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Sun, Aug 16, 2009

NTSB Makes Safety Recommendation Regarding Sleep Apnea

Mesa Airlines Hawaii Flight Spurs Call For Tracking OSA In Commercial Pilots

In a recently-released final report concerning a Mesa Airlines flight operating as go! Airlines in Hawaii, it was determined that the pilot acting as captain of the aircraft and the first officer both inadvertently fell asleep in flight, causing the airplane to overshoot its destination by 26 miles. As part of the investigation it was determined that the captains' sleep schedule had been interrupted by previously undiagnosed obstructive sleep apnea (OSA).

According the information released by the NTSB, if a commercial pilot is diagnosed with OSA, the Federal Aviation Administration (FAA) 2006 Guide for Aviation Medical Examiners states that an aviation medical examiner (AME) must submit all pertinent medical information and current status report and include sleep study with a polysomnogram, use of medications and titration study [in which the optimal pressure for CPAP is identified] results. The guidance further notes that an initial special issuance of a medical certificate for the disorder requires an FAA decision. Subsequent issuance of a medical certificate may be authorized through the AME if the applicant provides a report performed in the last 90 days from the treating physician that describes the present treatment and its effectiveness in eliminating or reducing symptoms, including daytime sleepiness. A maintenance of wakefulness test is required if there is any question about compliance with or response to treatment, and the AME must defer the certification decision if the individual demonstrates sleep deficiency on a maintenance of wakefulness test, has developed an illness associated with OSA, or if there is doubt about compliance with or effectiveness of therapy. Treatment can only begin, however, after diagnosis, and there is evidence that certificated commercial pilots are significantly underdiagnosed.

The FAA does not provide guidance to AMEs describing risk factors for OSA, nor does the FAA routinely use medical information (such as height, weight, and blood pressure) collected during certification examinations to screen for the possible presence of the disorder. Furthermore, the Application for Airman Medical Certificate asks applicants about their history of over 20 specific conditions or symptoms but does not specifically ask about a history of OSA or the presence of symptoms, such as snoring or excessive daytime sleepiness, related to OSA.

Except for the FAA, every U.S. Federal agency that oversees passenger transportation either gathers or plans to gather subjective information specific to OSA from transportation operators. By contrast, the FAA is not yet formally considering such changes. Objective medical data already gathered by the FAA could be used to measure risk for OSA using existing consensus guidance on screening, but the most effective screening would require the FAA to gather additional information and develop additional guidance.

The NTSB concludes that efforts to identify and treat the disorder in commercial pilots could improve the safety of the traveling public. Therefore, the NTSB recommends that the FAA modify the Application for Airman Medical Certificate to elicit specific information about any previous diagnosis of OSA and about the presence of specific risk factors for that disorder. The NTSB further recommends that the FAA implement a program to identify pilots at high risk for OSA and require that those pilots provide evidence through the medical certification process of having been appropriately evaluated and, if treatment is needed, effectively treated for that disorder before being granted unrestricted medical certification. In addition, the NTSB recommends that the FAA develop and disseminate guidance for pilots, employers, and physicians regarding the identification and treatment of individuals at high risk of OSA, emphasizing that pilots who have OSA that is effectively treated are routinely approved for continued medical certification.

FMI: www.ntsb.gov

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