A proposed FAA policy that would require pilots and controllers with a body mass index (BMI) of 40 or more to be screened for obstructive sleep apnea (OSA) before obtaining a medical certificate is drawing fire from general aviation groups, which say it would set a “dangerous precedent” and is not justified by safety research.
In a recent FAA Federal Air Surgeon’s Medical Bulletin, Federal Air Surgeon Fred Tilton says the agency is planning to soon release a policy that would require aviation medical examiners to calculate the BMI for airman and air traffic control specialist applicants. Airman applicants with a BMI of 40 or more would then have to be evaluated by a board-certified sleep specialist for OSA and treated if diagnosed before they can receive the medical certificates.
Tilton says plans call to gradually expand the policy to airmen with lower BMI measurements “until we have identified and assured treatment for every airman with OSA.” FAA also plans similar assessments and protocols for air traffic control specialists, “but we have to finalize some logistical details before we can proceed.”
The policy has been in the works for “quite a while,” Tilton says, adding, “We have purposely moved slowly because we wanted to give everyone an opportunity to learn about some of the issues before we added major changes to the medical certification process.” The agency has published educational pamphlets on OSA, addressed the issue at flying safety meetings and added OSA to the aviation medical examiner curriculum.
Tilton says the issue of OSA has been a concern of the agency and the National Transportation Safety Board for some time. “OSA is almost universal in obese individuals who have a BMI over 40 and a neck circumference of 17 inches or more, but up to 30% of individuals with a BMI less than 30 have OSA,” he says. “OSA inhibits restorative sleep, and it has significant safety implications because it can cause excessive daytime sleepiness, cognitive impairment, cardiac dysrhythmias, sudden cardiac death, personality disturbances, and hypertension, to cite just a few.” He adds that the condition, if untreated, is disqualifying for airmen.
FAA also points to a series of NTSB recommendations made in 2009 to implement a program that identifies pilots at high risk for OSA and require evidence that those pilots have been evaluated and, if necessary, treated. The NTSB also recommended that FAA modify the airman medical certificate application to obtain information about previous OSA diagnosis and presence of risk factors.
But general aviation groups are questioning the safety justification for such a policy and say it would put up more barriers to flying. “The FAA has not presented nor have we seen any evidence of aeronautical hazards or threats based on sleep apnea in general aviation,” says Sean Elliott, vice president of advocacy and safety for the Experimental Aircraft Association (EAA). “To enter into the realm of predictive medicine based on no safety threat or symptoms – at a significant cost to individual aviators and the GA community – is not only a reach beyond FAA’s mission but a serious hurdle to those who enjoy recreational aviation.”
The recently passed Pilot’s Bill of Rights requires FAA to supply medical science and justification to support its policies, including any such change on OSA, EAA says, adding that FAA does not appear to have undertaken such an evaluation.
“We are joining in the call for an immediate suspension of this policy and [a] thorough review of its need and justification,” Elliott says. “There has been no evidence of sleep apnea as a cause or factor in more than a decade of general aviation accidents reviewed by FAA’s own General Aviation Joint Steering Committee, in which EAA participated.”