Obstructive
Sleep Apnea
(OSA)
Overview for the
Aerospace Community
Treating 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 lower
jaw (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 ans
The 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
• Diabetes
A 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 Apnea
Memory Loss Lung
Hypertension
Stroke
Headache
Heart
Attack
Arrhythmia
Diabetes
Fatigue
Drowsiness
Hy
pertensionObesity