OSA is one of the most common medical conditions affecting pilots today — and one of the most manageable. With proper diagnosis, treatment, and documentation, most pilots with OSA successfully maintain their medical certificate.
Informational Use Only. The information on this page reflects our understanding of current FAA medical certification requirements and is provided for general educational purposes only. FAA policies, the AME Guide, and special issuance protocols are updated frequently and without notice. The FAA AME Guide and FAA Civil Aerospace Medical Institute (CAMI) are the authoritative sources in all cases. Nothing on this page constitutes legal or medical advice. Always verify current requirements directly with your Aviation Medical Examiner and the official FAA AME Guide at faa.gov/ame_guide before making any certification decisions.
OSA Uses the FAA Six-Group Process
For all three classes, the AME assigns an OSA group at every examination. Diagnosis, BMI or an AHI severity label does not by itself dictate deferral. Group 5 directs ISSUE, if otherwise qualified, with the required assessment. For Group 6, symptoms pose an immediate aviation-safety risk and THE AME MUST DEFER. Existing Special Issuance cases follow their authorization.
The FAA requires the AME to assign one of six groups, using the full clinical assessment, treatment history and any existing authorization.
Group 1 — Existing OSA Special Issuance: follow the authorization and OSA AASI/SI requirements
Group 2 — Prior sleep assessment, no OSA authorization: provide Specification Sheet A; submit the requested information within 90 days and obtain SI if treated
Group 3 — No current OSA risk after AME assessment; document in Block 60
Group 4 — Low OSA risk: discuss risks, provide education and document in Block 60
Group 5 — High OSA risk: ISSUE, if otherwise qualified; provide Specification Sheet B for the required assessment, document in Block 60 and submit requested information within 90 days
Group 6 — Symptoms severe enough to pose an immediate aviation-safety risk: document in Block 60
Obstructive Sleep Apnea causes repeated pauses in breathing during sleep, leading to oxygen desaturation and fragmented sleep. The result: excessive daytime sleepiness (EDS) — a direct flight safety hazard. The FAA's concern is not the diagnosis itself, but the risk of incapacitation or impaired judgment in the cockpit due to uncontrolled sleepiness. Effective treatment and absence of residual EDS are central to review, but are not individual clearance to fly. The AME applies the six-group process and any existing authorization; pilots must also comply with § 61.53.
STOP-BANG can help assess OSA risk. The FAA directs the AME to consider AASM risk criteria and clinical judgment within its six-group process; this questionnaire does not determine issuance or deferral. Each "yes" answer = 1 point.
Snoring
Do you snore loudly (louder than talking, or loud enough to be heard through closed doors)?
Tired
Do you often feel tired, fatigued, or sleepy during the daytime?
Observed
Has anyone observed you stop breathing during your sleep?
Pressure
Do you have or are you being treated for high blood pressure?
BMI
Is your Body Mass Index greater than 35?
Age
Are you older than 50?
Neck
Is your neck circumference greater than 40 cm (approximately 15.7 inches)?
Gender
Are you male?
Important: BMI and STOP-BANG scores are risk indicators, not automatic diagnoses or deferral criteria. The AME determines the appropriate FAA group and assessment; even a normal BMI does not rule out OSA.
The Apnea-Hypopnea Index (AHI) measures breathing interruptions per hour of sleep. These clinical severity labels do not replace the FAA six-group process or automatically require deferral.
The AME evaluates symptoms, prior assessment and treatment status under the six-group process. Mild severity alone does not establish medical qualification.
Treatment effectiveness and adherence require documentation. The application disposition follows the assigned FAA group and any existing Special Issuance authorization.
The AME assesses the full clinical picture, not the severity label alone. Symptoms presenting an immediate aviation-safety risk place the applicant in Group 6 and require deferral.
The FAA's review is focused on flight safety — specifically whether the airman has any residual risk of in-flight incapacitation or impaired judgment due to sleepiness.
A formal sleep study (polysomnography or home sleep apnea test from a board-certified sleep specialist) with a documented AHI. Self-reported snoring or fatigue is insufficient — objective testing is required.
The treatment modality must demonstrably control OSA. For CPAP, a data download showing AHI on therapy (residual AHI) is expected. For oral appliances, a follow-up sleep study is typically required to confirm efficacy.
The FAA PAP standard is use during at least 75% of sleep periods and an average minimum of six hours per sleep period. Provide actual usage data for the period required by the FAA protocol and your authorization.
The core safety question. You must be completely free of excessive daytime sleepiness (EDS) — no dozing while driving, watching TV, or in passive situations. Residual EDS despite treatment is disqualifying.
Any aviation incident, near-miss, or vehicle accident potentially related to OSA-induced sleepiness significantly elevates FAA scrutiny and may require a full Special Issuance regardless of current treatment status.
Hypertension is common with OSA and is independently evaluated. Obesity, atrial fibrillation, and type 2 diabetes frequently co-occur. The FAA reviews the full clinical picture — each comorbidity must also meet certification standards.
Using CPAP but having no data download — older machines without data tracking are not FAA-acceptable
Residual AHI on therapy still elevated (>10) — indicates mask fit issues, central apneas, or inadequate pressure
CPAP compliance below FAA threshold — short nights, skipping travel, or mask discomfort documented in the data
Reporting no daytime sleepiness but Epworth Sleepiness Scale score is elevated — inconsistency triggers scrutiny
Assuming a 'mild' label establishes eligibility — the FAA group, symptoms, treatment requirements and any authorization govern
Surgical treatment without post-op sleep study — outcome must be objectively documented, not assumed
Failing to disclose HTN or other comorbidities that share the same pathophysiology
Ignoring a high STOP-BANG score — complete the assessment required by your FAA group rather than assuming either clearance or automatic deferral
Multiple treatment modalities are accepted by the FAA. The key requirement in all cases is documented effectiveness — subjective improvement alone is not sufficient.
CPAP / BiPAP
Continuous or bilevel positive airway pressure is the gold standard. FAA requires documented compliance via device data download and a residual AHI demonstrating controlled disease.
Oral Appliance Therapy
Mandibular advancement devices are accepted for mild-to-moderate OSA. A follow-up sleep study showing effective AHI reduction is required — the appliance must be fitted by a qualified dental sleep specialist.
Surgical Treatment
Procedures like UPPP, nasal surgery, or hypoglossal nerve stimulation (Inspire) are accepted if post-operative sleep study documents effective treatment. Inspire therapy is gaining FAA acceptance with proper documentation.
Official FAA sources, clinical guidelines, and reputable educational resources used in developing this guide.
What sets our practice apart for OSA and sleep medicine certification cases.
HIMS Senior AME
FAA-designated HIMS Senior AME experienced in managing complex certification cases including OSA with comorbid hypertension, cardiac conditions, and metabolic disease.
Pilot, Not Just a Physician
Active corporate jet pilot (ATP, CFI, CFII, MEI) — understands the real-world stakes of a medical deferral and the importance of getting OSA documentation right the first time.
CPAP Data Review In-Office
We review your CPAP compliance download during your visit and can advise you before submitting to the FAA. Many pilots don't know their data is problematic until it's too late.
Comorbidity Coordination
OSA rarely travels alone. We understand how to structure a certification package that addresses OSA alongside hypertension, weight, cardiac history, or diabetes in a single, coherent submission.
Direct Physician Access
You work directly with the doctor — no case managers, no handoffs. One point of contact from consultation through certification.
Remote Consultations Available
Nationwide consultations available remotely for pilots who want guidance on whether their OSA documentation is ready before traveling for their medical exam.