TRAVIS AIR FORCE BASE, Calif. -- A rapid medical prototyping team at David Grant USAF Medical Center has designed a kit that will open deployment locations to aircrew and warfighters with obstructive sleep apnea corrected by a continuous positive airway pressure machine.
The team, composed of active duty and reserve members at Travis Air Force Base, California, call their creation the Travis Kit. The kit provides the electrical power CPAP users need to operate their devices when deployed to austere locations.
“Sleep apnea is a medical condition that would have prevented aircrew from flying into the most austere areas,” said Col. (Dr.) Al M. Elsayed von Bayreuth, 60th Medical Group associate chief of professional staff, staff pathologist and primary medical review officer. “Based on our limited field tests, four charged batteries can run the CPAP device for eight to 12 days. The operational aspects of this will affect not just the Air Force, but the Army, Navy, Special Forces and anyone who flies.”
The Travis Kit weighs about 22 pounds and fits into a double-cushioned helmet bag. The kit includes a full face mask, a nasal mask with harness, heated and unheated tubing, filters, two datacards – one to mail to the user’s medical waiver authority for compliance verification while the spare is being used – four battery chargers and four chargeable batteries that can be fully charged with two to three hours of continuous or interrupted power.
Elsayed von Bayreuth, Maj. Stephen Vela, 60th MDG Flight and Operational Medicine Flight commander and Tech. Sgt. Ryan Padgett, 821st Contingency Response Group, introduced the kit in March at the 2018 Aerospace Medicine Summit and NATO Science and Technology Organization gathering at Ramstein Air Base, Germany.
Currently, the kit is only available to Airmen at Travis, but team members hope it will be adopted Air Forcewide.
“We are using word of mouth from our presentation at Ramstein and our soon-to-be published medical articles,” said Vela, who is also a physician assistant. “Our hope is that this will gain traction and then more and more Airmen will be able to benefit from this easy to procure kit. We know this is an easy fix that just requires a minor edit to the referral for a member's CPAP and supplies.”
Obstructive sleep apnea is a potentially serious sleep disorder in which a person’s breathing repeatedly stops and starts during sleep. OSA can result in abrupt awakenings accompanied by gasping or choking, excessive daytime sleepiness, difficulty concentrating during the day, high blood pressure and mood changes, such as depression or irritability. A CPAP machine corrects the breathing problem by delivering constant and steady air pressure so the individual does not have abrupt awakenings.
It is estimated that 22 million Americans and one in 15 adults have moderate to severe sleep apnea. A 2010 study published by Madigan Army Medical Center in Tacoma, Washington, found that 85 percent of 725 active duty members from all services – about 93 percent were men – had a clinically relevant sleep disorder, with OSA being the most frequent diagnosis followed by insomnia. Participants self-reported sleeping an average of 5.74 hours per night.
Although sleep needs vary among individuals, the American Academy of Sleep Medicine says adults need an average of seven to eight hours of sleep nightly to feel alert and well-rested during the day.
Airmen with medical conditions like OSA undergo a medical evaluation board review and receive an assignment limitation code. The code restricts them from permanent and temporary duty assignments in areas where they would not have access to reliable electric power to run their CPAP device.
Not everyone diagnosed with OSA requires a CPAP device, but OSA of any severity requires aircrew and ground-based controllers to obtain an aeromedical waiver.
“This would not change with use of the Travis Kit,” said Vela.
However, the kit hopefully will allow members who need a CPAP device to request a deployment waiver for austere environments, he said.
Flight medicine will issue the Travis Kit to Airmen newly diagnosed with OSA when they prepare their waiver package for the MEB, said Elsayed von Bayreuth.
“Imagine, anyone with a CPAP pack and batteries can go anywhere in the world,” he said.
In daily interactions with crews deploying around the globe, Elsayed von Bayreuth, who is also a flight surgeon, said he repeatedly witnessed instances where the most qualified member could not go on a critical mission because of the reliable power limitation.
“The current regulation says reliable power, but I don’t know what that means,” said Elsayed von Bayreuth. “The term is not sufficiently objective to enable precise determination if a particular deployed location is suitable for members with controlled OSA.”
To resolve the issue, Elsayed von Bayreuth recruited a team that included Vela, a nurse, a command surgeon, an expeditionary medical support commander, a certified master diver, a private pilot, a Marine Corp mechanical engineer, a psychologist and an ear, nose and throat surgeon.
Padgett was also on the team. A loadmaster on the C-5M Super Galaxy, Padgett is currently assigned to the 821st CRG as a ramp coordinator and contingency tactician. He was diagnosed with OSA about 18 months ago.
Padgett wasn’t certain that he had OSA while flying with the 22nd Airlift Squadron and he wasn’t anxious to find out.
“There’s a stigma attached if you can’t fly,” he said.
After learning that people were using batteries to power their devises on camping trips, Padgett went to the Flight Medicine Clinic hoping to get approval to use batteries in his CPAP device on deployments.
“I was trying to solve the problem myself when I ran into ‘Doc’ Vela, who said, ‘It’s funny you should say that because we have a project to look into this,’” said Padgett. “They ordered the batteries and I got to field test them.”
Without recharging, two batteries will last Padgett four to six days.
“Previously, the wording (in the regulation) said I needed access to reliable power,” said Padgett. “Now, the battery is my reliable power. I just need access to a generator once or twice a week. I can plug the charger in on the jet, in a tent, in the work center, anywhere.”
The team is preparing a report for the Competent Aerospace Medical Regulating Authorities offering a better definition of reliable power.
“We also propose a more precise definition of OSA corrected by CPAP,” said Elsayed von Bayreuth.
“These changes may seem minor, however in our views, they may prove to be most valuable in opening the doors for some commanders to put forward their most qualified personnel to serve on some of our nation’s most critical missions.”