OBSTRUCTIVE SLEEP APNEA SYNDROME (OSAS) AND FITNESS TO FLY: A CASE REPORT

We report the case of a 45-year old male, holding a first class flight licence, affected by Obstructive Sleep Apne Syndrome (OSAS). This pilot was undergoing periodic; medical examination in the ItAF Medico - Legal Institul “A. Mosso” in Milan. During a visit he reported for the first time that he had been suffering of daytime sleepiness an sleep fragmentation during the last two years, disturbance subsequently confirmed as OSAS. In the last few month his subjective disturbances subsided thanks to a CPA (Continuous Positive Air Pressure) therapy. Eventhough the subject showed no neurological/ps chiatric signs, we decided [taking into account the Joir Aviation Requirements - Flight Crew Licensing (Medica JAR-FCL 3.160 (g)] to carry out further specific medic; checks in other specialized medical institutions (the 5 Raffaele Hospital Milan, Brain Care srl in Padua, and thNeuroscience/Rehabilitation Department of the University of Ferrara) in order to collect more objective, physiological and performance data. We performed tests relating to the diurnal vigilance, the sleep wakefulness continuum, and the most relevant cognitive processes: routine EEG, Maintenance Wakefulness Test (MWT), polygraphic recording of the nocturnal sleep using CPAP and a battery of neuropsychological test exploring several important cognitive functions (selective advanced cognitive skills). The CPAP treatment allowed a normal nocturnal ventilatory pattern, and a good quantity and quality of the sleep. The subsequent diurnal vigilance was also normal in terms of self-evaluation and according to the objective results of the MWT. All the neuropsychological tests showed a normal range of scores. Consequently, we declared the pilot fit to fly, just adding a limitation in terms of validity of the medical certifi cate, in order to have a thorough follow-up of the case.