Obstructive sleep apnea in airline pilots during daytime sleep following overnight flights

Abstract

To identify the vulnerability of recovery sleep, this study investigated the occurrence of obstructive sleep apnea during daytime sleep following overnight flights in healthy airline pilots. We conducted daytime polysomnography following a long-haul nighttime flight in 103 pilots. The following variables were assessed: apnea-hypopnea index, respiratory disturbance index and oxygen desaturation index. Moderateto-severe obstructive sleep apnea was defined as an apnea-hypopnea index ≥15. Seventy-three pilots (70.9%) with no known history of obstructive sleep apnea presented with moderate-to-severe obstructive sleep apnea. Pilots showed high mean apnea-hypopnea, respiratory disturbance and oxygen desaturation indices. The body mass index, Berlin questionnaire score and cumulative flight time contributed to these indices, with both body mass index and cumulative flight time remaining significant at an apnea-hypopnea index ≥15. We found that pilots are vulnerable to obstructive sleep apnea during daytime sleep after night-time flights, which may deteriorate their health, increase fatigue and impair overall flight safety. Further research is needed to ensure flight safety, as daytime recovery sleep is unavoidable for night-time flight pilots. The pilots' normal and recovery sleep patterns should both be studied to develop an effective sleep management protocol.

Health in the Skies: A Narrative Review of the Issues Faced by Commercial Airline Pilots

“…Occupational physicians should inform airline pilots about proper sleep habits as well as on the relationships between sleep disorders, fatigue, and depression [4][5][6][7][8][9][10][11]. Current health surveillance activities should also include adequate screening programs for sleep disorders and OSA.…”

“…In a study by Alhejaili et al [ 8 ], OSA was identified by home sleep testing in 69% of Saudi-based airline pilots. On analyzing 103 pilots after a long-haul night-time flight using daytime polysomnography, Han et al [ 9 ] found that 73 (70.9%) had moderate-to-severe daytime OSA despite no known previous history. Elevated body mass index and cumulative flight time were identified as independent predictors [ 9 ].…”

“…On analyzing 103 pilots after a long-haul night-time flight using daytime polysomnography, Han et al [ 9 ] found that 73 (70.9%) had moderate-to-severe daytime OSA despite no known previous history. Elevated body mass index and cumulative flight time were identified as independent predictors [ 9 ]. Pilots should be educated about the long-term importance for health of obtaining adequate sleep on off-duty days.…”

Peri-operative night-time work of anaesthesiologists

“…Although such an effect has not been widely described in clinical studies related to anaesthesia, night-time work has been shown to be associated with increased morbidity in other work settings. 6 Recent data also suggests that anaesthesiologists believe the current conditions of their night-time practice adversely affect their professional performance, the safety of their patients, and their own quality of life. 7 Many countries have adopted the European Working Time Regulations, thus showing an interest in providing organisational support to night-time workers.…”

“…Night-time work is also probably accompanied by poorer healthcare professional well being. Although such an effect has not been widely described in clinical studies related to anaesthesia, night-time work has been shown to be associated with increased morbidity in other work settings 6 . Recent data also suggests that anaesthesiologists believe the current conditions of their night-time practice adversely affect their professional performance, the safety of their patients, and their own quality of life 7 …”