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* Effects of moderate alcohol consumption and hypobaric hypoxia: implications
for passengers’ sleep, oxygen saturation and heart rate on long-haul flights
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Sleep
Original research
Effects of moderate alcohol consumption and hypobaric hypoxia: implications for
passengers’ sleep, oxygen saturation and heart rate on long-haul flights
1. Rabea Antonia Trammer1,
2. Daniel Rooney1,
3. Sibylle Benderoth1,
4. Martin Wittkowski1,
5. Juergen Wenzel1,
6. http://orcid.org/0000-0003-0336-6705Eva-Maria Elmenhorst1,2
1. 1 Department of Sleep and Human Factors Research, Institute of Aerospace
Medicine, German Aerospace Center, Cologne, Germany
2. 2 Institute of Occupational, Social and Environmental Medicine, Medical
Faculty, RWTH Aachen University, Aachen, Germany
1. Correspondence to PD Dr. Eva-Maria Elmenhorst, Department of Sleep and Human
Factors Research, Institute of Aerospace Medicine, German Aerospace Center,
Cologne, Nordrhein-Westfalen, Germany; eva-maria.elmenhorst@dlr.de
ABSTRACT
Background Passengers on long-haul flights frequently consume alcohol. Inflight
sleep exacerbates the fall in blood oxygen saturation (SpO2) caused by the
decreased oxygen partial pressure in the cabin. We investigated the combined
influence of alcohol and hypobaric hypoxia on sleep, SpO2 and heart rate.
Methods Two groups of healthy individuals spent either two nights with a 4-hour
sleep opportunity (00:00–04:00 hours) in the sleep laboratory (n=23; 53 m above
sea level) or in the altitude chamber (n=17; 753 hPa corresponding to 2438 m
above sea level, hypobaric condition). Participants consumed alcohol before one
of the nights (mean±SE blood alcohol concentration 0.043±0.003%). The order of
the nights was counterbalanced. Two 8-hour recovery nights (23:00–07:00 hours)
were scheduled between conditions. Polysomnography, SpO2 and heart rate were
recorded.
Results The combined exposure to alcohol and hypobaric condition decreased SpO2
to a median (25th/75th percentile) of 85.32% (82.86/85.93) and increased heart
rate to a median (25th/75th percentile) of 87.73 bpm (85.89/93.86) during sleep
compared with 88.07% (86.50/88.49) and 72.90 bpm (70.90/78.17), respectively, in
the non-alcohol hypobaric condition, 94.97% (94.59/95.33) and 76.97 bpm
(65.17/79.52), respectively, in the alcohol condition and 95.88% (95.72/96.36)
and 63.74 bpm (55.55/70.98), respectively, in the non-alcohol condition of the
sleep laboratory group (all p<0.0001). Under the combined exposure SpO2 was
201.18 min (188.08/214.42) below the clinical hypoxia threshold of 90% SpO2
compared with 173.28 min (133.25/199.03) in the hypobaric condition and 0 min
(0/0) in both sleep laboratory conditions. Deep sleep (N3) was reduced to
46.50 min (39.00/57.00) under the combined exposure compared with both sleep
laboratory conditions (alcohol: 84.00 min (62.25/92.75); non-alcohol: 67.50 min
(58.50/87.75); both p<0.003).
Conclusions The combination of alcohol and inflight hypobaric hypoxia reduced
sleep quality, challenged the cardiovascular system and led to extended duration
of hypoxaemia (SpO2 <90%).
* Altitude
* Polysomnography
* Sleep
* Aviation
* Hypoxia
* Hypoxemia
DATA AVAILABILITY STATEMENT
Data are available upon reasonable request. Data will be made available by the
corresponding author upon reasonable request.
https://doi.org/10.1136/thorax-2023-220998
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* Altitude
* Polysomnography
* Sleep
* Aviation
* Hypoxia
* Hypoxemia
DATA AVAILABILITY STATEMENT
Data are available upon reasonable request. Data will be made available by the
corresponding author upon reasonable request.
View Full Text
FOOTNOTES
* Contributors RAT: Conceptualization, formal analysis, writing - original
draft, writing - review and editing. DR: Conceptualization, methodology,
investigation, writing - review and editing. SB: Conceptualization,
investigation, writing - review and editing. MW: Conceptualization,
methodology, investigation, writing - review and editing. JW:
Conceptualization, methodology, investigation, writing - review and editing.
E-ME: Conceptualization, methodology, investigation, writing - review and
editing, supervision, project administration, funding acquisition, guarantor.
* Funding DLR Aeronautics Program (institutional funding; grant number: not
applicable).
* Competing interests None declared.
* Provenance and peer review Not commissioned; externally peer reviewed.
* Supplemental material This content has been supplied by the author(s). It has
not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been
peer-reviewed. Any opinions or recommendations discussed are solely those of
the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and
responsibility arising from any reliance placed on the content. Where the
content includes any translated material, BMJ does not warrant the accuracy
and reliability of the translations (including but not limited to local
regulations, clinical guidelines, terminology, drug names and drug dosages),
and is not responsible for any error and/or omissions arising from
translation and adaptation or otherwise.
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* LINK DIFFERENT DEVICES 25 PARTNERS CAN USE THIS PURPOSE
* IDENTIFY DEVICES BASED ON INFORMATION TRANSMITTED AUTOMATICALLY 44 PARTNERS
CAN USE THIS PURPOSE
YOUR PRIVACY
We process your data to deliver content or advertisements and measure the
delivery of such content or advertisements to extract insights about our
website. We share this information with our partners on the basis of consent and
legitimate interest. You may exercise your right to consent or object to a
legitimate interest, based on a specific purpose below or at a partner level in
the link under each purpose. These choices will be signaled to our vendors
participating in the Transparency and Consent Framework.
Privacy and cookie policies
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STRICTLY NECESSARY COOKIES
Always Active
These cookies are necessary for the website to function and cannot be switched
off in our systems. They are usually only set in response to actions made by you
which amount to a request for services, such as setting your privacy
preferences, logging in or filling in forms. You can set your browser to
block or alert you about these cookies, but some parts of the site will not then
work. These cookies do not store any personally identifiable information.
Cookies Details
PERFORMANCE COOKIES
Performance Cookies
These cookies allow us to count visits and traffic sources so we can measure and
improve the performance of our site. They help us to know which pages are the
most and least popular and see how visitors move around the site. All
information these cookies collect is aggregated and therefore anonymous. If you
do not allow these cookies we will not know when you have visited our site, and
will not be able to monitor its performance.
Cookies Details
FUNCTIONAL COOKIES
Functional Cookies
These cookies enable the website to provide enhanced functionality and
personalisation. They may be set by us or by third party providers whose
services we have added to our pages. If you do not allow these cookies then
some or all of these services may not function properly.
Cookies Details
TARGETING COOKIES
Targeting Cookies
These cookies may be set through our site by our advertising partners. They may
be used by those companies to build a profile of your interests and show you
relevant adverts on other sites. They do not store directly personal
information, but are based on uniquely identifying your browser and internet
device. If you do not allow these cookies, you will experience less targeted
advertising.
Cookies Details
GOOGLE & IAB TCF 2 PURPOSES OF PROCESSING
Google & IAB TCF 2 Purposes of Processing
Allowing third-party ad tracking and third-party ad serving through Google and
other vendors to occur. Please see more information on Google Ads
https://policies.google.com/privacy?hl=en-US
Cookies Details
STORE AND/OR ACCESS INFORMATION ON A DEVICE 52 PARTNERS CAN USE THIS PURPOSE
Store and/or access information on a device
Cookies, device or similar online identifiers (e.g. login-based identifiers,
randomly assigned identifiers, network based identifiers) together with other
information (e.g. browser type and information, language, screen size, supported
technologies etc.) can be stored or read on your device to recognise it each
time it connects to an app or to a website, for one or several of the purposes
presented here.
List of IAB Vendors | View Illustrations
PERSONALISED ADVERTISING AND CONTENT, ADVERTISING AND CONTENT MEASUREMENT,
AUDIENCE RESEARCH AND SERVICES DEVELOPMENT 70 PARTNERS CAN USE THIS PURPOSE
Personalised advertising and content, advertising and content measurement,
audience research and services development
* USE LIMITED DATA TO SELECT ADVERTISING 50 PARTNERS CAN USE THIS PURPOSE
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Advertising presented to you on this service can be based on limited data,
such as the website or app you are using, your non-precise location, your
device type or which content you are (or have been) interacting with (for
example, to limit the number of times an ad is presented to you).
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Object to Legitimate Interests Remove Objection
* CREATE PROFILES FOR PERSONALISED ADVERTISING 37 PARTNERS CAN USE THIS PURPOSE
Switch Label
Information about your activity on this service (such as forms you submit,
content you look at) can be stored and combined with other information about
you (for example, information from your previous activity on this service and
other websites or apps) or similar users. This is then used to build or
improve a profile about you (that might include possible interests and
personal aspects). Your profile can be used (also later) to present
advertising that appears more relevant based on your possible interests by
this and other entities.
View Illustrations
* USE PROFILES TO SELECT PERSONALISED ADVERTISING 35 PARTNERS CAN USE THIS
PURPOSE
Switch Label
Advertising presented to you on this service can be based on your advertising
profiles, which can reflect your activity on this service or other websites
or apps (like the forms you submit, content you look at), possible interests
and personal aspects.
View Illustrations
* CREATE PROFILES TO PERSONALISE CONTENT 16 PARTNERS CAN USE THIS PURPOSE
Switch Label
Information about your activity on this service (for instance, forms you
submit, non-advertising content you look at) can be stored and combined with
other information about you (such as your previous activity on this service
or other websites or apps) or similar users. This is then used to build or
improve a profile about you (which might for example include possible
interests and personal aspects). Your profile can be used (also later) to
present content that appears more relevant based on your possible interests,
such as by adapting the order in which content is shown to you, so that it is
even easier for you to find content that matches your interests.
View Illustrations
* USE PROFILES TO SELECT PERSONALISED CONTENT 13 PARTNERS CAN USE THIS PURPOSE
Switch Label
Content presented to you on this service can be based on your content
personalisation profiles, which can reflect your activity on this or other
services (for instance, the forms you submit, content you look at), possible
interests and personal aspects, such as by adapting the order in which
content is shown to you, so that it is even easier for you to find
(non-advertising) content that matches your interests.
View Illustrations
* MEASURE ADVERTISING PERFORMANCE 64 PARTNERS CAN USE THIS PURPOSE
Switch Label
Information regarding which advertising is presented to you and how you
interact with it can be used to determine how well an advert has worked for
you or other users and whether the goals of the advertising were reached. For
instance, whether you saw an ad, whether you clicked on it, whether it led
you to buy a product or visit a website, etc. This is very helpful to
understand the relevance of advertising campaigns.
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Object to Legitimate Interests Remove Objection
* MEASURE CONTENT PERFORMANCE 34 PARTNERS CAN USE THIS PURPOSE
Switch Label
Information regarding which content is presented to you and how you interact
with it can be used to determine whether the (non-advertising) content e.g.
reached its intended audience and matched your interests. For instance,
whether you read an article, watch a video, listen to a podcast or look at a
product description, how long you spent on this service and the web pages you
visit etc. This is very helpful to understand the relevance of
(non-advertising) content that is shown to you.
View Illustrations
Object to Legitimate Interests Remove Objection
* UNDERSTAND AUDIENCES THROUGH STATISTICS OR COMBINATIONS OF DATA FROM
DIFFERENT SOURCES 43 PARTNERS CAN USE THIS PURPOSE
Switch Label
Reports can be generated based on the combination of data sets (like user
profiles, statistics, market research, analytics data) regarding your
interactions and those of other users with advertising or (non-advertising)
content to identify common characteristics (for instance, to determine which
target audiences are more receptive to an ad campaign or to certain
contents).
View Illustrations
Object to Legitimate Interests Remove Objection
* DEVELOP AND IMPROVE SERVICES 44 PARTNERS CAN USE THIS PURPOSE
Switch Label
Information about your activity on this service, such as your interaction
with ads or content, can be very helpful to improve products and services and
to build new products and services based on user interactions, the type of
audience, etc. This specific purpose does not include the development or
improvement of user profiles and identifiers.
View Illustrations
Object to Legitimate Interests Remove Objection
List of IAB Vendors
USE PRECISE GEOLOCATION DATA 27 PARTNERS CAN USE THIS PURPOSE
Use precise geolocation data
With your acceptance, your precise location (within a radius of less than 500
metres) may be used in support of the purposes explained in this notice.
List of IAB Vendors
ENSURE SECURITY, PREVENT AND DETECT FRAUD, AND FIX ERRORS 44 PARTNERS CAN USE
THIS PURPOSE
Always Active
Your data can be used to monitor for and prevent unusual and possibly fraudulent
activity (for example, regarding advertising, ad clicks by bots), and ensure
systems and processes work properly and securely. It can also be used to correct
any problems you, the publisher or the advertiser may encounter in the delivery
of content and ads and in your interaction with them.
List of IAB Vendors | View Illustrations
DELIVER AND PRESENT ADVERTISING AND CONTENT 49 PARTNERS CAN USE THIS PURPOSE
Always Active
Certain information (like an IP address or device capabilities) is used to
ensure the technical compatibility of the content or advertising, and to
facilitate the transmission of the content or ad to your device.
List of IAB Vendors | View Illustrations
MATCH AND COMBINE DATA FROM OTHER DATA SOURCES 37 PARTNERS CAN USE THIS PURPOSE
Always Active
Information about your activity on this service may be matched and combined with
other information relating to you and originating from various sources (for
instance your activity on a separate online service, your use of a loyalty card
in-store, or your answers to a survey), in support of the purposes explained in
this notice.
List of IAB Vendors
LINK DIFFERENT DEVICES 25 PARTNERS CAN USE THIS PURPOSE
Always Active
In support of the purposes explained in this notice, your device might be
considered as likely linked to other devices that belong to you or your
household (for instance because you are logged in to the same service on both
your phone and your computer, or because you may use the same Internet
connection on both devices).
List of IAB Vendors
IDENTIFY DEVICES BASED ON INFORMATION TRANSMITTED AUTOMATICALLY 44 PARTNERS CAN
USE THIS PURPOSE
Always Active
Your device might be distinguished from other devices based on information it
automatically sends when accessing the Internet (for instance, the IP address of
your Internet connection or the type of browser you are using) in support of the
purposes exposed in this notice.
List of IAB Vendors
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