FAA adds another hoop for medicals

[stagecoachco]

FAA is going after sleep apnea.

http://www.avweb.com/avwebflash/news/FAA-Targets-Fat-Pilots-And-Controllers220978-1.html

 

[bbchien]

It's already in the Federal Air Surgeon's medical bulletin. The target is BMI>40 but it will come down to 32 over time.

 

[flyingron]

It's been coming. Doc Bruce has mentioned it a few times. I can understand the 40 BMI, that's pretty heavy (even at my heaviest I never topped out at over 30), but 17" neck circumference seems excessively discriminatory for those of us who are in excess of 6' tall.

The study that most people use for the neck circumference to OSA risk statistics did correct the 17" based on height. The same study shows that BMI and questions about falling asleep don't really do anything for enhancing the prediction based on neck size.

The statement in the article Bruce posted (in blue) is in fact FALSE based on the data.

As for females, the research shows 16" as a predictive neck size for women.

 

[bbchien]

It's been coming. Doc Bruce has mentioned it a few times. I can understand the 40 BMI, that's pretty heavy (even at my heaviest I never topped out at over 30), but 17" neck circumference seems excessively discriminatory for those of us who are in excess of 6' tall.

Well, the epidemiology is very very tight, for BMI>40 AND neck circumference >17" together.

 

[Z06_Mir]

It's already in the Federal Air Surgeon's medical bulletin. The target is BMI>40 but it will come down to 32 over time.

What about females, since we generally have a higher BMI? Will we be held to the same standard when the number starts coming down?

 

[bbchien]

Yes. The prevalence is so overwhelming. This is supposed to be one-time only (as I was told). Dr. Lomangino opted AGAINST the overnight home screening as they have no idea who really wore the device overnight.

Our only hope is a separate BMI table for women.

Loss of alertness is a political hot button- NWA at MSP and ATC falling asleep at Reagan National Airport.

 

[flyingron]

So is there official guidance (as 182 asks, what about women, what about correcting for hight)? The article has a lot of fluff in it but little details.

This all harkens back to a few cases where airline pilots (notably one of the Go! pilots) who had undiagnosed sleep apnea. Frankly, the incidence appears rare enough that it sounds like a real knee jerk burden on the non-commercial flyers.

 

[Fearless Tower]

Out of curiosity, how many pilots are out there with BMIs over 40?

I mean a BMI over 40 must be the equivalent of two FAA sized people!

 

[bbchien]

Well, I can say that every one of my SA airmen is obese for height.....nary a skinny guy among them.

 

[kyleb]

Well, I can say that every one of my SA airmen is obese for height.....nary a skinny guy among them.

But the neck size thing is interesting. Mine is 16.5" and I'm 5'7, 155 with a 24ish BMI. It was 16" when I was 17 and weighed 135.

 

[bbchien]

But the neck size thing is interesting. Mine is 16.5" and I'm 5'7, 155 with a 24ish BMI. It was 16" when I was 17 and weighed 135.

That comes from the Anesthesia literature. It's part of how we assessed who might be a "disasterous intubation" ahead of time. It's been validated as a risk factor for airway obstruction, and has been known since the 60's.

 

[Fearless Tower]

Well, I can say that every one of my SA airmen is obese for height.....nary a skinny guy among them.

Oh I agree on overweight being common, but a BMI of 40 is absolutely MASSIVE!

 

[James_Dean]

Out of curiosity, how many pilots are out there with BMIs over 40?

I mean a BMI over 40 must be the equivalent of two FAA sized people!

This will hit me and I know several pilots who are larger than I am.

 

[SkyHog]

******mit.

 

[saracelica]

I just looked at my BMI. Supposedly I need to get to be 165lbs (or grow a couple inches in height) to be "normal" yeah at 165 I am skin and bones and what my friends call "to skinny" I hope to loose some weight though.

 

[Fearless Tower]

This will hit me and I know several pilots who are larger than I am.

So you are saying you have a BMI of 40 or greater?

 

[ifconfig]

There are limitations to the BMI with respect to the muscular. Not that there are too many GA pilots with this ‘problem,’ but BMI limitations of the sort talked about here—obviously not the >40—will sideline some very healthy athletes.

Fat shaming!

 

[James_Dean]

So you are saying you have a BMI of 40 or greater?

Yes. I'm 5'10" and 280 lbs.

Edit - I really don't have a problem with this guideline as the data certainly seem to indicate that it is an issue. I'm a big guy and have been since I was a toddler. I've been exercising regularly for the last year and have gotten in much better cardio shape while shedding more than a few pounds. I've been a weight lifter off and on since high school and do have a bit of muscle under the extra padding. My wife claims that I don't snore but my father wears a CPAP and I have had a child who had to have surgery to correct issues that were causing severe OSA. It is damn unhealthy if you have it and can and does lead to incapacitation.

 

[cowman]

That BMI chart is a joke. I think I know one guy... out of everyone I know who might actually fit into the normal category. He's been underweight his whole life and continually advised by doctors to increase his calorie intake.

 

[ClimbnSink]

Get skinny people, all your problems will go away. Plus you get a free useful load increase.

 

[PilotAlan]

Get skinny people, all your problems will go away. Plus you get a free useful load increase.

Yeah, OK. Must be nice to have a "typical" body type.
When I was in the Academy, running 5 miles a day and 4% body fat, I had 54 inch chest, a 30 inch waist, a 22 inch neck.
I was 5'8", weighed 210, and was "obese" according to the CDC.

My "target weight" is 155lbs. I couldn't get there without amputating both legs. I haven't weighed 155 since I was 15 years old and playing football.

 

[ClimbnSink]

I understand

 

[PilotAlan]

Tilton says "Once we have appropriately dealt with every airman examinee who has a BMI of 40 or greater, we will gradually expand the testing pool by going to lower BMI measurements until we have identified and assured treatment for every airman with OSA,"

So, they are using their Federal regulatory powers to "root out" every person who has SA by forcing everyone who MAY to be screened.
This is a very troubling precedent, forcing people to be screened for conditions they have not been diagnosed with, so they find every single person with SA.

What's next? Required stress tests for everyone over 40 in order to find every case of undiagnosed coronary disease?
Required fasting blood sugar tests to find every case of undiagnosed diabetes?
Required psychological exam to find every undiagnosed mental illness?
Why don't we require mandatory exams for every conceivable disqualifying illness?

We'll certainly make aviation safer, there won't be any pilots!

 

[PilotAlan]

I understand

Whatever.
That was a gratuitous insult, and extremely uncalled for.
You don't know me, or anything about me. But based on that post I now know a great deal about you.

 

[PilotAlan]

Well, the epidemiology is very very tight, for BMI>40 AND neck circumference >17" together.

I don't have a problem with that. It's the racheting down to people with normative body types on the belief that they have to "find" every case of SA.
Once you leave the range with tight epidemiology, it's nothing more that a witch hunt with no corroborating evidence.

Why not just require it for everyone? Where's the limiting principle?
This is an extremely dangerous precedent.

 

[Gary F]

I don't have a problem with that. It's the racheting down to people with normative body types on the belief that they have to "find" every case of SA.
Once you leave the range with tight epidemiology, it's nothing more that a witch hunt with no corroborating evidence.

Why not just require it for everyone? Where's the limiting principle?
This is an extremely dangerous precedent.

Pretest probability. I bet that over 90% of those with BSA over 40 have sleep disordered breathing.

 

[Cruiser]

Yes. The prevalence is so overwhelming. This is supposed to be one-time only (as I was told). Dr. Lomangino opted AGAINST the overnight home screening as they have no idea who really wore the device overnight.

Our only hope is a separate BMI table for women.

Loss of alertness is a political hot button- NWA at MSP and ATC falling asleep at Reagan National Airport.

So how is restriction on third class medicals for GA pilots suppose to improve the alertness of commercial airline pilots on insane schedules or union issues for bored controllers?

 

[PilotAlan]

Pretest probability. I bet that over 90% of those with BSA over 40 have sleep disordered breathing.

Did you read the first sentence?

I don't have a problem with that. It's the racheting down to people with normative body types on the belief that they have to "find" every case of SA.
Once you leave the range with tight epidemiology, it's nothing more that a witch hunt with no corroborating evidence.

 

[cowman]

I'm also 5'8"...

From looking at that table my "normal" weight range should be between 125 and 158lbs. That's ridiculous... I probably fit in there around the time I was a high school freshman and was one of the scrawniest kids around.

The BMI assumes you're sedentary and have an "average" frame. It's not a measurement of body fat, it's overall mass so that excess could very well be muscle. Most pro-athletes are overweight or obese by the standard of that chart.

 

[Gary F]

Did you read the first sentence?

I'm not sure what you were trying to argue. Where to set the pretest probability cutoff?

 

[PilotAlan]

I'm not sure what you were trying to argue. Where to set the pretest probability cutoff?

Largely, yes.

But partially, the concept of driving testing based on "rooting out" undiagnosed conditions. Where do you stop?

I understand that >40 BMI and >17 in neck has a very tight correlation. But that's only a temporary waypoint. They have already decided they will ratchet the BMI cutoff down as time goes on. Where is the level of correlation that is sufficient? And who decides?
Can the next air surgeon decide there is a correlation between age and coronary disease, and that all pilots over 60 years old must have a stress test (at their own expense, of course)? Or screening for cataracts? Or some other screening? How about requiring post-partal pilots to get screened for depression prior to exercising their airman privileges?

What is the limiting principle that there must be some evidence of a problem, rather than shotgun testing of airmen?

 

[stagecoachco]

Largely, yes.

But partially, the concept of driving testing based on "rooting out" undiagnosed conditions. Where do you stop?

I understand that >40 BMI and >17 in neck has a very tight correlation. But that's only a temporary waypoint. They have already decided they will ratchet the BMI cutoff down as time goes on. Where is the level of correlation that is sufficient? And who decides?
Can the next air surgeon decide there is a correlation between age and coronary disease, and that all pilots over 60 years old must have a stress test (at their own expense, of course)? Or screening for cataracts? Or some other screening? How about requiring post-partal pilots to get screened for depression prior to exercising their airman privileges?

What is the limiting principle that there must be some evidence of a problem, rather than shotgun testing of airmen?

I have a problem with this also. It seems like the FAA is going to conduct a study to find at which BMI sleep apnea is a likely problem. But instead of funding the study themselves, they are going to have pilots fund the study by requiring the screening at their expense.

 

[ifconfig]

What is the limiting principle that there must be some evidence of a problem, rather than shotgun testing of airmen?

For the record, I completely agree with this sentiment. It's another encroachment of a faceless, bureaucratic government into determining what they think of as appropriate behavior (yes, behavior—after all, it's behavior they're going after here) and all, of course, for Very Good Reasons™

I'm quite certain that with this door open, the next steps will be to consider other behaviors they deem acceptable (how many times a week do you have sexual intercourse? F**king less than twice a week is deemed psychologically deficient).

Perhaps I'm being overly sensitive but bureaucracies don't take individual humanity into account. Systematically, and by design, it can't. And that's somewhat scary.

Not that anyone bitching on a board can actually do anything about it. Thanks to ObamaCare, your individuality is a thing of the past. Welcome to the New America.

Enjoy the decline.

 

[DFH65]

Largely, yes.

But partially, the concept of driving testing based on "rooting out" undiagnosed conditions. Where do you stop?

I understand that >40 BMI and >17 in neck has a very tight correlation. But that's only a temporary waypoint. They have already decided they will ratchet the BMI cutoff down as time goes on. Where is the level of correlation that is sufficient? And who decides?
Can the next air surgeon decide there is a correlation between age and coronary disease, and that all pilots over 60 years old must have a stress test (at their own expense, of course)? Or screening for cataracts? Or some other screening? How about requiring post-partal pilots to get screened for depression prior to exercising their airman privileges?

What is the limiting principle that there must be some evidence of a problem, rather than shotgun testing of airmen?

They are going to do away with the third class medical haven't you heard so none of this matters.

BMI is a joke, 30 years ago the summer after I graduated from High School I played in an division wide all star football game I was in the best shape of my life (sound like Al Bundy). 6' 1.5" 215 pounds could run a 6.5 minute mile and bench press 350 lbs. My BMI was 28. I would have to weigh 191 to have a BMI just in the normal range. I am headed that way although with no intention of getting to 191 but at least now my BMI is under 40. I do have OSA must be because my neck is 17.5".

 

[bbchien]

I have a problem with this also. It seems like the FAA is going to conduct a study to find at which BMI sleep apnea is a likely problem. But instead of funding the study themselves, they are going to have pilots fund the study by requiring the screening at their expense.

No, that data already exists. Did you open my attachments- it's in BLUE at the bottom of the FASMB. We docs have known about this since 2003.

So how is restriction on third class medicals for GA pilots suppose to improve the alertness of commercial airline pilots on insane schedules or union issues for bored controllers?

It's going to apply to all pilots, Cruiser, across the board. What I object to is the cost. It would be simple to do this with an overnight home desaturation "data tape print out". $250 and insurance would pay, so after the insurance, about $50.

They are going to do away with the third class medical haven't you heard so none of this matters.

BMI is a joke, 30 years ago the summer after I graduated from High School I played in an division wide all star football game I was in the best shape of my life (sound like Al Bundy). 6' 1.5" 215 pounds could run a 6.5 minute mile and bench press 350 lbs. My BMI was 28. I would have to weigh 191 to have a BMI just in the normal range. I am headed that way although with no intention of getting to 191 but at least now my BMI is under 40. I do have OSA must be because my neck is 17.5".

Yeah, but you're not 18 anymore.

Lastly, I don't think they will ever screen folks below BMI=30. There are must TOO many pilots in that group. The CAMI can't deal with the current load....so adding another 50,000 cases to its load will be just about the dealbreaker, right there.

Right now they are 105 days behind. Can't get much worse without breaking.

 

[DFH65]

I have not received the official bill for my recent sleep study but I was quoted $1000 for the first night an $1200 the second night. The machine is $500 to $1000 or more.

Seems to me with the advent of auto cpap machines you could significantly cut costs using the home tests to show that sleep apnea exists then supply an auto cpap with a fairly wide range of pressure and with the detailed reporting adjust the pressures accordingly if needed.

 

[PilotAlan]

No, that data already exists. Did you open my attachments- it's in BLUE at the bottom of the FASMB. We docs have known about this since 2003...
What I object to is the cost. It would be simple to do this with an overnight home desaturation "data tape print out". $250 and insurance would pay, so after the insurance, about $50

I read your attachment, Doc.
It says up to 30% of the population with BMI under 30 have OSA.
So, we have OSA at epidemic proportions within the population with average body types. Where is the evidence that this is causing serious problems?

Again, I understand the correlation with BMI >40, but it seems the cited numbers of epidemic proportions are out of line with documented issues.

 

[Papa Foxtrot]

Dr. Lomangino opted AGAINST the overnight home screening as they have no idea who really wore the device overnight.

So what will the screening consist of? Will the FAA be satisfied with a "Maintenance of Wakefulness" test? Requiring overweight Class 3 cert. holders to pay uninsured, out-of-pocket for a sleep study should certainly help reduce the pilot population...

 

[bbchien]

So what will the screening consist of? Will the FAA be satisfied with a "Maintenance of Wakefulness" test? Requiring overweight Class 3 cert. holders to pay uninsured, out-of-pocket for a sleep study should certainly help reduce the pilot population...

read the page that I cut n pasted from the FASMB in post #4. Also my edited post #35.

You "fail also to get (it)" the integration of national "policy". Under Obamacare, the elective Sleep Study has to be paid for under legally allowable insurance policies.

Another reason my personal policy went up $300 per month. And I can now safely get pregnant. Whoopers.

They are going to do away with the third class medical haven't you heard so none of this matters.

Another sore point between myself and the now deposed Craig Fuller. Q: WhyTF was he wasting our energy on something that was never going to happen? That was a disservice to everyone! A: He wanted to "look good".

 

[Papa Foxtrot]

Seems to me with the advent of auto cpap machines you could significantly cut costs using the home tests to show that sleep apnea exists then supply an auto cpap with a fairly wide range of pressure and with the detailed reporting adjust the pressures accordingly if needed.

I would guess that would also be a non-starter for the same reason that the recording dose oximeter was nixed. No way to be sure who used the machine...