Fatigue and Sleep in Airline Cabin Crew: A Scoping Review
Abstract
:1. Introduction
1.1. Health Consequences of Shift Work
1.2. Specific Considerations for the Aviation Industry
1.3. Primary Objectives
- To summarise what is currently known in the literature on fatigue, sleepiness and other sleep-related constructs in cabin crew;
- To identify common factors that are associated with fatigue, sleepiness and other sleep-related constructs in cabin crew, e.g., operational factors such as rosters and flight routes or individual factors such as age and gender;
- To pinpoint existing gaps and limitations in the current literature on fatigue, sleepiness and other sleep-related constructs and to provide suggestions for future directions.
1.4. Secondary Objective
- 4.
- To summarise what is known about cabin crews’ mental health, specifically depression, anxiety and stress.
2. Methods
2.1. Eligibility Criteria
2.2. Information Sources & Search
2.3. Selection of Sources of Evidence
2.4. Data Charting & Synthesis of Results
- Article information: author, year of publication, title, journal title, type of study and aim/objective of the study;
- Participant: sample size, cabin crew percentage in the sample, sample characteristics (age and sex), hierarchy and tenure;
- Context: location and type of routes (international versus domestic or long versus short haul);
- Concepts: Outcomes of interest to this scoping review; fatigue, sleepiness, other sleep-related constructs and mental health. With each outcome, the type of measure used, any associated factors and the reported prevalence were examined.
3. Results
Selection of Sources of Evidence
4. Characteristics of Sources of Evidence
Demographic Characteristics
5. Concept Characteristics
5.1. Fatigue
5.2. Sleepiness
5.3. Other Relevant Measures
5.4. Mental Health
6. Results of Individual Sources of Evidence
6.1. Fatigue
6.2. Flight Operation Variables
6.3. Individual Variables
7. Sleepiness
Flight Operation Variables
8. Other Relevant Measures
8.1. Flight Operation Variables
8.2. Individual Variables
9. Mental Health
9.1. Depression & Anxiety
9.2. Stress
10. Discussion
10.1. Flight Operations
10.2. Individual Differences
10.3. Mental Health
11. Limitations
12. Limitations of the Current Review Process
13. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Inclusion Criteria | Exclusion Criteria | |
---|---|---|
Exposure of Interest | Cabin crew of a commercial airline | Other aviation capacities: military, cargo, pilots, ground staff, air traffic controllers |
Participants | Research must be cabin crew-focused. All ages and genders included. If other occupations are included in the sample, it needs to fulfil one of two criteria (1) a minimum of 70% of the sample are cabin crew or (2) if less than 70%, cabin crew results must be reported separately to other occupation(s). | Non-cabin crew population. Study sample is not cabin crew dominant (<70% of the sample) and does not report cabin crew results exclusively. |
Reported outcomes | Fatigue: Subjective, validated scale, subscale or non-validated measure of fatigue. Sleepiness: Subjective, validated and non-validated measures of sleepiness. Sleep-relevant measures: This includes objective and subjective measures related to sleep, including PSG, actigraphy, PVT, sleep diaries, validated scales, subscales and non-validated measures related to sleep. Mental health: This is a secondary objective. Therefore, one of the three outcomes listed above needs to be fulfilled also. This can be a validated scale, subscale or non-validated questionnaire that examines mental health states. | No outcome measures on either fatigue and/or sleepiness. Outcomes on jet lag and burnout. |
Setting | On-the-job measures | Laboratory settings |
Language | English | Non-English |
Type of Publication | Original Research, Thesis | Review, Conference Abstracts, Book Chapters, Technical Reports |
Other | All publication dates and all countries | Full text not available |
Search Date | Databases | Search Strategy |
---|---|---|
20 September 2021 | Scopus | “flight attendant” OR “cabin crew” OR “air crew” OR “aircrew” OR “air hostess” OR “airline crew” AND “fatigue” OR “sleep” OR “tired” OR “alert” OR “drowsy” OR “insomnia” OR “lethargic”. |
CINAHL | ||
Medline OVID | ||
APA PsychInfo | ||
EMBASE |
Author (Year) | Title | Type of Study | Main Measures |
---|---|---|---|
Beh & McLaughlin (1991) [38] | Mental performance of air crew following layovers on transzonal flights | Observational |
|
Castro, Carvalhais & Teles (2015) [39] | Irregular working hours and fatigue of cabin crew | Observational |
|
Chung & Chung (2009) [40] | An exploration of quality of life and related factors among female flight attendants | Cross-sectional |
|
Goffeng et al. (2019) [41] | Risk of fatigue among airline crew during 4 consecutive days of flight duty | Observational |
|
Grajewski et al. (2016) [42] | Sleep disturbance in female flight attendants and teachers | Cohort Study |
|
Haugli, Skogstad & Hellesoy (1994) [43] | Health, sleep and mood perceptions reported by airline crews flying short and long hauls | Observational |
|
Haurma, Suvanto & Partinen (1994) [44] | The effect of four-day round trip flights over 10 time zones on the sleep-wakefulness patterns of airline flight attendants | Observational |
|
Hu et al. (2019) [45] | Insomnia, work-related burnout and eating habits affecting the work ability of flight attendants | Cross-sectional |
|
Kecklund, Akerstedt & Lowden (1997) [46] | Morning work: Effects of early rising on sleep and alertness | Cohort Study |
|
Lowden & Akerstedt (1998) [47] | Retaining home-base sleep hours to prevent jet lag in connection with a westward flight across nine time zones | Quasi-experimental |
|
Lowden & Akerstedt (1999) [48] | Eastward long-distance flights, sleep and wake patterns in air crews in connection with a two-day layover | Observational |
|
MacDonald et al. (2003) [49] | Job stress among female flight attendants | Cross-sectional |
|
McNeely et al. (2014) [50] | The self-reported health of U.S. flight attendants compared to the general population | Cross-sectional |
|
McNeely et al. (2018) [51] | Estimating the health consequences of flight attendant work: Comparing flight attendant health to the general population in a cross-sectional study | Cross-sectional |
|
Omholt, Tveito & Ihlebaek (2017) [52] | Subjective health complaints, work-related stress and self-efficacy in Norwegian aircrew | Cross-sectional |
|
Ono et al. (1991) [53] | Working hours and fatigue of Japanese flight attendants | Observational |
|
Perrin et al. (2019) [54] | Timing of Australian flight attendant food and beverage while crewing: A preliminary investigation | Cross-sectional |
|
Ruscitto (2015) [55] | Predicting jet lag in long-haul cabin crew and making a simple meal plan to ameliorate it—Chapter 5 | Thesis chapter: cross-sectional |
|
Ruscitto (2015) [55] | Predicting jet lag in long-haul cabin crew and making a simple meal plan to ameliorate it—Chapter 3 | Thesis chapter: Observational and experimental |
|
Sallinen et al. (2020) [56] | A large-scale European union study of aircrew fatigue during long night and disruptive duties | Cross-sectional |
|
Smolensky et al. (1982) [57] | A health Profile of American Attendants | Cross-sectional |
|
Suvanto et al. (1990) [58] | Flight attendants’ desynchronosis after rapid time zone changes | Observational |
|
van den Berg, Signal & Gander (2020) [59] | Fatigue risk management for cabin crew: The importance of company support and sufficient rest for work-life balance—a qualitative study | Focus Group |
|
van den Berg, Signal & Gander (2019) [60] | Perceived workload is associated with cabin crew fatigue on ultra-long-range flights | Observational |
|
van den Berg et al. (2015) [61] | Monitoring and managing cabin crew sleep and fatigue during an ultra-long-range trip | Observational |
|
Wahlstedt et al. (2010) [62] | Psychosocial work environment and medical symptoms among Swedish commercial airline cabin crew | Cross-sectional |
|
Wen et al. (2021) [37] | Health risks and potential predictors of fatigue and sleepiness in airline cabin crew | Cross-sectional |
|
Validated Fatigue Measures: | Study | Main Findings |
---|---|---|
Samn-Perelli Crew Status Check (SP) | [37,41,56,60,61] |
|
The Multidimensional Assessment of Fatigue Scale | [40] | |
The Chalder Fatigue Scale | [55] |
|
Flinders Fatigue Scale | [37] | |
Fatigue questionnaires/subscales: | ||
Focus groups: Fatigue | [59] |
|
Subjective questionnaire: fatigue-related | [39,43,50,51,53,57,62] |
|
Profile of Mood States—Fatigue | [49] |
|
Liverpool Jet Lag Questionnaire—Fatigue subscale | [55] |
|
Sleepiness Measures | Study | Main Findings |
---|---|---|
Karolinska Sleepiness Scale (KSS) | [46,47,56,60,61] |
|
Accumulated Time with Sleepiness Scale | [48] |
|
Epworth Sleepiness Scale | [37] |
Objective Measures | Study | Main Findings |
---|---|---|
Polysomnography | [46] |
|
Actigraphy | [42,47,48,55,60,61] |
|
Psychomotor Vigilance Task (PVT) | [60,61] | |
Attentional Capture Task & Sustained Attention to Response Task | [41] |
|
Validated Measures | ||
Pittsburgh Sleep Quality Index (Global) | [40] | |
Sleep Condition Indicator | [37] | |
Athens Insomnia Scale | [45] |
|
Shift Work Disorder Questionnaire | [37] |
|
Survey of Shiftworkers | [54] |
|
Sleep-related measures/subscales | ||
Liverpool Jet Lag Questionnaire—Sleep subscale | [55] |
|
Subjective Health Complaints Inventory—Sleep | [52] |
|
Sleep/wake diary | [38,41,42,44,46,56,61] |
|
Subjective questionnaires—Sleep related | [38,39,41,43,44,46,50,51,55,57,58] |
|
Anxiety and Depression Measures/Subscales | Study | Main Findings |
---|---|---|
Brief Symptoms Rating Scale—anxiety and depression | [45] |
|
Subjective Health Complaints Inventory—Anxiety & Depression | [52] |
|
Patient Health Questionnaire -2 | [37] | |
Subjective Questionnaire—Anxiety & Depression | [50,51,57] | |
Stress and psychological health measures/subscales | ||
Accumulated Time with Sleepiness Scale—Mood and mental strain | [48] | |
Subjective Questionnaire—Stress | [46] |
|
Profile of Mood States—Psychological distress | [49] |
|
QPS—Nordic Questionnaire—Stress | [52] |
|
The Stress Arousal Checklist | [55] |
|
The World Health Organisation Quality of Life—psychological health | [40] |
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Wen, C.C.Y.; Cherian, D.; Schenker, M.T.; Jordan, A.S. Fatigue and Sleep in Airline Cabin Crew: A Scoping Review. Int. J. Environ. Res. Public Health 2023, 20, 2652. https://doi.org/10.3390/ijerph20032652
Wen CCY, Cherian D, Schenker MT, Jordan AS. Fatigue and Sleep in Airline Cabin Crew: A Scoping Review. International Journal of Environmental Research and Public Health. 2023; 20(3):2652. https://doi.org/10.3390/ijerph20032652
Chicago/Turabian StyleWen, Candice C. Y., Darsh Cherian, Maya T. Schenker, and Amy S. Jordan. 2023. "Fatigue and Sleep in Airline Cabin Crew: A Scoping Review" International Journal of Environmental Research and Public Health 20, no. 3: 2652. https://doi.org/10.3390/ijerph20032652