Health Implications of Shift Work in Airline Pilots and Cabin Crew: A Narrative Review and Pilot Study Findings

Background: Airline pilots and cabin crew are exposed to multiple occupational stressors, including circadian disruption, irregular meal timing, cabin environment and radiation, which collectively affect sleep, metabolism and overall health. This study aimed to evaluate the health implications of shift work in aviation by combining self-reported experiences with existing scientific evidence. Methods: A cross-sectional survey of 101 airline personnel was conducted to assess sleep patterns, fatigue, nutrition-related challenges and health symptoms. The survey findings were integrated with a literature review to contextualize observed health outcomes within known effects of circadian disruption and aviation-related stressors. Results: Sleep disturbances (71%) and fatigue (89%) were the most prevalent symptoms, while 60% of respondents reported weight fluctuations and 50% limited access to nutritious food during duty. Appetite alterations, reduced taste perception and frequent melatonin use indicated behavioral adaptation to circadian misalignment. Among female aircrew (63%), thyroid and reproductive concerns were reported, aligning with documented impacts of radiation exposure and endocrine disruption. The findings correspond with existing evidence linking aviation-related circadian stress to cardiometabolic, endocrine and gastrointestinal imbalance. Conclusions: Shift work and occupational exposures in aviation contribute to significant disturbances in sleep, metabolism and overall health among aircrew. Preventive strategies should integrate fatigue risk management, circadian-aligned scheduling, improved in-flight nutrition and comprehensive occupational health surveillance to safeguard crew well-being and operational safety.