We keep you in the air
Obstructive Sleep Apnea
Asleep at the controls
On a daytime flight one February day in 2008, a commercial aircraft with three crewmembers and 40 passengers flew past its destination airport after both the captain and first officer
fell asleep. The pilot awoke and turned back to the destination airport, where all deplaned safely – but behind schedule. The National Transportation Safety Board determined that
contributing factors so the incident were the captain’s undiagnosed obstructive sleep apnea (OSA) and the flight crew’s recent work schedules, which included several days of
early-morning start times. An obscure condition tackles a pro lineman With the shocking death of NFL lineman Reggie White, the problem of OSA was thrust into the limelight.
Up to that time, OSA was relatively unknown outside the medical community. Today, OSA is recognized as a major contributor to many possible health
In some estimates, it has been suggested that OSA affects-4 - 7% of middle-aged people.70% of clinically obese patients.34% of all NFL lineman.
The pathophysiology of OSA
Apnea is a medical term that means “being without respiration.” Obstructive sleep apnea is characterized as a repetitive upper airway obstruction during sleep, as a result of narrowing
of the respiratory passages. Most people with this disorder are overweigh and have higher deposits of adipose (fatty) tissue in their respiratory passages, and the size of their soft palates
and tongues are larger than average. These conditions decrease the size of the upper airway and decrease airway muscle tone, especially when sleeping
In the supine (back down and horizontal) position. Gravity can pull tissue down and over the airway, further decreasing its size,
impeding air flow to the lungs during inhalation.
The major impact of OSA
Snoring can result when the airway becomes partially obstructed. With further tissue obstruction of the airway, there may be
complete occlusion. Whether the obstruction is partial (hypopnea) or total (apnea), the subject struggles to breathe and is aroused
from sleep. Often, these sleep interruptions are unrecognized, even if they occur hundreds of times a night.
The real danger is that the OSA sufferers may not realize the condition and are only aware that they typically awaken feeling sleepy
and tired. Losing sleep is more than a simple inconvenience. Good, sound sleep is essential for good health and clear mental and emotional
functioning. Additionally, OSA is associated with a reduction in blood oxygen levels feeding the brain, which, of course, is a major health
concern. Repetitive decreases in blood oxygen Levels associated with OSA may eventually increase:
Strain on the cardiovascular system.
Risk of heart attack.
Risk of stroke.
30% - 50% of patients with heart disease.
60% of patients suffering strokes.
A costly problem on the ground
The National Sleep Foundation (NSF) estimates that sleep deprivation and sleep disorders cost Americans more than $100 billion
annually in lost productivity, medical expenses, sick leave, and property and environmental damage. In addition, the NSF estimates that -
About 70 million people in the U.S. have some sort of sleep problem.40 million suffer from chronic sleep disorders.
As many as 30 million are affected by intermittent, sleep-related problems .The national highway traffic safety administration conservatively
estimates that -100,000 accidents are caused by drowsy drivers each year, resulting in more than 1,500 fatalities, 71,000 injuries, and $12.5
billion in diminished productivity and property loss.
People with OSA have a six times greater risk factor for automobile accidents.
Once recognized and identified, OSA is highly treatable, either with surgery or non-surgical approaches. Obviously, non-surgical methods
should be tried first –
Change sleeping position (sleep on side or stomach).
Change sleeping environment (mattress, light level, temperature, etc.).
Lower body fat (10% weight loss will decrease the OSA index by 25%).
Dental appliances that thrust the lower jaw forward or otherwise open the airway are an excellent treatment for
mild-to-moderate OSA and are about 75% effective.
A potential problem in flight?
The implications for pilots and crewmembers are significant. It has been suggested that people with mild-to-moderate OSA can show
performance degradation equivalent to 0.06 to 0.08% blood alcohol levels, which is the measure of legal intoxicationin most states. Most pilots
will not fly intoxicated, but OSA sleep deprivation may be causing the equivalent effects! Further exacerbating the problem are time zone changes
and post-flight alcohol consumption, which can inhibit wakefulness. Normally, when you stop breathing while asleep, the brain
automatically sends a wake-up call after about 10 seconds, and you wake up, gasping for air. Multiple time zone changes and alcohol consumption
both inhibit arousal mechanisms and may result in oxygen deprivation of 30 seconds or longer before you heed the wake-up call.
When you add up the oxygen starvation resulting from many occurrences per night, along with the subsequent arousals, the effect is
Typically a person suffering from OSA is not aware of the condition. The only way it can be detected is through a sleep study. A complaint of loud and
excessive snoring may be an important clue, since that is characteristically the first sign of OSA. Other symptoms suggesting OSA include:
Difficulty in concentrating, thinking, or remembering.
Daytime sleepiness, fatigue, and the need to take frequent naps.
Short attention span.
Pilot Medical Notifications
Davis Aircraft, Inc