Obese Pilots To Be Grounded If They Have Sleep Apnea

By: CBS News (Posted by Melissa Brunner)
By: CBS News (Posted by Melissa Brunner)
A new medical bulletin released to aviation medical examiners by Federal Air Surgeon Dr. Fred Tilton says pilots with a body mass index (BMI) of 40 or higher will need to go for screening for sleep apnea.

An error by controllers at an air traffic center put planes too close to each other over central Illinois. It was the second error by controllers at the FAA's Chicago Center radar facility in Aurora reported in a week, Friday, Dec. 21, 2007. (CBS/iStockphoto)

The Federal Aviation Administration (FAA) wants to start screening obese pilots for obstructive sleep apnea, a medical condition that may be making them too tired when flying a plane.

A new medical bulletin released to aviation medical examiners by Federal Air Surgeon Dr. Fred Tilton says pilots with a body mass index (BMI) of 40 or higher will need to go for screening for the condition, and eventually the agency will expand the testing pool to include all pilots.

BMI is a ratio of height over weight, and people with a score of 30 and over are considered obese.

The same protocol will be eventually implemented for air traffic controllers as well.

Obstructive sleep apnea occurs when air flow decreases or stops entirely during sleep because the airway has become narrowed or blocked.

"Untreated (obstructive sleep apnea) is a disqualifying condition for airmen and air traffic control specialists (ATCSs), and it is a concern for the other modes of the Department of Transportation," wrote Tilton.

Almost everyone has brief periods of losing breath when they sleep, explained Dr. Steven Feinsilver, director of the Center for Sleep Medicine at The Mount Sinai Hospital in New York City, to CBSNews.com. Typically a person may briefly stop or slow breathing about five to 10 times per hour. But someone with obstructive sleep apnea may stop breathing 40 to 50 times or more each hour, he said.

Symptoms of sleep apnea include heavy snoring soon after falling asleep that might get louder through the night, according to the National Institutes of Health. Snoring can be interrupted by long silent periods of no breathing, which are followed by a loud snort or gasp.

Not everyone who snores has sleep apnea, Feinsilver points out -- about 90 percent of snorers don't, he estimated.

Sleep apnea can cause those affected to wake up tired or unrefreshed, and they may experience sleepiness during the day. They may be more likely to fall asleep at work, feel sleepy while driving, be forgetful, have headaches or act impatient and irritable.

Untreated sleep apnea may also raise risk for high blood pressure, heart problems and stroke.

Tilton explained in his editorial that obstructive sleep apnea is nearly universal in individuals with a BMI 40 or higher, who would be considered very obese, and have a neck circumference of 17 inches or more.

Pilot fatigue has been a factor in several air safety incidents, including the crash of Colgan Air flight 3407 near Buffalo, N.Y., in February 2009.

However, the Aircraft Owners and Pilots Association said in a statement, "there is no evidence to support the need for such screenings among general aviation pilots."

Feinsilver, the sleep medicine expert, thinks it's important for people to get treated for sleep apnea, but he disagrees with Tilton's contention that all very obese people have the condition. Screening obese people might catch some "low-hanging fruit," he said, but he estimates only about 40 percent of obese people have the condition.

"One objection I had is the idea that most obese people have sleep apnea," he said. "It's clearly not true." But he added, "I wouldn't want this to detract from other concerns."

That concern, he said, is that the majority of people who are too sleepy during the day are simply not getting enough restful sleep. "There's no question about that," said Feinsilver.

Pilots especially are more likely to work on variable shift schedules -- which tend to be prevalent in the transportation industry -- that may make getting a sufficient night's sleep more difficult because the sleep cycles often have to change. Even a pilot who routinely flies through the night may be at greater risk for being tired, as humans are not great nocturnal animals, according to the doctor.

As part of the screening effort, pilots will be required to get their sleep apnea treated before being medically certificated to fly.

The most common treatment for the condition is a continuous positive airway pressure (CPAP) machine, which is a device with a motor that blows air through a tube into a mask the patient wears. The technology has been around more than 30 years, and Feinsilver calls it a "quick fix" that will make people feel better in a matter of nights of using it properly. They'll likely notice improvements in their excessive sleepiness.

"Which is the only reason people put up with this stupid looking thing," he joked of the bulky appartatus.

For people who are tired just because they haven't gotten a sufficient sleep -- one figure often tossed around is seven hours and fifteen minutes a night, but Feinsilver notes that varies widely in different people -- they may want to practice better "sleep hygiene."

Such practices include avoiding naps during the day, skipping caffeine and other stimulants, exercising, avoiding large meals close to bedtime and creating a pleasant sleeping environment, according to the National Sleep Foundation.

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