FAA’s Sleep Apnea Screening Policy Stalled

By Roy Maurer Dec 6, 2013

​A key U.S. House of Representatives panel approved legislation that would compel the Federal Aviation Administration (FAA) to follow established rulemaking procedures, including a public comment period, before implementing new requirements that pilots and air traffic controllers be screened for obstructive sleep apnea prior to receiving a medical certificate.

The House Transportation and Infrastructure Committee Dec. 4, 2013, moved the legislation on to the full House of Representatives. The full House and the Senate must still consider and pass the legislation before it goes to President Barack Obama to be signed into law. 

Obstructive sleep apnea inhibits restorative sleep. “It has significant safety implications because it can cause excessive daytime sleepiness, cognitive impairment, cardiac dysrthythmias, sudden cardiac death, personality disturbances and hypertension,” according to the FAA. 

The agency said that the sleep disorder is “nearly universal in obese people who have a body mass index (BMI) over 40. 

The FAA said that it is “not changing its medical standards related to sleep apnea,” but “pursuing a new approach to find undiagnosed and untreated cases.” All pilots and controllers with a BMI over 40 would be required to be evaluated by a physician who is a sleep specialist, and all pilots diagnosed with sleep apnea would be required to be treated before they obtained their medical certification, which the agency said “is not new.”

The bipartisan measure to circumvent FAA policy without a formal rulemaking was introduced by House aviation subcommittee Chairman Rep. Frank LoBiondo, R-N.J. 

“While sleep apnea has never been identified as a primary cause or contributing factor of an aviation accident, health issues can arise unexpectedly, which is why I have always supported reasonable, effective and proactive efforts to improve aviation safety,” LoBiondo said in a statement. “Should a revision to existing policies on sleep disorders be warranted, then the FAA should engage in an open rulemaking process to ensure all viewpoints, including those of medical experts, are heard and carefully considered.” 

Subcommittee Ranking Member Rep. Rick Larsen, D-Wash., agreed, saying, “The FAA needs to address the issue of sleep apnea in an open and transparent way that lets all stakeholders and safety experts provide input.”

The sleep apnea policy was announced in the FAA’s Federal Air Surgeon’s Medical Bulletin in November 2013.

Similarly, the Congress intervened and President Barack Obama signed into law a bill in October 2013 requiring that the Transportation Department’s Federal Motor Carrier Safety Administration use the regulatory process if it wishes to implement new rules on sleep apnea for commercial truck drivers

The aviation bill is supported by aviation industry organizations and unions, including the Air Line Pilots Association (ALPA). “A medical certificate for a commercial airline pilot is their livelihood, and any actions taken to change or alter the requirements to acquire or retain one needs to be thoroughly discussed in advance with ALPA, the airlines, and the FAA,” the pilots union said in a statement.

Aircraft Owners and Pilots Association President Mark Baker said that the FAA has no business “rulemaking by policy.” The rulemaking process will “give pilots the chance to comment on changes that could cost them millions, while giving the FAA the opportunity to explore less intrusive methods for ensuring the safety of flight,” Baker said.

Current FAA Policy on Sleep Apnea

Untreated sleep apnea is currently a disqualifying medical condition under FAA rules. Medical examiners are advised by the FAA to be alert for sleep apnea and other sleep-related disorders such as insomnia, restless leg disorder, and neuromuscular or connective tissue disorders, the agency said. 

Currently, if a pilot is diagnosed with sleep apnea, an examiner must submit all pertinent medical information, a current status report and use of medications to the FAA. The agency then decides if a special issuance medial certificate is appropriate.

Pilots diagnosed with sleep apnea and being treated under the care of a physician and their medical examiner may fly. According to the FAA, there are currently 4,917 pilots who are being treated for sleep apnea and are flying with a special issuance medical certificate. Of those, 367 have a BMI of 40 or greater.

The National Transportation Safety Board determined that sleep apnea was a contributing factor in the Feb. 13, 2008, Mesa Airlines flight incident which involved two pilots who fell asleep during the flight. The airplane traveled 26 miles past the destination airport before the flight crew resumed communications with air traffic control. All three crewmembers and 40 passengers onboard arrived safely. It was revealed that the captain had undiagnosed sleep apnea.

The NTSB database reveals 34 accidents, 32 of which were fatal, involving people who had sleep apnea and 294 incidents involving some type of sleep disorder. Sleep apnea is not listed as the cause of those accidents, however. 

Roy Maurer is an online editor/manager for SHRM.

Follow him on Twitter @SHRMRoy.

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