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Airline cabin crew operate in dynamic work environments that are continuously changing, from unpredictable shift work hours to travelling through multiple time zones. These likely impact cabin crews’ overall health and may affect their performance on safety-related tasks. Research on this population has been limited; therefore, the aim was to summarise the relevant literature regarding fatigue, sleepiness and mental health of cabin crew. This review followed the PRISMA-ScR guidelines and conducted a systematic search utilising five databases. The initial search identified 1223 studies, and through vigorous screening processes, 27 studies were selected for this review. Over half of the selected studies focused on international or long-haul flights, and a large proportion of the sample participants were women. Findings suggested a high prevalence of fatigue and sleepiness as well as unsatisfactory sleep quality with elevated susceptibility to sleep disorders. Factors identified with health outcomes were associated with flight operations (e.g., rosters) and individual differences (e.g., age and coping strategies). Regarding mental health, cabin crews are potentially at a greater risk for depression and anxiety compared to the general public. This review draws attention to the importance of using a standardised approach, such as validated measures for fair and consistent inferences.

Sleep has been found to play a key role in fear conditioning, extinction learning and extinction recall, the paradigm modelling the development, maintenance and treatment of anxiety disorders including post-traumatic stress disorder (PTSD), which are disorders commonly associated with sleep disturbances. Previous studies examining associations between sleep and fear or extinction processes predominately focused on objectively measured sleep architecture using polysomnography, and the majority of the research has been done in healthy populations. To date, little research has focused on subjective sleep measures and particularly in clinical populations including PTSD, which often experience subjectively poor sleep. Here we investigated whether subjective sleep disturbance, sleep onset latency, wake after sleep onset or sleep efficiency were related to fear conditioning, extinction learning or extinction recall in a large sample of individuals with a range of PTSD symptom severity and healthy controls. Overall, we did not find that sleep was associated with fear conditioning extinction learning or extinction recall. However, emerging evidence highlighting the critical role of sex in PTSD risk, fear conditioning processes, as well as in the sleep-fear conditioning relationship. Exploratory analyses examining sex-specific effects found that shorter sleep onset latency and greater sleep efficiency during the previous night were associated with improved extinction recall in women with higher PTSD symptom severity. This suggests that less time falling asleep and longer time asleep while in bed may be protective against the commonly observed impaired extinction recall in PTSD in highly symptomatic women, but is not relevant in men.