Obstructive Sleep Apnoea (OSA)

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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

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

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:

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

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 other treatment modalities other evidence of control will be required
Requirement for annual review for Class 1 and 3

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

The Clinical Practice Guideline is provided by way of guidance only and subject to the Clinical practice guidelines disclaimer