Background: Aviation pilots and cabin crew regularly undertake shift work, and may experience circadian disruption, restricted sleep, sleepiness and impaired health. Research on aviation fatigue and sleepiness has focused on pilots, with less being known about cabin crew. This study aimed to identify likely predictors of fatigue, sleepiness, shift work disorder (SWD) and depression in cabin crew. Methods: An online anonymous survey was distributed to active cabin crew around the world. It measured sleepiness, fatigue, and screened for insomnia, depression and SWD. Information on individuals’ habits and work schedules were collected. Results: 930 valid responses were analysed. 63.5% of the sample had abnormal levels of fatigue and 46.9% experienced excessive daytime sleepiness. 68.0% were at risk for SWD, 57.7% screened positive for insomnia, and 40.0% for depression. Caffeine and use of alcohol and drugs for sleep were independently associated with insomnia and SWD (p < 0.05), whereas, type of route (international, domestic, both) and number of duty days per week predicted fatigue (p < 0.05). Conclusions: Cabin crew had a high prevalence of fatigue, sleepiness and elevated risk for SWD, insomnia and depression. Many cabin crew engaged in behaviours detrimental to good sleep hygiene, highlighting targets for future interventional studies.

Airline cabin crew operate in dynamic work environments that are continuously changing, from unpredictable shift work hours to travelling through multiple time zones. These likely impact cabin crews’ overall health and may affect their performance on safety-related tasks. Research on this population has been limited; therefore, the aim was to summarise the relevant literature regarding fatigue, sleepiness and mental health of cabin crew. This review followed the PRISMA-ScR guidelines and conducted a systematic search utilising five databases. The initial search identified 1223 studies, and through vigorous screening processes, 27 studies were selected for this review. Over half of the selected studies focused on international or long-haul flights, and a large proportion of the sample participants were women. Findings suggested a high prevalence of fatigue and sleepiness as well as unsatisfactory sleep quality with elevated susceptibility to sleep disorders. Factors identified with health outcomes were associated with flight operations (e.g., rosters) and individual differences (e.g., age and coping strategies). Regarding mental health, cabin crews are potentially at a greater risk for depression and anxiety compared to the general public. This review draws attention to the importance of using a standardised approach, such as validated measures for fair and consistent inferences.

OBJECTIVES: Airline cabin crew experience high levels of fatigue and sleepiness. Whether these are solely related to their work schedules/jetlag or are in part related to individual factors is unknown. The COVID-19 pandemic has significantly disrupted the aviation industry and many cabin crew have been grounded. This provides a unique opportunity to assess the causes of fatigue and sleepiness in this population.METHODS: An online anonymous survey was distributed in April–June 2020 to cabin crew who were 1) flying, 2) grounded but doing alternative work, and 3) grounded, not working, or unemployed. The survey measured fatigue, sleepiness, and mental health. It also screened their risk for insomnia, depression, and shift work disorder and assessed drug and caffeine use.RESULTS: Collected were 409 valid responses: 45 currently flying; 35 grounded but doing alternate work; and 329 not working. On average, all three groups experienced normal levels of fatigue and sleepiness. The risk for major depressive disorder was 27.4%, with 59.5% of individuals reporting abnormal levels of anxiety. Caffeine intake and the use of drugs and alcohol to facilitate sleep were common, although not different between those currently flying vs. grounded.CONCLUSIONS: With reduced workloads or not flying, cabin crew reported lowered fatigue and sleepiness compared to prepandemic findings, along with reduced risk for major depressive disorder. However, a high occurrence of negative emotional states were reported, potentially related to the uncertainty surrounding the pandemic. This study suggests fatigue and sleepiness is primarily related to airline operational rather than personal variables.Wen CC-Y, Nicholas CL, Howard ME, Trinder J, Jordan AS. Understanding sleepiness and fatigue in cabin crew using COVID-19 to dissociate causative factors. Aerosp Med Hum Perform. 2022; 93(1):50–53.