Pilots and controllers who may be obese will have an extra hoop to jump for their medical certification to ensure they don't have obstructive sleep apnea (OSA). Federal Air Surgeon Dr. Fred Tilton has notified (PDF) Air Medical Examiners (AMEs) that they will soon be required to measure the body mass index (BMI) of all pilots and controllers during their medicals. Anyone with a BMI of 40 or more (up to 25 is normal) and with a neck circumference of 17 inches or more will automatically have to be evaluated for OSA by a doctor who is a "board certified sleep specialist."  Anyone who has OSA has to get it treated successfully before he or she can fly again because OSA is a disqualifying condition. And, chances are, if their BMI is that high (five feet eight inches and 260 pounds) and their neck is that thick they do have OSA, according to Tilton. "OSA is almost universal" in those individuals, Tilton tells the AMEs. OSA disrupts restorative sleep and causes daytime sleepiness, cognitive impairment and can even cause sudden cardiac death, but Tilton doesn't say in his brief note what data (how many OSA-related accidents have been recorded, for instance) his staff have used to draft the new rule. But it doesn't end with the obviously fat.

Tilton says that while the initial action will target those with the BMIs above 40, his plan is to root out all sleep apnea victims and ensure they don't fly until they're treated. "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," he wrote. That means even the moderately overweight (BMI of 30 or less) can likely expect the referral to a sleep specialist because Tilton says that up to 30 percent of those who carry an extra 20 or 30 pounds have OSA. For unknown reasons, pilots will be targeted first. There are "logistical details" to be dealt with before the rule is implemented for controllers but Tilton said the plan is to include them, too.  National Air Traffic Controllers Association declined comment.