Treating OSA Continuous positive airway pressure The Bottom Line (CPAP) machine If you experience one or more symptoms of Once recognized and identified, OSA is • Probably the best, non-surgical treatment obstructive sleep apnea, it is recommended that highly treatable, either with surgery or for reducing AHI when used consistently nonsurgical approaches. you consult a doctor, since treatment for OSA is over six hours a night effective for decreasing fatigue and increasing Obviously, non-surgical methods should • Uses air pressure to hold the tissues open aviation safety. be tried first – during sleep What about your medical certificate? If your • Decreases daytime OSA is treatable, you can maintain your airman Behavioral changes sleepiness, as medical certificate and continue to enjoy your aviation career. • Change sleeping position measured by (sleep on side or stomach). surveys and However, flying with untreated OSA constitutes objective tests an unnecessary risk and can become a safety- • Change sleeping environment of-flight issue. (mattress, light level, temperature, etc.). • Improves cognitive functioning on • A 10% weight loss will decrease the OSA tests Apnea-Hypopnea Index (AHI) by 25%.

Surgical Methods Publication No. AM-400-10/2 (rev. 11/27/16) Obstructive These can be very significant surgeries that Provided by don’t always succeed and can lead to side Aerospace Medical Education Division, AAM-400 Sleep Apnea effects. They should be used only after non- surgical methods have failed. (OSA) • Nasal airway surgery: Corrects for swelling To request copies of this brochure online: of the turbinates, septal deviation, and http://www.faa.gov/pilots/safety/pilotsafetybrochures/ Overview for the nasal polyps. Aerospace Community • Palate implants: Stiffen the palate to prevent it from collapsing. Dental appliances • Uvulopalatopharyngoplasty (UPPP): Dentists specialized in sleep medicine Prevents collapse of the palate, tonsils, or contact: (American Academy of Dental Sleep and pharynx. Medicine) are trained the use of oral appliance therapy for the treatment of obstructive sleep • Tongue reduction surgery: Decreases the apnea and snoring. size of the base of the tongue. • Oral appliances (OA) using mandibular • Genioglossus advancement: Pulls the Federal Aviation Administration repositioning are highly effective for mild tongue forward to enlarge the airway. Civil Aerospace Medical Institute to moderate OSA and snoring. AAM-400 • Maxillomandibular Advancement (MMA), P.O. Box 25082 Moves the upper jaw (maxilla) and lower Oklahoma City, OK 73125 jaw (mandible) forward. (405) 954-4831

The FAA’s medical certification guidance is based upon More information on OSA is available Online at: recommendations and criteria established by the American www.faa.gov/go/ame Academy of Sleep Medicine (AASM) ( http://www.aasmnet.org/). OK-16-2037 Asleep at the controls The pathophysiology of OSA times a night. The real danger is that the OSA A potential problem in flight? sufferers may not realize the condition and are On a daytime flight in 2008, a commercial Apnea means “being without respiration.” only aware that they typically awaken feeling The implications for pilots and crewmembers aircraft with three crewmembers and 40 Obstructive sleep apnea is characterized sleepy and tired. are significant. passengers flew past its destination airport as a repetitive upper airway obstruction Losing sleep is more than a simple It has been suggested that people with mild- after both the captain and first officer fell during sleep, as a result of narrowing of the inconvenience. Good, sound sleep is essential to-moderate OSA can show performance asleep. respiratory passages. for good health and clear mental and degradation equivalent to 0.06 to 0.08% blood Mild OSA is defined as an Apnea-Hypopnea emotional functioning. alcohol levels, which is the measure of legal Index (AHI) of 5-15/hr and severe OSA as an Additionally, OSA is associated with a intoxication in most states. AHI > 30/hr. Moderate OSA would fall between reduction in blood oxygen levels feeding the Most pilots will not fly intoxicated, but OSA these ranges. brain, which, of course, is a major health sleep deprivation may be causing the concern for neurocognitive deficit. equivalent effects! Further exacerbating the problem are time zone changes and post- flight alcohol consumption, which can inhibit Repetitive decreases in blood oxygen wakefulness. levels associated with OSA may eventually The pilot awoke and turned back to the increase: The NTSB reported a six fold increase in the destination airport, where all deplaned safely-- risk of aviation crashes for pilots with OSA. • Blood pressure but behind schedule. Normally, when you stop breathing while The National Transportation Safety Board • Strain on the cardiovascular system asleep, the brain automatically sends a (NTSB) determined that contributing factors to • Risk of heart attack wake-up call after about 10 seconds, and you wake up, gasping for air. the incident were the captain’s undiagnosed • Risk of stroke obstructive sleep apnea (OSA) and the flight Most people with this disorder are overweight Multiple time zone changes and alcohol crew’s recent work schedules, which included • Risk of neurocognitive decline and have higher deposits of adipose (fatty) consumption inhibit arousal mechanisms several days of early-morning start times. tissue in their respiratory passages, and the • Diabetes and may result in oxygen deprivation of Up to that time, OSA was relatively unknown size of their soft palates and tongues are 30 seconds or longer before you heed the Lung outside the medical community. larger than average. Memory Loss wake-up call. When you add up the oxygen Hypertension starvation resulting from many occurrences Today, OSA is recognized as the primary These conditions decrease the size of the Stroke per night, along with the subsequent arousals, source of sleep-disordered breathing (SD) and upper airway and decrease airway muscle the effect is significant fatigue. a major contributor to many possible health- tone, especially when sleeping in the supine related chronic health conditions. (back down and horizontal) position. Headache Recognizing OSA The NTSB listed OSA on its “Most Wanted” Gravity can pull tissue down and over the Complications Typically, a person suffering from OSA is not list of Transportation Safety Improvements for airway, further decreasing its size, impeding Heart aware of the condition. of Sleep Apnea Attack 2015 in North America: air flow to the lungs during inhalation. The only way it can be objectively detected • 10-15% of females and 20-30% of males is through various forms of sleep studies. have OSA Arrhythmia A complaint of loud and excessive snoring The major impact of OSA may be an important clue, since that is • 15% of males and 5% of females are characteristically the first sign of OSA. confirmed through diagnosis Snoring can result when the airway becomes Diabetes partially obstructed. With further tissue Other symptoms suggesting OSA include: OSA affects: obstruction of the airway, there may be • Difficulty in concentrating, thinking, • 70% of morbid obese patients complete occlusion. Whether the obstruction Fatigue or remembering is partial (hypopnea) or total (apnea), the • Daytime sleepiness, fatigue, and the need • 70% of patients with Type II diabetes patient struggles to breathe and is aroused to take frequent naps • 40% of patients with hypertension from sleep. Drowsiness • Headaches • 30% of patients with morning headache Often, these sleep interruptions are Obesity Hypertension • Irritability • 20% of veterans unrecognized, even if they occur hundreds of • Short attention span