Plane & Pilot
Tuesday, February 11, 2014

The Slippery Slope Of OSA

The FAA ignores obvious accident causes when it focuses on Obstructive Sleep Apnea

Body Mass Index, or BMI, was created about 100 years ago in Belgium, and is calculated by dividing a person's weight in pounds by their height in inches squared, then multiplying that result by 703. If you're using metric measurements, you don't multiply by 703. It's not a direct measure of body fat, although it's used as if it were. Having a high BMI doesn't automatically mean you have OSA, and having a low BMI doesn't automatically mean you don't have it.

The FAA isn't the only government transportation agency with an OSA fascination. The Federal Motor Carrier Safety Administration (FMSCA) plans for mandatory sleep apnea testing of truck drivers with a BMI of 35 or higher when they renew their commercial driver licenses. If found to have OSA, FMCSA wants drivers to be treated using a continuous positive airway pressure (CPAP) machine. CPAP uses a mask worn during sleep to force air into a person's airway. A CPAP typically costs from $700 to $1,850. An average cost for polysomnogram sleep testing is $2,625, according to a trucking industry source. This testing monitors brain waves, blood oxygen levels, heart rate, eye movement and muscle activity for at least one sleep period and sometimes two. The FAA favors the same testing and CPAP treatment.

The first phase of the Tilton/FAA plan requires testing if your BMI is 40 or more, and if your neck has a circumference of at least 17 inches. Tilton said the trigger point would eventually be lowered to cover anyone who might have OSA. That could be every pilot and controller applicant.

In a fact sheet published to help justify its OSA plan, the FAA points to the NTSB report of an incident from February 13, 2008. Flight 1002 operated by Mesa Airlines was a Bombardier CL-600 with 40 passengers, one flight attendant and two pilots on board. The regional jet took off from Honolulu, Hawaii, at 9:16 a.m. About 9:40, halfway through the flight to General Lyman Field in Hilo, Hawaii, the pilots stopped responding to controllers. Radio contact didn't resume until 18 minutes later. By then, the airplane had overshot Hilo by 26 miles, about three minutes of flying time. The aircraft subsequently landed safely. About three months after the incident, the captain was diagnosed with severe OSA. The first officer didn't have OSA. Both had been working long hours on consecutive days, flying up to eight legs in nine hours and averaging 17 minutes between flights. They didn't have adequate time for breaks, meals or restorative sleep and had to start work at 5:40 a.m., on the three days leading to the incident.

In its fact sheet, the FAA stated that the captain had undiagnosed OSA, but ignored the fact that the first officer fell asleep without having OSA. The FAA also failed to mention that the NTSB Safety recommendation highlighted pilot fatigue caused by shift timing, working a large number of consecutive days, flying a large number of legs during the day and other issues. The FAA failed to mention that the NTSB drafted its recommendation in the context of commercial airline activity. On page six of the August 7, 2009, safety recommendation cited by the FAA, the NTSB states about OSA, "...the NTSB concludes that efforts to identify and treat the disorder in commercial pilots could improve the safety of the traveling public."

In its fact sheet, the FAA said the NTSB database has 34 accidents involving people who had sleep apnea, 32 of which involved fatalities. When I did a search for accident reports referencing sleep apnea, I also came up with 34 returns from the approximately 135,000 reports on file. However, the reports included NTSB speculation that someone may have been "at risk" for sleep apnea, wording that would have alerted the search engine to flag the report. Probable causes of these accidents included flight by non-instrument-rated pilots into IMC, partial engine power loss and encountering a sudden severe crosswind, among others. None was blamed on "sleep apnea."


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