How are you as an AME adapting to the new FAA documentation rules for sleep apnea?

"In the air transport business more than any other, the human element is everything. That big plane in front of the hangar is only as good as the man who flies it, and he is only as good as the people on the ground who work with him."

W. A. (Pat) Patterson, President United Airlines, quoted in the book 'High Horizons,' 1944.

Are you documenting OSA (or lack of risk factors) correctly on the Form 8500-8?
The latest Federal Air Surgeon's newsletter reminded Aviation Medical Examiners about the emphasis on considering the diagnosis of obstructive sleep apnea and conditions of sleep fragmentation for every pilot evaluated for flight physicals. The latest process, released in March 2015, emphasizes the importance of flight examiners issuing medical certificates unless clear aviation safety risks exist, and promoting education to pilots on the risks of sleep-related disordered breathing.
Examiners should only defer medical applications for pilots who are clearly affected (e.g. falling asleep in the office), and should document in Box 60 (the medical narrative) of the Form 8500-8 if the airman has been screened for obstructive sleep apnea using the American Academy of Sleep Medicine's published guidelines.   
New suggestions for AMEs include:
  • No disqualification of pilots based on BMI alone. The risk of OSA is determined by an integrated assessment of history, symptoms, and physical/clinical findings. BMI is now automatically calculated for the AME when the height and weight measurements are entered into the MedXPress system while completing the Form 8500-8.
  • The OSA screening process must be completed by the Aviation Medical Examiner using the American Academy of Sleep Medicine (AASM) guidelines.
  • Documentation of the OSA screening can be provided by the Aviation Medical Examiner (AME) simply by checking the appropriate block while completing the airman’s Form 8500-8 and documenting that the AASM Tables 2 and 3 risk factors have been assessed.
  • Pilots determined to be at significant OSA risk will be issued a medical certificate and referred for an evaluation.
  • OSA evaluations may be completed by any physician (including the AME), not just sleep specialists, using the American Academy of Sleep Medicine’s guidance.
  • Evaluations do not require a laboratory sleep study or even a home study if the evaluating physician determines the airman does not require it.
  • Results of the evaluations can be provided from the pilot to the AME, forwarded to the Aerospace Medical Certification Division (AMCD), or sent to the Regional Flight Surgeon’s (RFS’s) office within 90 days of the FAA exam to satisfy the evaluation requirement. The pilot continues to fly during this period.
  • If the pilot needs additional time beyond 90 days to complete the evaluation, a 30-day extension will be granted by the AMCD or the RFS upon request.
  • Pilots diagnosed with OSA can send documentation of effective treatment to the AMCD or the RFS’s office in order to receive consideration for a Special Issuance medical certificate.
  • The FAA will send the pilot a Special Issuance letter documenting the follow-up tests required and timing of the reports.
  • Most follow-up reports will only require usage data from the CPAP machine and a brief statement from a physician.

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  • CAMA, on behalf of physicians engaged in the practice of Aviation Medicine aims to:

    • To promote the best methodology for assessment of the mental and physical requirements for civil aviation pilots.

    • To actively enlarge our scientific knowledge.

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  • To promote professional fellowship among our colleagues from allied scientific disciplines.

  • To bind together all civil aviation medical examiners into an effective, active medical body to promote aviation safety for the good of the public.