Sleep Disorders Among Commercial Airline Pilots

BACKGROUND: Over the next 20 yr, international market expansion will necessitate the production of new commercial airplanes and the recruitment of additional crewmembers and technicians. Research has proven that fatigue and lack of sleep are risk factors for impaired cognitive performance and human error. Pilots frequently report fatigue to their employers, which may be related to sleep disturbance. Airline pilots, in particular, often experience circadian desynchronization and other types of sleep disorders. Shift workers have been observed to be at higher risk of fatigue that affects their performance and alertness. In Saudi Arabia, sleep disorders among airline pilots are understudied and underreported. The primary objective of this study was to screen for and determine the risk of sleep disorders, fatigue, and depression among pilots.METHODS: A cross-sectional epidemiological study with national commercial pilots was conducted from March 2019 to March 2020 using validated questionnaires to screen for the risk of sleep disorders, fatigue, and depression.RESULTS: In total, 344 pilots participated in the study. Half the sample was at risk for insomnia and fatigue. Older and more experienced pilots were less likely to suffer impaired sleep quality, insomnia, sleepiness, fatigue, and depression. In total, 59 (17.2%) pilots were at high risk for sleep apnea.CONCLUSION: The current study found that pilots were at risk of developing sleep disorders. A more robust and objective assessment is warranted for screening.Alzehairi A, Alhejaili F, Wali S, Al Qassas I, Balkhyour M, Pandi-Perumal SR. Sleep disorders among commercial airline pilots. Aerosp Med Hum Perform. 2021; 92(12):937–944.

An Improved Integral Column Generation Algorithm Using Machine Learning for Aircrew Pairing

The crew-pairing problem (CPP) is solved in the first step of the crew-scheduling process. It consists of creating a set of pairings (sequence of flights, connections, and rests forming one or multiple days of work for an anonymous crew member) that covers a given set of flights at minimum cost. Those pairings are assigned to crew members in a subsequent crew-rostering step. In this paper, we propose a new integral column-generation algorithm for the CPP, called improved integral column generation with prediction ([Formula: see text]), which leaps from one integer solution to another until a near-optimal solution is found. Our algorithm improves on previous integral column-generation algorithms by introducing a set of reduced subproblems. Those subproblems only contain flight connections that have a high probability of being selected in a near-optimal solution and are, therefore, solved faster. We predict flight-connection probabilities using a deep neural network trained in a supervised framework. We test [Formula: see text] on several real-life instances and show that it outperforms a state-of-the-art integral column-generation algorithm as well as a branch-and-price heuristic commonly used in commercial airline planning software, in terms of both solution costs and computing times. We highlight the contributions of the neural network to [Formula: see text].

McLeod Syndrome in a Commercial Airline Pilot

BACKGROUND: The following case report describes the first known case of McLeod Syndrome in a commercial airline pilot. The case describes a 56-yr-old experienced pilot who showed a slow and subtle decline in cognitive function and muscle control in the cockpit. On further examination, the pilots erratic behavior and movement along with lab abnormalities pointed toward McLeod Syndrome. CASE REPORT: The pilot was recommended for evaluation by his fellow crewmembers due to his fidgetiness, clumsiness, and lack of focus during critical portions of flight. The pilot reported having a long-standing history of elevated CK levels. Further lab investigations revealed acanthocytes on blood smear while neurological evaluation detected chorea. The combination of clinical and laboratory features along with genetic test results were all consistent with McLeod Syndrome. DISCUSSION: The case highlights how subtle behavioral and motor coordination changes can be a warning sign for an underlying progressive neurological disorder that requires further workup and referral. Haas C, Levin D, Milone M, Vardiman-Ditmanson J, Mathers C. McLeod syndrome in a commercial airline pilot. Aerosp Med Hum Perform. 2021; 92(9):734737.

292 Rest Schemes and Inflight Sleep Duration on Long Range and Ultra-Long Range Commercial Airline Routes

Introduction Pilots flying long range (LR; 8-16 hour) and ultra-long range (ULR; 16+ hour on 10% of trips) commercial airline routes use a variety of work/rest schedules during flights, resulting in a wide distribution of total inflight sleep time (TIFS) amounts. Since sleep is a strong predictor of performance, it is important to quantify TIFS and determine rest scheme patterns that optimize sleep opportunity and subsequent alertness and performance. Here we report rest schemes for pilots on LR and ULR routes and longer TIFS values than previously reported. These rest schemes can serve as templates to increase TIFS and improve pilot performance, particularly on ULR routes. Methods 427 commercial airline pilots provided data for this sub-study that was part of a larger study on Fatigue Risk Management System (FRMS) routes. Inflight sleep timing and duration were measured on 3 LR and 5 ULR routes. Inflight sleep times were self-reported in a sleep/work logbook and verified using actigraphy. Results Most outbound and inbound landing crews took one break during the second half of the flight (average LR TIFS=4.0 hr; average ULR TIFS=4.9 hr), while most outbound and inbound relief crews consequently took one break during the first half of the flight (average LR TIFS=3.5 hr; average ULR TIFS=4.5 hr). However, three of the five ULR routes used more complex split rest schemes for landing and relief crews, primarily on outbound flights (average TIFS=5.0 hr). Across all routes and both crews, the maximum average TIFS reached ~6 hours. Conclusion Our results indicate that pilots on average are sleeping inflight more than previous studies demonstrated. Additionally, we found that crews on some ULR flights used more complicated rest schemes, but still generally preferred 2 or 3 breaks. These findings have implications for airline procedures and aviation policies by showing that pilots may be sleeping longer than originally expected on LR and ULR flights. Recommending rest schemes that allow for the greatest inflight sleep opportunity may provide the best chance for inflight recuperation, especially before the Top of Descent critical phase of flight. Support (if any) United Airlines

Medical Events on Board Aircraft: Reducing Confusion and Misinterpretation in the Scientific Literature

INTRODUCTION: A topic in aviation medicine that attracts much attention from the scientific community as well as from the media concerns medical incidents on board commercial airline flights. It was noticed that many papers on the subject were written by authors whose specialization was outside that of aviation medicine and that they sometimes made basic errors concerning the application of scientific principles of the subject. A review was undertaken to determine if there were any patterns to the observed errors and, if so, to consider whether recommendations might be provided that could reduce their frequency.METHOD: A literature search was undertaken of MEDLINE using PubMed for English-only articles published between January 1, 1974, and February 1, 2019, employing the following search terms: air emergency, air emergencies, air passenger, air travel, aircraft, airline, aviation, commercial air, flight, and fitness to fly. In addition, other relevant papers held in the personal collection of the authors were reviewed.RESULTS: Many cases of misinterpretation or misunderstanding of aviation medicine were found, which could be classified into eight main categories: references; cabin altitude; pressure/volume relationship; other technical aspects of aircraft operations; regulations; medical events; in-flight deaths; and automated external defibrillator.CONCLUSION: Papers were identified as having questionable statements of fact or of emphasis. Such instances often appeared to result from authors being unfamiliar with the subject of aviation medicine and/or the commercial aviation environment. Simple steps could be taken by authors to reduce the future rate of such instances and recommendations are provided.Thibeault C, Evans AD. Medical events on board aircraft: reducing confusion and misinterpretation in the scientific literature. Aerosp Med Hum Perform. 2021; 92(4):265273.

A Qualitative Study Exploring Well-Being and the Potential Impact of Work-Related Stress Among Commercial Airline Pilots

Increasing evidence suggests that commercial airline pilots can experience physical, mental, and social health difficulties. Qualitative interviews with commercial airline pilots explored the relationship between work-related stress and well-being. Participatory workshops involving pilots were conducted. The methodology of this action-based research involved a blend of person-centered design approaches; specifically, “stakeholder evaluation” and “participatory design.” The findings further support the hypothesis that pilot well-being is being negatively affected by the nature of their work. The biopsychosocial model of the lived experience of a pilot, as presented in this paper, provides a useful structure to examine pilot well-being, and to identify and scope potential coping strategies to self-manage health and well-being issues associated with the job of being a pilot.

A Model for Reducing the Cost of Refueling in a Flight Route Problem With Discounted Fuel Prices

Acquiring and purchasing fuel represents a significant part of operating and managing expenses for an airline, so commercial airline companies are implementing strategies for minimizing costs of fuel for their flight routes. A nonlinear mathematical model for the airline refueling problem is presented to minimize the total cost in a flight route problem. The model is enhanced to include possible discounts in fuel prices, which are performed by adding dummy variables and some restrictive constraints, or by fitting a suitable function that relates prices to the purchased amounts. The obtained fuel plan explains exactly the amounts of fuel to be purchased from each airport in the route. A case study is introduced for a certain flight rotation in a domestic US air aviation company. The mathematical model including stepped discounted fuel prices is formulated, and the results show that introducing the discounted fuel prices dramatically change the strategy of fuel purchase amounts in the aircraft flight problem.