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Background:
The occupational demands of professional airline pilots such as shift work, work schedule irregularities, sleep disruption, fatigue, physical inactivity, and psychological stress may promote adverse outcomes to cardiometabolic health. This review investigates the prevalence of cardiometabolic health risk factors for airline pilots.
Me...
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Citations
... These factors contribute to hypertension, hyperlipidemia, obesity, obstructive sleep apnea and diabetes. In a systematic review by Wilson et al., even though there tended to be less smokers among pilots, more than half of pilots have been found to be overweight or obese, with low physical activity levels, and frequently exhibit high levels of alcohol intake [8]. High quality epidemiologic studies specific to pilot cardiometabolic health risk, are lacking. ...
Coronary artery disease (CAD) is highly prevalent among pilots due to the nature of their lifestyle, and occupational stresses. CAD is one the most common conditions affecting pilots' medical certification and is frequently nondisclosed by pilots fearing the loss of their certification. Traditional screening methods, such as resting electrocardiograms (EKGs) and functional stress tests, have limitations, especially in detecting non-obstructive CAD. Recent advances in cardiac imaging are challenging the current paradigms of CAD screening and risk assessment protocols, offering tools uniquely suited to address the occupational health challenges faced by pilots. Coronary artery calcium scoring (CACS) has proven valuable in refining risk stratification in asymptomatic individuals. Coronary computed tomography angiography (CCTA), is being increasingly adopted as a superior tool for ruling out CAD in symptomatic individuals, assessing plaque burden as well as morphologically identifying vulnerable plaque. CT-derived fractional flow reserve (CT-FFR) adds a physiologic component to the anatomical prowess of CCTA. Cardiac magnetic resonance imaging (CMR) is now used as a prognosticating tool following a coronary event as well as a stress testing modality. Investigational technologies like pericoronary fat attenuation and artificial intelligence (AI)-enabled plaque quantification hold the promise of enhancing diagnostic accuracy and risk stratification. This review highlights the interplay between occupational demands, regulatory considerations, and the limitations of the traditional modalities for pilot CAD screening and surveillance. We also discuss the potential role of the recent advances in cardiac imaging in optimizing pilot health and flight safety.
Graphical abstract
... La prevalencia de factores de riesgo en pilotos es similar a la encontrada en la población general, aunque con características particulares como mayor duración del sueño, menor actividad física, tasas de tabaquismo reducidas, mayor consumo regular de alcohol, menor obesidad y una elevada tasa superior a 25 de índice de masa corporal 4 . Además, se han identificado nueve factores de riesgo cardiovascular que son modificables: consumo de tabaco, sobrepeso, hipertensión arterial, perímetro abdominal, hiperlipidemia que abarca colesterol total, HDL y LDL, triglicéridos e hiperglucemia que presentan en un 94% las mujeres y un 90% los hombres 5 . ...
En 2019, la OMS reportó 17,9 millones de muertes por enfermedades cardiovasculares, siendo los infartos y accidentes cerebrovasculares los principales causantes. Los pilotos de helicóptero enfrentan riesgos similares a la población general, como tabaquismo, obesidad y estrés, que se agravan con la adaptación a la altitud. En Ecuador, el 15% de la población padece enfermedades isquémicas del corazón, y en los pilotos militares, estos factores contribuyen al riesgo cardiovascular.Esta investigación observacional, transversal, de campo, realizada entre octubre de 2019 y febrero de 2020 con 54 pilotos de helicóptero militares, evaluó su capacidad funcional mediante el Shuttle Walking Test (SWT). Los resultados mostraron que los pilotos presentaron un consumo de oxígeno submáximo promedio de 31,0 ml/kg/min, con una capacidad funcional media del 78%. Los pilotos de la región Sierra tuvieron mejor desempeño en el SWT, recorriendo hasta 947 metros más que los de la Costa. Se identificaron factores de riesgo cardiovascular, como el colesterol elevado y los triglicéridos, que influencian negativamente la capacidad funcional, además de otros factores como el sedentarismo y el consumo de alcohol. El 80% de los pilotos presentó un riesgo cardiovascular moderado. En conclusión, el control de los factores de riesgo cardiovascular, como el colesterol y los triglicéridos, podría mejorar la salud y el rendimiento físico de los pilotos, favoreciendo su desempeño en tareas de alta exigencia.
... This research consistently underscores the substantial impact of back pain on workforce productivity and individual welfare [6,7]. While existing literature within the aviation context explores physiological and psychological stressors associated with flying-such as prolonged sitting, vibration, and gravitational forces-a comprehensive understanding of the specific factors contributing to back pain among commercial airline pilots remains notably limited [8][9][10][11]. ...
Background
Musculoskeletal disorders, including back pain, pose a significant challenge to workforce health, particularly in professions characterized by prolonged periods of sedentary activities. This challenge is notably relevant in commercial airline piloting due to unique ergonomic issues. Despite extensive research on back pain in various occupational settings, an understanding of the specific factors contributing to back pain among commercial airline pilots in Saudi Arabia is still lacking.
Methods
This cross-sectional survey aimed to investigate the prevalence of back pain among Saudi Arabian commercial airline pilots. A structured questionnaire, developed through literature review and expert consultation, covered demographic information, occupational details, and back pain history. The survey was administered online to active pilots recruited through the Saudi Airlines Medical Services, with data collection spanning six weeks.
Results
Among 310 predominantly male participants (99.0%), a significant prevalence of back pain was identified, with 71.3% reporting lower back pain in the last 12 months. Factors associated with a decreased likelihood of low back pain included comfortable seat conditions (odds ratio [OR]: 0.3; 95% confidence interval [CI]: 0.2–0.7), a senior officer position (OR: 0.5, 95% CI: 0.3–0.8), and regular exercise (OR: 0.6, 95% CI: 0.3–1.0). Higher flying hours in the past year were associated with an increased prevalence of back pain (OR: 2.2, 95% CI: 1.2–4.1). The multivariable analysis revealed that a comfortable seat was the single independent factor most significantly associated with back pain (OR: 0.3; 95% CI: 0.1–0.7).
Conclusions
This study highlights a notable prevalence of back pain among Saudi Arabian commercial airline pilots, underscoring the need for targeted interventions. The critical role of seat comfort emphasizes the importance of ergonomic considerations. Findings contribute to the global discourse on pilot health, emphasizing the necessity for ongoing evaluation and potential revisions to existing guidelines.
Clinical trial number
Not applicable.
... pilots, which are associated with elevated psychological stress and fatigue [9][10][11]. ...
... Recent findings suggest there is a notable proportion of airline pilots experiencing depressive symptoms [17] and excessive fatigue [9]. Among the literature, there is heterogeneity in the prevalence of mental health risk factors among airline pilots. ...
... A recent systematic review reported a 21% (20.8−21.6 CI) prevalence of mild depression among airline pilots [9]. Further, a web-based survey reported a prevalence of 57% for meeting their threshold for mild depression [15], whereas another systematic review reported that the prevalence of depression ranged from 1.9% to 12.6% [8]. ...
Background
Lifestyle behaviors including physical activity, sleep, nutrition, smoking, and alcohol consumption are independently associated with health, yet the relationship between these behaviors and mental health has not been explored among airline pilots. The aim of this study was to measure the association between health behaviors and mental health.
Methods
A cross‐sectional study was conducted among 502 airline pilots. The primary outcome measure was the mental component score (MCS), derived from the Short Form Health Survey 12v2. We collected information regarding age, sex, ethnicity, height, body mass, alcohol consumption, tobacco smoking status, moderate‐to‐vigorous physical activity (MVPA), fruit and vegetable intake, and sleep duration.
Results
After controlling for demographic and anthropometric parameters, MVPA, fruit and vegetable intake, and sleep duration were positively correlated with MCS (p ≤ 0.001), and alcohol consumption and tobacco smoking were negatively correlated with MCS (p ≤ 0.001). Multiple linear regression analyses revealed alcohol consumption was the strongest predictor of MCS (β = −0.308, p ≤ 0.001), followed by smoking (β = −0.236, p ≤ 0.001), MVPA (β = 0.233, p ≤ 0.001), sleep (β = 0.148, p ≤ 0.001), and fruit and vegetable intake (β = 0.097, p = 0.003).
Conclusion
The results suggest that greater physical activity, sleep duration, and fruit and vegetable intake are associated with better mental health. Meanwhile, excessive alcohol consumption and tobacco smoking undermine mental health status.
... Other age groups explored across the lifespan were young children (0-5 years) [29,31,60], college/university students (ages ∼ 18-25 years) [61], and older adults (mean age ≥ 60 years) [62,63]. Populations were also defined by nationality, location, and occupation, including: immigrant children [54], children and adolescents from Arabic countries [64], and airline pilots [65]. Population definitions were rarely confined to health or disease status, such as only including healthy populations [32,60,62,66], or individuals with type 1 diabetes [55]. ...
... Finally, all reviews assessed physical activity, and most reviews assessed all three behaviors (physical activity, sedentary behavior or screen-time, and sleep, 26/32). Thirty reviews assessed sedentary behavior, of which three specifically did not assess screen-time [33,65,66], nine reviews explicitly allowed screen-time as either a sedentary behavior indicator or separate behavior [19,21,51,52,55,56,59,60,69], and the remaining 18 reviews did not clearly state if screen-time would be considered in their review (See Supplemental Table 5). ...
... These similarities are not without caution; the three meta-analyses pooled estimates revealed high heterogeneity amongst their individual studies (i 2 > 95) [51,60,68]. In addition to children, one systematic review and one pooled analysis assessed prevalence of 24-hour movement behaviors in adults, including in airline pilots and UK adults before and during the COVID-19 pandemic [65,67]. These reviews used different metrics for insufficient activity (i.e., not meeting physical activity guidelines), which resulted in ranges of 51. ...
Background: Physical activity, sedentary behavior, and sleep, collectively known as the 24-hour movement behaviors, demonstrate individual and joint benefits on physical and mental health. Examination of these behaviors has expanded beyond guideline adherence to reviews of isotemporal substitution models (ISM) and compositional data analysis (CoDA). This umbrella review sought to review existing systematic reviews to 1) characterize the breadth and scope, 2) examine prevalence estimates for 24-hour movement guideline adherence, and 3) examine the relationship between these behaviors with health outcomes based on various approaches.
Methods: Eight databases and multiple supplementary strategies were used to identify systematic reviews, meta-analyses and pooled analyses that included two or more of the three 24-hour movement behaviors and a multi-behavior assessment approach. Overall review characteristics, movement behavior definitions, approaches, and health outcomes assessed were extracted, and methodological quality was assessed using the AMSTAR2 tool. Review characteristics (Aim 1), guideline prevalence estimates (Aim 2), and associations with health outcomes (Aim 3) were examined.
Findings: Thirty-two reviews (20 systematic reviews, 10 meta-analyses, and 2 pooled analyses) were included. Reviews captured the entire lifespan, global regions, and several physical and mental health outcomes. Individual and total guideline adherence waned from preschool to adolescence, but reviews reported similar prevalence estimates and ranges (i.e., within 10%). Common approaches included ISM and CoDA, evaluating 24-hour movement behavior’s interactive associations with health outcomes, guideline adherence, and profile-based analysis. Despite heterogeneous approaches, reviews found consistent evidence for beneficial associations between meeting all three guidelines and high amount of physical activity on physical and mental health outcomes, but varied assessment of sedentary behavior or sleep. Most reviews were rated as low or critically low quality.
Conclusions: The breadth and scope of current reviews on 24-hour movement behaviors was wide and varied in this umbrella review, including all ages and across the globe. Prevalence estimates among populations beyond children need to be synthesized. Amongst the variety of definitions and approaches, reviews found benefit from achieving healthy amounts of all three behaviors. Longitudinal multi-behavior original research studies with rigorous assessment of sleep and sedentary behavior may help improve future systematic reviews of these various approaches.
... The demanding nature of the profession, irregular work schedules, and exposure to various stressors such as altitude changes, jet lag, and long working hours can take a toll on pilots' cardiovascular health [6]. Additionally, the sedentary nature of the job, limited opportunities for regular exercise, and disrupted sleep patterns can contribute to the development of risk factors for SCD, such as obesity, hypertension, and diabetes [7]. ...
... The identification of biomarkers, such as troponin, NT-proBNP, and hs-CRP, as potential predictors of SCD risk in pilots is a promising development, [7,18,19]. These biomarkers could be used to identify pilots at increased risk of SCD and guide targeted interventions to reduce their risk. ...
... The effectiveness of preventive measures, such as regular cardiovascular risk assessment and lifestyle modifications, in reducing the risk of SCD in pilots highlights the importance of a comprehensive approach to SCD prevention [7,16,17]. ...
Background: Sudden cardiac death (SCD) remains a significant threat to pilots and is a leading cause of death worldwide, jeopardizing flight safety and causing devastating consequences. This review examines trends in SCD among pilots from a global perspective, analyzing evidence from 2011 to 2023, with a focus on its growing impact as a global crisis and recent findings pointing to a potential rise in incidence, particularly after 2019. Objectives: To analyze the prevalence, risk factors and prevention strategies for SCD in pilots, particularly post-COVID-19. Methods: The PRISMA guidelines for systematic meta-analysis was used, a search of peer-reviewed literature for international aviation databases, and pilot associations was conducted to identify relevant data. The analysis focused on trends in SCD prevalence, risk factors, prevention strategies, and recent findings, including the potential impact of COVID-19, the role of vaccination, and important biomarkers to screen for predisposition. Eligibility criteria included studies reporting SCD incidence, risk factors, or prevention strategies in pilots. Data were extracted, and meta-analyses conducted. Results: Recent studies suggest a potential increase in SCD incidence among pilots following the COVID-19 pandemic. Cardiovascular complications, increased stress, disruptions in healthcare, and changes in lifestyle may contribute to this potential rise. Identified risk factors include age, male gender, and cardiovascular comorbidities. Biomarkers such as troponin, N-terminal pro-B-type natriuretic peptide (NT-proBNP), and high-sensitivity C-reactive protein (hs-CRP) have been identified as potential indicators of increased SCD risk in pilots. Preventive measures include regular cardiovascular assessments and lifestyle modifications. Conclusion: SCD remains a significant and rising threat to pilots, posing a global crisis that requires immediate attention. Through a comprehensive approach that includes risk assessment, preventive measures, emergency response, and preventive protocols, the aviation industry can mitigate this risk and safeguard the lives of pilots and passengers. This review also suggests standardized examination protocol for pilots includes regular cardiovascular risk assessment, biomarker screening, monitoring of COVID-19 and vaccination status, lifestyle modifications, and a standardized reporting system. The adoption of a standardized protocol by aviation regulatory bodies and airlines worldwide is crucial to address the growing threat of SCD among pilots and ensure the highest standards of aviation safety. Research Article
... For instance, Alaminos-Torres et al. [5] reported that 53.6% of 304 Spanish male pilots were overweight, with 6.4% being obese, and significant proportions presenting with high relative adiposity, abdominal obesity, hypertension, hypercholesterolemia, and hyperglycemia. Wilson et al.'s systematic review also revealed a substantial prevalence (>50%) of overweight and obesity, insufficient physical activity, elevated fatigue, and regular alcohol intake among pilots [6]. We have recently reported a higher prevalence of previous infections with herpes simplex virus 1 and Helicobacter pylori in APs compared to office workers, which may be associated with the prevalence of specific non-communicable diseases, including CVD, in this professional group [7]. ...
... The prevalence of both overweight and poor sleep quality in our sample of commercial pilots is largely consistent with previous literature. A study involving 1198 Brazilian commercial APs found that 53.7% were overweight [17], and a systematic review reported a substantial occurrence of over 50% for overweight and obesity in this occupational group [6]. Poor sleep quality is also highly prevalent among APs. ...
Background
Cardiovascular disease is a leading cause of premature career termination in commercial airline pilots (APs). In this cross-sectional study, we sought to investigate the relationship between intima-media thickness (IMT), a marker of subclinical atherosclerosis, and cardiovascular risk factors in APs, focusing on overweight status and sleep quality.
Methods
A total of 140 male APs were categorized into four groups based on body mass index (BMI) and Pittsburgh Sleep Quality Index (PSQI) score: overweight poor sleepers (OW-PS), overweight good sleepers (OW-GS), normal weight poor sleepers (NW-PS), and normal weight good sleepers (NW-GS). IMT was quantified in the common carotid artery (CCA) and carotid bulb using ultrasound, yielding a composite IMT (IMTcom) measure. Common cardiovascular risk factors were assessed in all participants.
Results
The prevalence of overweight and poor sleep quality was 43.6% and 32.9%, respectively. The OW-PS group had significantly higher age, heart rate, total cholesterol, and low-density lipoprotein (LDL) cholesterol compared to other groups (p<0.05). Overweight pilots, regardless of sleep quality, had increased IMTcom compared to normal-weight pilots (p<0.001). Age and LDL cholesterol were independent predictors of IMTcom in the OW-PS and OW-GS groups (p<0.05).
Conclusions
Overweight status, irrespective of sleep quality, is associated with increased IMT in APs, suggesting a higher burden of subclinical atherosclerosis. Interventions focused on reducing LDL cholesterol levels and managing age-related cardiovascular risk factors could be advantageous in mitigating the risk of atherosclerotic vascular disease in overweight pilots.
... Sleep problems are common among pilots; for example, a previous survey found 24.6% of shorthaul and 23.5% of long-haul pilots reported major sleep problems 8 nights a month (3). Furthermore, previous studies found that pilots' health problems were mainly in the cervical, shoulder, and lumbar spine, such as cervical spondylosis, periarthritis of the shoulder, reflex shoulder, arm and hand pain, swelling and numbness, back and leg pain, lumbar disc herniation, and lumbar muscle strain (10,(25)(26)(27)(28). These factors were also reported in our interviews. ...
Introduction
Physical and mental health problems among pilots affect their working state and impact flight safety. Although pilots’ physical and mental health problems have become increasingly prominent, their health has not been taken seriously. This study aimed to clarify challenges and support needs related to psychological and physical health among pilots to inform development of a more scientific and comprehensive physical and mental health system for civil aviation pilots.
Methods
This qualitative study recruited pilots from nine civil aviation companies. Focus group interviews via an online conference platform were conducted in August 2022. Colaizzi analysis was used to derive themes from the data and explore pilots’ experiences, challenges, and support needs.
Results
The main sub-themes capturing pilots’ psychological and physical health challenges were: (1) imbalance between family life and work; (2) pressure from assessment and physical examination eligibility requirements; (3) pressure from worries about being infected with COVID-19; (4) nutrition deficiency during working hours; (5) changes in eating habits because of the COVID-19 pandemic; (6) sleep deprivation; (7) occupational diseases; (8) lack of support from the company in coping with stress; (9) pilots’ yearly examination standards; (10) support with sports equipment; (11) respecting planned rest time; and (12) isolation periods.
Discussion
The interviewed pilots experienced major psychological pressure from various sources, and their physical health condition was concerning. We offer several suggestions that could be addressed to improve pilots’ physical and mental health. However, more research is needed to compare standard health measures for pilots around the world in order to improve their physical and mental health and contribute to overall aviation safety.
... Inadequate sleep in the general population confers a higher risk of adverse cardiovascular outcomes, irrespective of traditional risk factors [6,7]. Given the high susceptibility of APs to sleep disturbances, it is unsurprising that this professional group has a reported increased risk of cardiometabolic diseases [8]. However, the exact pathophysiological mechanisms linking disrupted sleep and poor cardiovascular health in APs remain unclear. ...
Background
Insomnia and poor sleep are leading modifiable risk factors for cardiovascular disease. Given the high susceptibility of airline pilots (APs) to sleep disturbances, we sought to investigate the hypothesis that poor sleep in this professional group correlates with alterations in plasma biochemical markers that would reflect critical aspects in the pathophysiology of cardiometabolic disorders.
Methods
In this preliminary cross-sectional study, we examined the relation of poor sleep to fourteen plasma biomarkers reflecting multiple cardiometabolic pathways in a convenience sample of 117 male APs. The Pittsburgh Sleep Quality Index (PSQI) was used to categorize the participants into good sleepers (n = 70, 59.8%; PSQI scores from 0 to 4) and poor sleepers (n = 47, 40.2%; PSQI scores of 5 or higher). The concentrations of biomarkers were compared between the two groups using both univariable and multivariable analyses.
Results
Compared to good sleepers, APs identified as poor sleepers exhibited significantly different levels of four plasma cardiometabolic biochemical markers in univariable analysis. However, in multivariable-adjusted analysis, only three biomarkers, adiponectin, fibroblast growth factor (FGF)-21, and growth differentiation factor (GDF)-15, remained independently associated with poor sleep.
Conclusion
Poor sleep quality in APs correlates with lower plasma concentrations of adiponectin and elevated levels of FGF-21 and GDF-15. Further longitudinal studies are required to elucidate the role of these biomarkers in the link between sleep disturbances and cardiometabolic risk in this professional group.
... across different time zones, often disrupts their natural body rhythms. In addition, pilots may suffer from fatigue, exposure to cosmic radiation, irregular meal times, disrupted sleep patterns, and even symptoms of depression [6][7][8][9][10]. The sedentary nature of their job and the cabin environment, characterized by noise and vibrations [11], further compound these challenges. ...
... Previous studies have indicated a higher prevalence of malignant melanoma [12] among pilots compared to the general population. Additionally, this professional group exhibits a significant incidence of cardiometabolic risk factors [8] and functional gastrointestinal disorders (FGIDs) [13]. However, the potential impact of infectious pathogens on exacerbating these health issues remains uncertain due to the lack of seroepidemiological investigations specifically focused on common infectious pathogens among APs. ...
... This study is the first to compare the seropositivity rates of 17 common infectious agents in two distinct groups: APs, a professional category commonly affected by NCDs [6,8], and OWs. Additionally, it provides valuable insights into specific oncogenic pathogens. ...
Background
The variation in infection risk among individuals is thought to be partially influenced by occupational factors. This study aims to investigate the seropositivity rates of 17 common infectious agents in male airline pilots (APs), a professional group known to experience a high prevalence of cardiovascular and gastrointestinal diseases.
Methodology
In our study, we employed a case-control design with 100 male APs as cases, matched by age, sex, and tenure (i.e., at least five years of service) to 100 male office workers (OWs) who served as controls. We measured the IgG antibody levels to 17 pathogens using specific enzyme-linked immunosorbent assays, including herpes simplex virus 1, herpes simplex virus 2, varicella-zoster virus, Epstein-Barr virus, cytomegalovirus, human herpesvirus 6, human herpesvirus 7, Kaposi’s sarcoma-associated herpesvirus, Toxoplasma gondii, human T-lymphotropic virus 1, BK virus, John Cunningham virus, Merkel cell polyomavirus, human papillomavirus 16, human papillomavirus 18, Chlamydia trachomatis, and Helicobacter pylori. The determination of seropositivity cutoffs for each pathogen was made in accordance with the guidelines provided by the respective kit manufacturers.
Results
The seropositivity rates for the 17 pathogens ranged from 1% for human T-lymphotropic virus 1 to 94% for varicella-zoster virus and were similar in both professions, except for herpes simplex virus 1 and Helicobacter pylori, which were more prevalent in APs.
Conclusions
Our findings suggest a higher prevalence of previous infections with herpes simplex virus 1 and Helicobacter pylori in APs compared to OWs. These infections may be associated with the prevalence of specific non-communicable diseases in this professional group. However, additional longitudinal studies are needed to substantiate this hypothesis.
