Effects Of Alternating East-West Rotations On Aircrew Fatigue

Michel Klerlein (M.D.), Alain Gisquet (M.D.)

Air France Occupational Health Services

Authors have not received non-

governmental ot non-academic support

or funding for the material which we

intend to present

Both authors are employees of Air France.

Their opinion does not necesseraly reflect

the views of Air France

ICASM 2018 - Bangkok 2/12

Statement

➢ During systematic

occ.med. follow up

➢ Criteria:

− At least 4 rotations during last 6

weeks

− Exclusion return to work after

sickness or on request exams

➢ Inclusion of 296 cabin

crew, 61 captain, 96 F/O

➢ Main outcome: Samn-

Perelli fatigue scale

ICASM 2018 - Bangkok 3/10

Questionnaire

Cabin Crew

n = 295

Captain

n = 61

First Officer

n = 96

Age 44.1 55.1 44.7

Commuting (mn/d) 118.0 89.6 109.3

Epworth Score 10.8 9.7 11.2

% Epworth > 10 51.2 % 42.6 % 54.2 %

Sleep quality 2.62 2.37 2.50

Sleep problems 50.0 % 41.0 % 41.7 %

On sleeping pill 17.6 % 11.5 % 20.8 %

ICASM 2018 - Bangkok 4/12

Fatigue, Sleepiness, Sleep Quality : frequent complaints

Overall differences are not statistically significant

(Except for internal comparison in pilots)

p = 0.027

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The Air France network : layovers mentionned in the questionnaire

Alternance are defined by a difference of minimum 3 h combined to

an opposite jetlag between 2 consecutive layovers

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East-West alternances are common

43210

250

200

1 50

1 00

50

0

Number of east-west switches last 6 weeks

Num

ber

of A

ircr

ew

Distribution of aircrew by the count of east-west switches last 6 weeks

ICASM 2018 - Bangkok 7/12

Small relationship between SP score and count of E/W switches

σ 𝒋𝒆𝒕𝒍𝒂𝒈 × (𝟏 + 𝑬𝑾𝒔𝒘𝒊𝒕𝒄𝒉𝒆𝒔) = GKi

ICASM 2018 - Bangkok 8/12

Combining jet lag and E/W alternance : the GKi index

=

ICASM 2018 - Bangkok 9/12

GKi properties

1er quartile 21 .000

Médiane 35.500

3e quartile 59.250

Maximum 180.000

42.21 1 48.201

30.000 40.000

30.203 34.449

A au carré 17.75

Valeur de P < 0.005

Moyenne 45.206

EcTyp 32.185

Variance 1035.902

Asymétrie 1 .24276

Aplatissement 1 .16455

N 446

Minimum 0.000

Test de normalité d'Anderson-Darling

Intervalle de confiance = 95 % pour la moyenne

Intervalle de confiance = 95 % pour la médiane

Intervalle de confiance = 95 % pour l'écart type

1 801 501 209060300

Médiane

Moyenne

5045403530

Intervalles de confiance = 95 %

Rapport récapitulatif pour ASTREINTE

ICASM 2018 - Bangkok 10/12

No univariate relationshipbetween GKi and Fatigue …

02

46

8

Sam

n-P

ere

lli F

atigue S

cale

0 50 100 150 200GK index

R-squared=0.13 %

P-value: 0.5194

Samn-Perelli score by the GK index

➢ No

relationship

with the strain

index

➢ But some

link with sleep

quality,

somnolence

and being

female

ICASM 2018 - Bangkok 11/12

…Neither in multivariate analysis

Age

Seniority

Commuting

Epworth

Sleep qual.

Wake duration

GK index

Gender=2

0 .2 .4 .6 .8

R-square = 37.5 %

(dependant variable : Samn-Perelli score when filling the questionnaire)

Coefficient plot of a multilinear regression

➢No link in multivariate analysis between

fatigue, intensity of jet lag and E/W alternance

during the last 6 weeks

➢ According to crew, airlines should minimize

E/W alternance at 1 per month

➢Despite these results, the occupational

medecine department supports this

recommandation on the basis of

− Bad baseline sleepiness and fatigue scores

− Fear of enhanced consumption of sleeping medications

ICASM 2018 - Bangkok 12/12

In summary

ICASM 2018 - Bangkok

Questions ?