SLEEP BREATHING PHYSIOLOGY AND DISORDERS • ORIGINAL ARTICLE Assessment of sleepiness, fatigue, and depression among Gulf Cooperation Council commercial airline pilots Tareq M. Aljurf 1 & Awad H. Olaish 1 & Ahmed S. BaHammam 1 Received: 10 May 2017 /Revised: 24 July 2017 /Accepted: 28 August 2017 # Springer International Publishing AG 2017 Abstract Purpose No studies have assessed the prevalence of fatigue, depression, sleepiness, and the risk of obstructive sleep apnea (OSA) among commercial airlines pilots in the Gulf Cooperation Council (GCC). Methods This was a quantitative crosssectional study con- ducted among pilots who were on active duty and had flown during the past 6 months for one of three commercial airline companies. We included participants with age between 20 and 65 years. Data were collected using a predesigned electronic questionnaire composed of questions related to demographic information in addition to the Fatigue Severity Scale (FSS), the Berlin Questionnaire, the Epworth Sleepiness Scale (ESS), and the Hospital Anxiety and Depression Scale (HADS). Results The study included 328 pilots with a mean age ± stan- dard deviation of 41.4 ± 9.7 years. Overall, 224 (68.3%) pilots had an FSS score ≥ 36 indicating severe fatigue and 221 (67.4%) reported making mistakes in the cockpit because of fatigue. One hundred and twelve (34.1%) pilots had an ESS score ≥ 10 indicating excessive daytime sleepiness and 148 (45.1%) reported falling asleep at the controls at least once without previously agreeing with their colleagues. One hun- dred and thirteen (34.5%) pilots had an abnormal HADS de- pression score (≥ 8), and 96 (29.3%) pilots were at high risk for OSA requiring further assessment. Conclusion Fatigue, sleepiness, risk of OSA, and depression are prevalent among GCC commercial airline pilots. Regular assessment by aviation authorities is needed to detect and treat these medical problems. Keywords Sleepiness . Depression . Anxiety . Sleep apnea . Pilots . Airlines Introduction With its current explosive growth, the Middle East (ME) trav- el market is the fastest growing worldwide. According to the International Air Transport Association (IATA), in 2014 alone, the region’s aviation industry reported an annual growth of 11%, which is the highest in the world [1]. Other reports show that such growth is forecasted to continue at a similar rate in the upcoming decades as a recent financial report released by Alpen Capital predicted that between 2012 and 2032, the traffic growth in the ME will most prob- ably Boutperform that across all other regions^ [2]. It is also expected that the area will receive over 2610 new aircraft over the same time period. Six countries, in particular, the Gulf Cooperation Council (GCC) countries (Saudi Arabia, United Arab Emirates, Qatar, Kuwait, Bahrain, and Oman), make up 77% of the total ME fleet size and have shown more striking growth numbers [2]. Reports in 2013 have shown a 5-year compounded annual growth rate of 15.9% in terms of passenger-kilometers on scheduled services, which is more than double the global rate of 6.0% [3]. However, with such a rise in demand, there is a concomi- tant shortage of skilled employees among GCC airline com- panies [2]. Furthermore, these companies are facing post 9/11 security expenses combined with increasingly competitive fare prices following the rise of low cost airlines. In order to overcome these challenges, airline companies have been * Ahmed S. BaHammam ashammam2@gmail.com 1 The University Sleep Disorders Center, Department of Medicine, College of Medicine and National Plan for Science and Technology, King Saud University, Box 225503, Riyadh 11324, Saudi Arabia Sleep Breath DOI 10.1007/s11325-017-1565-7