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Original Article
Volume 357:18-27 July 5, 2007 Number 1

Effect of Aircraft-Cabin Altitude on Passenger Discomfort
J. Michael Muhm, M.D., M.P.H., Paul B. Rock, D.O., Ph.D., Dianne L. McMullin, Ph.D., Stephen P. Jones, Ph.D., I.L. Lu, Ph.D., Kyle D. Eilers, David R. Space, and Aleksandra McMullen, M.S.

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Background Acute mountain sickness occurs in some unacclimatized persons who travel to terrestrial altitudes at which barometric pressures are the same as those in commercial aircraft during flight. Whether the effects are similar in air travelers is unknown.

Methods We conducted a prospective, single-blind, controlled hypobaric-chamber study of adult volunteers to determine the effect of barometric pressures equivalent to terrestrial altitudes of 650, 4000, 6000, 7000, and 8000 ft (198, 1219, 1829, 2134, and 2438 m, respectively) above sea level on arterial oxygen saturation and the occurrence of acute mountain sickness and discomfort as measured by responses to the Environmental Symptoms Questionnaire IV during a 20-hour simulated flight.

Results Among the 502 study participants, the mean oxygen saturation decreased with increasing altitude, with a maximum decrease of 4.4 percentage points (95% confidence interval, 3.9 to 4.9) at 8000 ft. Overall, acute mountain sickness occurred in 7.4% of the participants, but its frequency did not vary significantly among the altitudes studied. The frequency of reported discomfort increased with increasing altitude and decreasing oxygen saturation and was greater at 7000 to 8000 ft than at all the lower altitudes combined. Differences became apparent after 3 to 9 hours of exposure. Persons older than 60 years of age were less likely than younger persons and men were less likely than women to report discomfort. Four serious adverse events, 1 of which may have been related to the study exposures, and 15 adverse events, 9 of which were related to study exposures, were reported.

Conclusions Ascent from ground level to the conditions of 7000 to 8000 ft lowered oxygen saturation by approximately 4 percentage points. This level of hypoxemia was insufficient to affect the occurrence of acute mountain sickness but did contribute to the increased frequency of reports of discomfort in unacclimatized participants after 3 to 9 hours. ( number, NCT00326703 [] .)

Source Information

From the Shared Services Group (J.M.M.), Boeing Commercial Airplanes (D.L.M., K.D.E., D.R.S., A.M.), and Phantom Works (S.P.J., I.L.L.), Boeing Company, Seattle; and the Center for Aerospace and Hyperbaric Medicine, Oklahoma State University Center for Health Sciences, Tulsa (P.B.R.).

Address reprint requests to Dr. Muhm at Boeing Medical, P.O. Box 3707 MC 7H-90, Boeing Company, Seattle, WA 98124-2207, or at mike.muhm{at}

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Related Letters:

Effect of Aircraft-Cabin Altitude on Passenger Discomfort
Schäcke G., Scutaru C., Groneberg D. A.
Extract | Full Text | PDF  
N Engl J Med 2007; 357:1445-1446, Oct 4, 2007. Correspondence

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