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Obstructive Sleep Apnoea (OSA)


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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


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


  • Objective measure demonstrating sleep apnoea control


  • 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


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