMEs will receive formal guidance from the FAA.


While he acknowledged that there have been no fatal GA accidents attributed to sleep apnea, Tilton said the FAA is pursuing this policy because sleep apnea is a serious problem in other modes of transportation and the agency believes many pilots may be flying with undiagnosed sleep disorders.


AOPA is insisting that the FAA withdraw the policy or submit to the rulemaking process. In a Dec. 12 letter to FAA Administrator Michael Huerta, AOPA reiterated its objection to the policy and warned that a webinar is no substitute for rulemaking.


“I am deeply troubled by the manner in which the Federal Air Surgeon is proceeding, and call upon you to put a stop to it so that all concerned parties can have input in determining how to most effectively address concerns regarding sleep disorders,” wrote AOPA President Mark Baker.


The letter also noted that the FAA is moving forward on this policy at a time when Congress has just introduced theGeneral Aviation Pilot Protection Act, legislation that would revise third-class medical requirements to expand the number of pilots who could fly without an FAA medical. Congress introduced the legislation after waiting 21 months for FAA to respond to a petition from AOPA and the Experimental Aircraft Association seeking more limited changes to the medical requirements.


Earlier this month, the House Transportation and Infrastructure Committee also took action, passing legislation that would require the FAA to go through the rulemaking process before implementing policy changes related to sleep disorders. The measure is now poised for a vote by the full House. Similar legislation affecting sleep disorders and the truck driving industry recently became law.


The Civil Aviation Medical Association, which is composed of aviation medical examiners, has also objected to the new policy, saying that the FAA is not tasked to provide long-term prognoses, there is no scientific evidence that undiagnosed obesity or OSA has compromised aviation safety, and that a sudden increase in the demand for special issuance medicals would add to existing processing delays.





 
Are these FAA docs fools or do they just have nothing else to do? Like they think that sleep apnea is the leading cause of fatigue, or even more specifically, lack of adequate sleep? I sure do hope congress decides to rein in these guys.
 
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At face value I'd say they recognize the trucking industry studies that show 28% of truckers have sleep apnea to some degree. They'd probably like to establish pilot numbers and expect them to be somewhat similar but they don't have a basis to establish those numbers. Or didn't have. They will now.
 
The way I see it, they still won't have a legitimate basis for determining a percentage of the pilot population with sleep apnea, because they're proposing to test only those pilots with high BMI. No doubt that segment of the pilot population has a more frequent incidence of sleep apnea than the population at large, so the data would be severely biased, thus invalid. Of course those with biased agendas commonly put forward biased data to "support" their cause - - -
 
According to the FAA statements there are 120,000 licensed pilots who fit the clinically obese definition. I don't know what percentage of the total pilot population that represents but for a policy administrator I understand that it may warrant some concern. It won't affect me so I have no strong emotions either way. I commented in opposition to the requirement through EAA because I don't think medical diagnostic requirements are the FAA's business. The bottom line is the requirement will motivate me to stay below the BMI-30 range so in truth I benefit from it. But I'm Mr. Silver Lining, right?

Edit: Cut/pasted from Wikipedia.
Number of active pilots. As of the end of 2011, in the US, there were an estimated 617,128 active certificated pilots.[SUP][19][/SUP] This number has been declining gradually over the past several decades, down from a high of over 827,000 pilots in 1980. There were 702,659 in 1990 and 625,581 in 2000. The numbers include:

  • 118,657 student pilots (128,663 in 1990 and 93,064 in 2000)
  • 227 recreational pilots (87 in 1990 and 340 in 2000)
  • 4,066 sport pilots (did not exist until 2005)
  • 194,441 private pilots (299,111 in 1990 and 251,561 in 2000)
  • 120,865 commercial pilots (149,666 in 1990 and 121,858 in 2000)
  • 142,511 airline transport pilots (107,732 in 1990 and 141,596 in 2000)
  • 15,220 glider-only pilots (9,567 in 1990 and 7,775 in 2000)
  • 21,141 rotorcraft-(helicopter)-only pilots (7,833 in 1990 and 9,387 in 2000)
 
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Interesting numbers SB,
I suspect that the large student drop has a lot to do with cost of flying and general regulatory discouragement. Also notice the large increase in glider only pilots, NO MEDICAL REQUIRED! I suspect that the large change in helicopter pilots is military related.
 
I know sleep apnea is real, but I view the sleep apnea diagnostic centers the same as I view back mold inspectors and low testosterone centers: the will always find what they are looking for. Near 100% diagnosis rate! I can't believe that the entire population is filled with ticking sleep apnea time bombs constantly crashing cars and airplanes due to fatigue.

It it would be interesting to look at the financials of these sleep centers and then look at their lobbying efforts.
 
I'd say the perspective depends on whether you're seeking care to improve wellness or treat sickness. The important point is the FAA shouldn't be involved in either. The FAA medical is supposed to qualify that the airman complies with minimum fitness requirements, right?
 
sort of like the customs agents wanting to see your passport, pilot's license and medical... another way to ensure "compliance".

I bet we all have a syndrome of some sort, any way we can get cubitis listed as being paid for by insurance?
 
What a surprise....NOT!! Like I said before, it's the "affliction du-jour"..... follow the money trail!!!!!!
 
This is pure and simple persecution. I had a size 18 neck when I was 15, which would have put me into their group of people that must prove that they don't have OSA. At that time I was in peak condition playing numerous sports. I have roughly a size 20 neck size now as I've become old and soft, I also fit their definition of obese. I definitely do not have OSA. However, my tiny petite wife with about a size 14 neck had sleep apnea so badly that this year she finally had surgery to remove tonsils, uvula, and soft palate to address her ability to breathe.

The FAA approach is simply a witch hunt designed to divide pilots into small enough groups that they will go down with a whimper. It's called divide and conquer. For those of you that sit back and say it doesn't affect you now so you don't care might want to think about what the FAA might want to do next that will affect you as part of a small group.

People of all sizes can be afflicted with Sleep Apnea. If the FAA wants to pursue this, then every pilot should be screened. Their only reason for going by BMI and neck size is simply to carve out a small enough group that most will sit back on the sidelines and not care about their brother pilots. Then over time they plan to tighten the standards and go after just a few more pilots each time around. Why would you even begin to believe they will stop at a BMI of 30? Along the way the flight surgeon will have a sudden revelation that OSA can happen to people of any size (which is true), so eventually, they will require this of every pilot. So, you can either take a stand and fight the battle now, or you can sit back and say it doesn't affect you yet, so you don't care. But when it's your turn, there may not be so many pilots left to help you fight the battle.

Why should I be subjected to thousands of $$ of purely subjective testing where the tester has a financial incentive to diagnose me with a problem for which they hold the ongoing treatment that I will be forced to pay. And nobody smells a rat here?

If the FAA continues pressing forward with this nonsense, then I have likely taken my last flight physical.

-CubBuilder
 
This is also a very clear indication that there are too many employees in idle positions who are collecting paychecks under the FAA umbrella.
 
As I understand the FAA Doc Boss is about to retire fairly soon, but wants to try get 1 more shoved up us pilots A$$ before he leaves. I hope the AOPA and our flying senators shove this one down their throat along with a drivers license medical. They truly want to ruin GA don't they! We need to fight back with AOPA leading us!
 
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