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United States Department of TransportationUnited States Department of Transportation

Guide for Aviation Medical Examiners

Special Issuances
AME Assisted - All Classes - Sleep Apnea/Obstructive Sleep Apnea (OSA)

Examiners may re-issue an airman medical certificate to airmen currently on an AASI for OSA if the airman provides the following:

  • An Authorization granted by the FAA;
  • Signed Airman Compliance with Treatment form or equivalent from the airman attesting to absence of OSA symptoms and continued daily use of prescribed therapy; and
  • A current status report from the treating physician indicating that OSA treatment is still effective.
    • For CPAP/ BIPAP/ APAP:
      • A copy of the cumulative annual PAP device report which shows actual time used (rather than a report typically generated for insurance providers which only shows if use is greater or less than 4 hours). Target goal should show use for at least 75% of sleep periods and an average minimum of 6 hours use per sleep period.
      • For persons with an established diagnosis of OSA who do not have a recording CPAP, a one year exception will be allowed to provide a personal statement that they regularly use CPAP and before each shift when performing flight or safety duties.
    • For Dental Devices and/or for Positional Devices: No conditions known to be co-morbid with OSA (e.g., diabetes mellitus, hypertension treated with more than two medications, atrial fibrillation, etc). Once Dental Devices with recording / monitoring capability are available, reports must be submitted.
    • For Surgery: For successfully treated surgical patients, a statement attesting to the continued absence of OSA symptoms is required.

Defer to the AMCD or the Region for further review if:

  • Concerns about adequacy of therapy or non-compliance;
  • Significant weight gain or development of conditions known to be co-morbid with OSA (e.g., diabetes mellitus, hypertension treated with more than two medications, atrial fibrillation, etc).

Note: The Examiner may request AMCD review to discontinue the AASI if there are indications that the airman no longer has OSA (e.g., significant weight loss and a negative study or surgical intervention followed by 3 years of symptom abatement and absence of significant weight gain or co-morbid conditions). In most cases, a follow-up sleep study will be required to remove the AASI.

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