FAA Guidelines for pilots

[danielmd06]

Good morning all.

I have been perplexed with a couple of questions recently. How often do you perform MWT's on your pilots for FAA clearance, and how often do you see these guys in clinic?

When I review the FAA guidelines, I see that MWT is only indicated when there is questionable efficacy of treatment (perhaps an elevated residual AHI on the patient's smart card downloads). At a recent AAN conference, I was surprised to find out that "MWT's are supposed to be done every year" from a prominent sleep physician.

Okay. So I went back to the FAA site and tired to find this information for myself, but don't see anything different than what I had previously thought.

For those of you who see these types of patients, what is your protocol for routine follow-up (I do every 12 months), and how often do you check an MWT?

I suppose the same question can be asked for truck drivers, too. I don't do MWT"s on them, but see them 1-2x yearly if they are compliant on CPAP.

Finally, any links would be greatly appreciated so I can do my homework.

Thanks.

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[michaelrack]

Here is some vague official info on OSA regulations for commercial drivers:

http://www.fmcsa.dot.gov/rules-regulations/topics/medical/faqs.aspx#question35 (see question 26, and they do have a helpful answer also on provigil)
http://www.aeroflowindustrialclinics.com/blog/category/dot-sleep-apnea-regulations (not an official website, but does accurately summarize the situation)

To get some clear-cut but not official (does not have the force of law) guidance, google
"Expert Panel Recommendations Obstructive sleep apnea and commercial driver safety"
- you should get a pdf file that states on the first page "Presented to Federal Motor Carrier Safety Administration January 14th 2008"

google "fmcsa obstructive sleep apnea regulations 1991" and a review article by Hartenbaum comes up on the bottom of the first google page.

The only official guidelines were issued by fmcsa in 1991- but these are clearly outdated and no one uses them in full anymore. For some reason, I am having trouble finding these on the web today, though in the past I have had no problems.

So basically, there are no current specific official rules on osa for commercial driver relevant to the sleep specialist- you are on your own!

 

[michaelrack]

I have heard that pilots are required to have MWT's, but don't know the specifics. I suspect there are few official guidelines (similar to the situation for truck drivers)

 

[michaelrack]

It's strange that I can't find the 1991 osa regs on the web- I bet they were removed from government web sites!

 

[danielmd06]

Thanks Mike.

I'll keep hunting for the pilots. Peculiar that the attending spoke with such authority but I cannot locate the actual rules/regulations. You would think that type of information would be straightforward to find.