Obstructive Sleep Apnoea (OSA)

Guidance for medical examiners when assessing a patient for either a general topic or condition - Obstructive Sleep Apnoea.

Aeromedical implications

Effect of aviation on condition

  • Irregular work and sleep hours
  • Difficulty carrying CPAP equipment when operating away from home
  • Lifestyle factors leading to increased BMI

Effect of condition on aviation

  • Overt incapacitation
    • hypersomnolence
  • Increased risk of cardiovascular disease, cerebrovascular disease, insulin resistance, hypertension and congestive heart failure
  • Subtle incapacitation
    • reduced attention and concentration
    • degraded cognition.

Approach to medical certification

Based on the condition

  • Identify moderate and severe OSA
  • Exclude other sleep disorders eg Central Sleep Apnoea, Narcolepsy

Based on treatment

  • Response to weight loss
  • Response to surgical management
  • Response to CPAP therapy
  • Response to other treatments (mandibular-advancement splints, nasal flaps).

Demonstrated stability

  • Symptom-free
  • Repeat sleep study demonstrating normalisation of sleep architecture post intervention
  • Maintenance of wakefulness test or Multiple sleep latency testing as required to demonstrate outcome of current sleep architecture
  • Downloaded CPAP data demonstrating control and compliance with therapy

Risk assessment protocol - information required

New cases

  • Investigation for OSA is required if:
    • symptoms of OSA
    • BMI > 40
    • epworth sleep score >8
  • Investigation for OSA should be considered if there is:
    • history of congestive heart failure, atrial fibrillation, treatment refractory hypertension, type 2 diabetes, nocturnal dysrhythmias, stroke, pulmonary hypertension, erectile dysfunction
    • history of aircraft or motor vehicle accident
    • neck circumference >42cm for men and > 40cm in women.

A report from a Sleep Physician with respect to:

  • Confirmed diagnosis
  • Presenting symptoms
  • Epworth Sleep Scale result
  • Clinical status
  • Investigations conducted (Sleep study / Maintenance of Wakefulness Test etc.)
  • Management
    • treatment
    • objective measure of sleep apnoea control
      • repeat sleep study following weight loss or surgery
      • repeat sleep study following initiation of CPAP treatment or CPAP download
    • side-effects
    • monitoring
  • Follow-up plan.

Renewal

A report from a Sleep Physician with respect to:

  • Clinical status (Alertness)
  • Progress
    • review of CPAP download (if applicable) - including usage statistics and objective measure of sleep apnoea control - Apnoea Hypopnea Index (AHI)
  • Investigations conducted
    • sleep study (if indicated)
    • maintenance of Wakefulness Test (if indicated)
    • multiple Sleep Latency Test (if indicated)
  • Management
    • treatment
    • side-effects
    • monitoring
  • Follow-up plan.

Indicative outcomes

  • Certification of Class 1,2 and 3 applicants is possible with evidence of satisfactory control
  • Once effective management and stability is demonstrated, CPAP download alone, may satisfy review requirements
  • In case of post-bariatric surgery with evidence of weight loss, a follow-up new sleep study is required to confirm cure
  • In case of other treatment modalities other evidence of control will be required
  • Requirement for annual review for Class 1 and 3

Favourable

  • Objective measure demonstrating sleep apnoea control

Unfavourable

  • Symptomatic OSA
  • Poor treatment compliance
  • Poor AHI control

Pilot information

  • If pilots or controllers are diagnosed with obstructive sleep apnoea they should ground themselves and obtain a DAME review
  • Moderate and severe sleep apnoea is associated with accidents and health problems
  • Modern CPAP machines are highly portable
  • If the CPAP machine used does not have a data download function, additional annual specialist reports, sleep studies or other tests may be required
  • Pilots are not to fly if they experience any problems with their treatment or experience a recurrence of their symptoms
  • If CPAP is used, it should be utilised for at least 5 hours per night and for 6 nights per week. It must be used during the sleep period just prior to flight
  • Effective control reduces the risk of cardiovascular disease, cerebrovascular disease, insulin resistance, hypertension and congestive heart failure

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Disclaimer

The clinical practice guidelines is provided by way of guidance only and subject to the clinical practice guidelines disclaimer.

Last updated:
Online version available at: https://www.casa.gov.au//licences-and-certificates/medical-professionals/dames-clinical-practice-guidelines/obstructive-sleep-apnoea-osa
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