Obstructive Sleep Apnea

The FAA treats sleep apnea as disqualifying until effective treatment is shown, because poor sleep can cause daytime sleepiness, cognitive impairment, heart rhythm problems, and hard-to-control blood pressure. Once you are treated and using your treatment consistently, you can usually keep flying through an AME Assisted Special Issuance (AASI). Obstructive sleep apnea (OSA) is on the FAA's AASI list for all classes. The protocol updated May 28, 2026 sets the rules below. If you have a different sleep disorder, such as central sleep apnea, narcolepsy, insomnia, or restless legs syndrome, your AME must contact the FAA for guidance, because those follow their own rules.

At every exam, your AME sorts you into one of six groups. Group 1: you already have a Special Issuance for OSA. Group 2: you have been diagnosed or assessed before but have no Special Issuance. Group 3: you are not at risk. Group 4: you are at low risk, so the AME discusses OSA with you and gives you educational material. Group 5: you are at high risk. Group 6: your symptoms are severe enough to be an immediate safety risk, and the AME must defer your exam. There is no automatic BMI or neck-size cutoff. The AME uses clinical judgment with the American Academy of Sleep Medicine (AASM) risk tables, which list factors such as obesity (BMI over 35), atrial fibrillation, treatment-resistant high blood pressure, type 2 diabetes, stroke, snoring, daytime sleepiness, and a receding jaw. In Groups 2 and 5, the AME can still issue your certificate if you are otherwise qualified. You will receive a Specification Sheet (A if you were assessed or treated before, B if you are at high risk), and the FAA will send a letter giving you 90 days to provide the information.

If you need a sleep study, it must be an in-lab polysomnogram (Type I) or a 7-channel home sleep test (Type II). The FAA accepts a Type III home test only where a Type II is not available, and an equivocal home test needs a higher-level study unless a sleep specialist documents why it isn't needed. A sleep medicine specialist must interpret the study. If your study is positive, you may not use your medical certificate until you submit your treatment records: an OSA Treated Status Report, or a compliance sheet plus a current detailed progress note and your latest sleep study report. For FAA purposes, an untreated apnea-hypopnea index (AHI) of 15 or higher requires treatment with a PAP device (CPAP, BiPAP, or APAP). The FAA's PAP targets are use on at least 75% of nights, an average of at least 6 hours per night, and a treated AHI of 5 or less. The FAA wants a cumulative annual device report that shows your actual hours of use, not an insurance report that only shows whether you used it more or less than 4 hours.

If your AME can answer "yes" to every item on the OSA Treated Status Report, the AME can issue your certificate and upload the report, and the FAA may then send you an Authorization. After that, each year you bring either a new signed Status Report or a current progress note saying treatment still works, plus your annual PAP report. The AME issues a certificate with a one-year time limit. If you use a dental or positional device, you must have no conditions linked to OSA, such as diabetes, high blood pressure treated with more than two medications, or atrial fibrillation. You also need daily use and no symptoms. If surgery treated your OSA, you need a statement that your symptoms are still gone. Your AME must defer to the FAA if there are concerns about compliance, significant weight gain, or new related conditions. If you may no longer have OSA, for example after significant weight loss and a negative study, or after surgery followed by 3 years without symptoms, your AME can ask the FAA to remove the AASI. In most cases a follow-up sleep study is required.