Obstructive Sleep Apnea

Obstructive sleep apnea (OSA) is an increasingly common condition in the pilot population, particularly as the FAA has implemented broader screening protocols. Since 2015, the FAA has required AMEs to assess OSA risk based on body mass index (BMI), neck circumference, and clinical history. Pilots with a BMI of 40 or greater are automatically referred for a sleep study. Those with BMIs between 30 and 40 may also be referred if other risk factors are present, such as a neck circumference exceeding 17 inches, witnessed apneas, or excessive daytime sleepiness.

The good news is that treated OSA is certifiable under the CACI (Conditions AMEs Can Issue) pathway in most cases, meaning your AME can issue your medical certificate at the time of exam without waiting for FAA headquarters review. To qualify for CACI, you must demonstrate effective treatment — most commonly CPAP (continuous positive airway pressure) therapy — with documented compliance data showing adequate usage. The FAA defines compliance as an average of at least 4 hours of CPAP use per night on at least 70% of nights, measured over a consecutive 30-day period within the 90 days before your exam.

Alternative treatments may also be acceptable. Oral appliances (mandibular advancement devices) can be used if a follow-up sleep study demonstrates adequate treatment. Surgical intervention such as UPPP (uvulopalatopharyngoplasty), MMA (maxillomandibular advancement), or Inspire hypoglossal nerve stimulator implantation may be acceptable with post-treatment sleep study documentation showing resolution of clinically significant apnea. Weight loss alone can resolve OSA in some cases — a follow-up sleep study documenting an AHI below 5 events per hour without treatment is needed to demonstrate resolution.