NTSB recommends pilot screening for Sleep Apnea

[Shillin3]

NTSB recommends screening for Sleep Apnea | Pilotbug (http://www.pilotbug.com/?p=595)

The NTSB has issued several recommendations in response to the February 13th, 2008 incident involving two go! airline pilots falling asleep and overshooting the airport at Hilo, Hawaii. Among them is to change the medical certificate application to specifically ask if the airman has sleep apnea and to identify high risk individuals.
According to the safety recommendation, studies have concluded that the go! airlines flight, operated by Mesa Airlines, wan not an isolated incident. Information contained in the National Aeronautics and Space Administration’s (NASA) Aviation Safety Reporting System (ASRS) reveled that from 1995 to 2007 there were 17 reported instances of at least one pilot falling asleep and in five of those, both pilots did. In addition, NASA found that 80% of pilots from 26 regional airlines had “nodded off” at one time or another, according to those responding to a 1999 survey.
Concerning the NTSB is the disconnect between the general population prevalence of sleep apnea and the pilot group. It is estimated that 7% of adults suffers from some form of sleep apnea, while only 0.5% of pilots holding a 1st Class medical have indicated to the FAA. One of the contributing factors to the go! airline’s captain falling asleep was his undiagnosed sleep apnea, causing increased daytime fatigue.
Several of the recommendation to the FAA are to:
1. Change the Application for Airman Medical Certificate to ask specific questions regarding sleep apnea.
2. Develop and utilize a program to identify those who may be susceptible to sleep apnea to be evaluated and treated before granting an unrestricted medical certificate.
3. Conduct research on fatigue of short-haul operations.
4. Require short-haul operators to modify operations based on recommendations provided by the research identified by the above recommendation #3.

[grumpytroll]

i bought a device called pure sleep. it is a simple molded mouth guard that will slightly push your lower jaw forward while sleeping to keep the airway open. It took some experimentation to get it molded correctly. I have slept wonderfully for months now as has my spouse. She never hears me snore and i feel wonderful. I suspect i snored for years and lost sleep and health but have solved the problem and am very rested in the morning. They have a website. Best 60 bucks i have ever spent on my health. Cheers

[datafox]

I think Buteyko breathing lessons might reduce or eliminate sleep apnea and snoring as well. If you've ever looked at someone who is snoring, they are usually breathing much more than they need to while at rest and they are usually breathing through their mouth.

Eliminate the hyperventilation & mouth breathing and a whole basket of medical problems can be eliminated.

I've had moderate to severe asthma at times throughout my entire life, sometimes preventing me from holding a medical. I tried everything out there, acupuncture, medicines, hospitals, chiropractic work, etc. Once I found Buteyko it was a matter of days and weeks until all my respiratory symptoms went away. Asthma, allergies and snoring all gone.

[gingernut]

I'm sure that it'd be difficult to argue that sleep apnoea isn't a real problem, but is there really a reliable/valid screening tool that could be used?

I suspect that question 1 is useful, not sure that anything else would help.:)

[homonculus]

Sorry gingernut, but there is. A sleep lab will diagnose it, although I cant see us getting every budding pilot to spend a night in a lab.

Sleep apnoea is a reality and a concern to anaesthetists because patients with real sleep apnoea have a significant increase in postoperative morbidity such as we always put these patients on ITU

However, real sleep apnoea, usually in middle age overweight men and characterised by REAL morning tiredness is less common than snoring after a night in a pub.

Treatment is surgery (not that effectice) or CPAP (a type of home ventilator) - very effective. Other treatment such as splints is I am afraid quack medicine.

I think this has all got out of hand - most ab initio pilots are too young and thin to suffer and as pilots are fitter than the average population (yes really) it is rare

[gingernut]

Yep, I agree, sleep apnoea is a very real problem, one which diagnosis should be accurate, and one which treatment is effective.

I get a bit twitchy when I hear the word "screening."

I guess the old criteria from the WHO still applies:


the condition screened for should be an important one
there should be an acceptable treatment for patients with the disease
the facilities for diagnosis and treatment should be available
there should be a recognised latent or early symptomatic stage
there should be a suitable test or examination which has few false positives - specifity - and few false negatives - sensitivity
the test or examination should be acceptable to the population
the cost, including diagnosis and subsequent treatment, should be economically balanced in relation to expenditure on medical care as a whole


The specificity/sensitivity question concerns me slightly. (Sorry, don't know the values for each in sleep apnoea screening).

I think we have to be careful that we don't ground pilots when there isn't actually an issue.:) A real proposition if we don't think through "screening" properly.

[Jolly Green]

I think your concern is valid for screenings in general, but in this case the science and medical practice are sufficient.

I was diagnosed with sleep apnea through a sleep study two weeks ago. They really can tell what stage of sleep you're in and what breathing difficulties are present in each stage. They showed me the printout of exactly when I stopped breathing, resulting in a brief wake up and immediate return to sleep -- at a rate of about 10 times a minute. Generally speaking the blood oxygen saturation shouldn't get below 90%, but mine got down to 86%. Also noteworthy, pure oxygen from a nasal canula did not improve the saturation rate (because I wasn't breathing).

My study was called a split study because it included the diagnosis for a statistically valid 3 hrs (minimum) followed by a period on the CPAP to evaluate posible treatment. They varied the pressure on the system to find the minimum amount to keep my airway open, and then kindly left it there for the remainder of the night. I can't remember how long its been since I've slept so well.

Now I have to return for another study to show our buddies in the FAA that I can stay awake. Once that's complete I'll be eligible for a return to 1st class medical.

[gingernut]

I'm probably not getting my point across very well about the difference between screening tests and diagnostic tests.

[gingernut]

Ok, I've had a few sleeps since my last post.

Let's say the test in question had a specificity of 80%.

In other words, when the test said that there is a problem, it was correct 80% of the time.

That means 20% of "innocent" pilots would be grounded.


Not a good situaton.

[homonculus]

Absolutely Gingernut. And to make it worse there is a lot of quackery - lots of 'experts' are doing sleep studies whereas far fewer ENT surgeons are actually treating patients.

The problem for pilots is not so much the episodes at night - most of us dont operate aircraft in bed - but the resultant fatigue in the day. If you really do have significant sleep apnoea, IMHO it would justify a loss of license because we know the dangers of fatigue. There is no sense having limits in crew duty hours yet let OSA patients fly.

There is no objective method of quantifying it - once you have enough episodes you have OSA - so it is a career stopping diagnosis. BUT it usually only occurs in middle age and with obesity so diagnosing it in ab initio pilots who are mostly young is a nonsense and screening at this stage is unecessary and likely to be a lottery

[Jarvy]

Screening and testing already in place for US CDL (HGV) drivers, so the NTSB has some practise at this.