Fatigue and Associated Factors among Airline Pilots
1Aeromedical Center, Korean Air, Seoul, 2Department of Nursing, Inha University College of Medicine, Incheon, KoreaCorrespondence to:
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Korean J Aerosp Environ Med 2021; 31(2): 38-44
Published August 31, 2021
Copyright © Aerospace Medical Association of Korea.
Methods: An anonymous, web-based questionnaire collecting data on sleep related characteristics was completed by airline pilots. The final 1,029 samples of completed questionnaires were analyzed. The association of the risk factors with fatigue was determined using logistic regression analysis.
Results: The prevalence of fatigue was 60% (Fatigue Severity Scale index≥3.2), disturbed sleep 28% (Pittsburgh Sleep Quality Index≥9), daytime sleepiness 17% (Epworth Sleepiness Scale≥10), and sleep apnea (Berlin Questionnaire≥2) 11%. The fully adjusted logistic regression showed that quality of life (odds ratio [OR]=0.16, confidence interval [CI]=0.11–0.24), daytime sleepiness (OR=1.26, CI=1.18–1.34), sleep quality (OR=1.44, CI=1.29–1.61), mental workload (OR=1.10, CI=1.05–1.14), vigorous physical activity (OR=0.82, CI=0.72–0.92), late starts (OR=1.25, CI=1.06– 1.46) and average weekly flying hours (OR=1.02, CI=1.00–1.03) were associated with higher levels of fatigue.
Conclusion: Lower quality of life, disturbed sleep, more subjective sleepiness, shorter sleep duration, higher mental workload, less vigorous physical activity, frequent late starts, and longer flying hour were shown to be risk factors for fatigue in airline pilots. These findings should be taken into account in the development of sleep and fatigue countermeasures for airline pilots.
- International Civil Aviation Organization. Manual of civil aviation medicine. 3rd ed. Montréal: International Civil Aviation Organization; 2012. pp. II-1-1-II-1-18.
- Caldwell JA. Fatigue in aviation. Travel Med Infect Dis 2005;3:85-96. https://doi.org/10.1016/j.tmaid.2004.07.008
- Rosekind MR, Gander PH, Gregory KB, Smith RM, Miller DL, Oyung R, et al. Managing fatigue in operational settings 2: An integrated approach. Behav Med 1996;21:166-170. https://doi.org/10.1080/08964289.1996.9933754
- Sack RL. Clinical practice. Jet lag. N Engl J Med 2010;362: 440-447. https://doi.org/10.1056/NEJMcp0909838
- Neu D, Kajosch H, Peigneux P, Verbanck P, Linkowski P, Le Bon O. Cognitive impairment in fatigue and sleepiness associated conditions. Psychiatry Res 2011;189:128-134. https://doi.org/10.1016/j.psychres.2010.12.005
- National Transportation Safety Board. Reduce fatigue-related accidents [Internet]. Washington, D.C.: National Transportation Safety Board; 2016 [cited 2021 Mar 15]. Available from: https://www.ntsb.gov/safety/mwl/Documents/2017-18/2017MWL-FctSht-Fatigue-A.pdf.
- International Civil Aviation Organization. FRMS: fatigue risk management systems — manual for regulators. Montréal: International Civil Aviation Organization; 2012.
- Chung KI, Song CH. Clinical usefulness of fatigue severity scale for patients with fatigue, and anxiety or depression. Korean J Psychosom Med 2001;9:164-173.
- Min SK, Lee CI, Kim KI, Suh SY, Kim DK. Development of Korean version of WHO quality of life scale abbreviated version (WHOQOL-BREF). J Korean Neuropsychiatr Assoc 2000;39:571-579.
- Sohn SI, Kim DH, Lee MY, Cho YW. The reliability and validity of the Korean version of the Pittsburgh Sleep Quality Index. Sleep Breath 2012;16:803-812. https://doi.org/10.1007/s11325-011-0579-9
- Kang K, Park KS, Kim JE, Kim SW, Kim YT, Kim JS, et al. Usefulness of the Berlin Questionnaire to identify patients at high risk for obstructive sleep apnea: a population-based door-to-door study. Sleep Breath 2013;17:803-810. https://doi.org/10.1007/s11325-012-0767-2
- Cho YW, Lee JH, Son HK, Lee SH, Shin C, Johns MW. The reliability and validity of the Korean version of the Epworth sleepiness scale. Sleep Breath 2011;15:377-384. https://doi.org/10.1007/s11325-010-0343-6
- Bourgeois-Bougrine S, Carbon P, Gounelle C, Mollard R, Coblentz A. Perceived fatigue for short- and long-haul flights: a survey of 739 airline pilots. Aviat Space Environ Med 2003;74:1072-1077.
- Aljurf TM, Olaish AH, BaHammam AS. Assessment of sleepiness, fatigue, and depression among Gulf Cooperation Council commercial airline pilots. Sleep Breath 2018;22:411-419. https://doi.org/10.1007/s11325-017-1565-7
- European Cockpit Association. Barometer on pilot fatigue [Internet]. Brussels: European Cockpit Association; 2012 [cited 2021 Mar 15]. Available from: https://www.eurocockpit.be/positions-publications/barometer-pilot-fatigue.
- Woo SM, Jeon JY, Kim DE, Hwang SH, Cho YW. Quality of life in Korean patients with obstructive sleep apnea. J Korean Neurol Assoc 2014;32:240-245.
- Caldwell JA, Mallis MM, Caldwell JL, Paul MA, Miller JC, Neri DF; Aerospace Medical Association Fatigue Countermeasures Subcommittee of the Aerospace Human Factors Committee. Fatigue countermeasures in aviation. Aviat Space Environ Med 2009;80:29-59. https://doi.org/10.3357/asem.2435.2009
- Petrilli RM, Roach GD, Dawson D, Lamond N. The sleep, subjective fatigue, and sustained attention of commercial airline pilots during an international pattern. Chronobiol Int 2006;23:1357-1362. https://doi.org/10.1080/07420520601085925
- Reis C, Mestre C, Canhão H, Gradwell D, Paiva T. Sleep complaints and fatigue of airline pilots. Sleep Sci 2016;9:73-77. https://doi.org/10.1016/j.slsci.2016.05.003
- Laberge L, Gaudreault M, Boudreau P, Dumont G, Boivin DB. 0708 Predictors of perceived fatigue: a survey of 1,566 commercial airline pilots. Sleep 2017;40(Suppl 1):A262. https://doi.org/10.1093/sleepj/zsx050.707
- Steptoe A, Bostock S. A survey of fatigue and well-being among commercial airline pilots. London: UCL Psychobiology Group; 2012.
- van Drongelen A, Boot CR, Hlobil H, Smid T, van der Beek AJ. Risk factors for fatigue among airline pilots. Int Arch Occup Environ Health 2017;90:39-47. https://doi.org/10.1007/s00420-016-1170-2
- International Civil Aviation Organization. Fitness to fly - a medical guide for pilots. Montréal: International Civil Aviation Organization; 2018.