Effects of moderate alcohol consumption and hypobaric hypoxia: implications for passengers' sleep, oxygen saturation and heart rate on long-haul flights.

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%).

Sleep-Induced Hypoxia under Flight Conditions: Implications and Countermeasures for Long-Haul Flight Crews and Passengers.

PURPOSE: Recuperation during sleep on board of commercial long-haul flights is a safety issue of utmost importance for flight crews working extended duty periods. We intended to explore how sleep and blood oxygenation (in wake versus sleep) are affected by the conditions in an airliner at cruising altitude. METHODS: Healthy participants' sleep was compared between 4-h sleep opportunities in the sleep laboratory (n = 23; sleep lab, ie, 53 m above sea level) and in an altitude chamber (n = 20; flight level, ie, 753 hPa, corresponding to 2438 m above sea level). A subgroup of 12 participants underwent three additional conditions in the altitude chamber: 1) 4-h sleep at ground level, 2) 4-h sleep at flight level with oxygen partial pressure equivalent to ground level, 3) 4-h monitored wakefulness at flight level. Sleep structure and blood oxygenation were analysed with mixed ANOVAs. RESULTS: Total sleep time at flight level compared to in the sleep laboratory was shorter (Δ mean ± standard error -11.1 ± 4.2 min) and included less N3 sleep (Δ -17.6 ± 5.4 min), while blood oxygenation was decreased. Participants spent 69.7% (± 8.3%) of the sleep period time but only 13.2% (± 3.0%) of monitored wakefulness in a hypoxic state (<90% oxygen saturation). Oxygen enrichment of the chamber prevented oxygen desaturation. CONCLUSION: Sleep - but not wakefulness - under flight conditions induces hypobaric hypoxia which may contribute to impaired sleep. The results caution against the assumption of equivalent crew recovery in-flight and on the ground but hold promise for oxygen enrichment as a countermeasure. The present results have implications for flight safety and possible long-term consequences for health in crews.

Influence of transient pressure changes on speech intelligibility: Implications for next-generation train travel.

High-speed trains are operated in increasingly complex railway networks and continual improvement of driver assistance systems is necessary to maintain safety. Speech offers the opportunity to provide information to the driver without disrupting visual attention. However, it is not known whether the transient pressure changes inside trains passing through tunnels interfere with speech intelligibility. Our primary goal was to test whether the most severe pressure variations occurring in high-speed trains (25 hPa in 2 s) affect speech intelligibility in individuals with normal hearing ability and secondly whether a potential effect would depend on the direction of the pressure change. A cross-over design was used to compare speech intelligibility, measured with the monosyllable word test by Wallenberg and Kollmeier, in steady ambient pressure versus subsequent to pressure events, both realised in a pressure chamber. Since data for a power calculation did not exist, we conducted a pilot study with 20 participants to estimate variance of intra-individual differences. The upper 80% confidence limit guided sample size of the main campaign, which was performed with 72 participants to identify a 10% difference while limiting alpha (5%) and beta error (10%). On average, a participant understood 0.7 fewer words following a pressure change event compared to listening in steady ambient pressure. However, this intra-individual differences varied strongly between participants, standard deviation (SD) ± 4.5 words, resulting in a negligible effect size of 0.1 and the Wilcoxon signed rank test (Z = -1.26; p = 0.21) did not distinguish it from chance. When comparing decreasing and increasing pressure events an average of 0.2 fewer words were understood (± 3.9 SD). The most severe pressure changes expected to occur in high-speed trains passing through tunnels do not interfere with speech intelligibility and are in itself not a risk factor for loss of verbal information transmission.

Effects of -12° head-down tilt with and without elevated levels of CO2 on cognitive performance: the SPACECOT study.

Microgravity and elevated levels of CO2 are two common environmental stressors in spaceflight that may affect cognitive performance of astronauts. In this randomized, double-blind, crossover trial (SPACECOT), 6 healthy males (mean ± SD age: 41 ± 5 yr) were exposed to 0.04% (ambient air) and 0.5% CO2 concentrations during 26.5-h periods of -12° head-down tilt (HDT) bed rest with a 1-wk washout period between exposures. Subjects performed the 10 tests of the Cognition Test Battery before and on average 0.1, 5.2, and 21.0 h after the initiation of HDT bed rest. HDT in ambient air induced a change in response strategy, with increased response speed (+0.19 SD; P = 0.0254) at the expense of accuracy (-0.19 SD; P = 0.2867), resulting in comparable cognitive efficiency. The observed effects were small and statistically significant for cognitive speed only. However, even small declines in accuracy can potentially cause errors during mission-critical tasks in spaceflight. Unexpectedly, exposure to 0.5% CO2 reversed the response strategy changes observed under HDT in ambient air. This was possibly related to hypercapnia-induced cerebrovascular reactivity that favors cortical regions in general and the frontal cortex in particular, or to the CNS arousing properties of mildly to moderately increased CO2 levels. There were no statistically significant time-in-CO2 effects for any cognitive outcome. The small sample size and the small effect sizes are major limitations of this study and its findings. The results should not be generalized beyond the group of investigated subjects until they are confirmed by adequately powered follow-up studies. NEW & NOTEWORTHY Simulating microgravity with exposure to 21 h of -12° head-down tilt bed rest caused a change in response strategy on a range of cognitive tests, with a statistically significant increase in response speed at the expense of accuracy. Cognitive efficiency was not affected. The observed speed-accuracy tradeoff was small but may nevertheless be important for mission-critical tasks in spaceflight. Importantly, the change in response strategy was reversed by increasing CO2 concentrations to 0.5%.

Passenger comfort on high-speed trains: effect of tunnel noise on the subjective assessment of pressure variations.

When passing through a tunnel, aerodynamic effects on high-speed trains may impair passenger comfort. These variations in atmospheric pressure are accompanied by transient increases in sound pressure level. To date, it is unclear whether the latter influences the perceived discomfort associated with the variations in atmospheric pressure. In a pressure chamber of the DLR-Institute of Aerospace Medicine, 71 participants (M = 28.3 years ± 8.1 SD) rated randomised pressure changes during two conditions according to a crossover design. The pressure changes were presented together with tunnel noise such that the sound pressure level was transiently elevated by either +6 dB (low noise condition) or +12 dB (high noise condition) above background noise level (65 dB(A)). Data were combined with those of a recent study, in which identical pressure changes were presented without tunnel noise (Schwanitz et al., 2013, 'Pressure Variations on a Train - Where is the Threshold to Railway Passenger Discomfort?' Applied Ergonomics 44 (2): 200-209). Exposure-response relationships for the combined data set comprising all three noise conditions show that pressure discomfort increases with the magnitude and speed of the pressure changes but decreases with increasing tunnel noise. Practitioner Summary: In a pressure chamber, we systematically examined how pressure discomfort, as it may be experienced by railway passengers, is affected by the presence of tunnel noise during pressure changes. It is shown that across three conditions (no noise, low noise (+6 dB), high noise (+12 dB)) pressure discomfort decreases with increasing tunnel noise.

Speech intelligibility and speech quality of modified loudspeaker announcements examined in a simulated aircraft cabin.

Acoustic modifications of loudspeaker announcements were investigated in a simulated aircraft cabin to improve passengers' speech intelligibility and quality of communication in this specific setting. Four experiments with 278 participants in total were conducted in an acoustic laboratory using a standardised speech test and subjective rating scales. In experiments 1 and 2 the sound pressure level (SPL) of the announcements was varied (ranging from 70 to 85 dB(A)). Experiments 3 and 4 focused on frequency modification (octave bands) of the announcements. All studies used a background noise with the same SPL (74 dB(A)), but recorded at different seat positions in the aircraft cabin (front, rear). The results quantify speech intelligibility improvements with increasing signal-to-noise ratio and amplification of particular octave bands, especially the 2 kHz and the 4 kHz band. Thus, loudspeaker power in an aircraft cabin can be reduced by using appropriate filter settings in the loudspeaker system.

Pressure variations on a train - Where is the threshold to railway passenger discomfort?

The implementation of recent guidelines for tunnel construction in Germany leads to extended air pressure variations inside trains and reduces pressure comfort for railway passengers. A questionnaire survey with 262 passengers revealed that pressure variations are rated less important for riding comfort than climatic and spatial aspects (study 1). A laboratory experiment (study 2) in the pressure chamber at the DLR Institute of Aerospace Medicine with 31 subjects (mean age = 37.7, SD = 12.7; 51.6% male) investigated the effects of systematic pressure variations on discomfort. The pressure changes (pressure increases and decreases) ranged from 1 to 100 mbar and were realized within 1-100 s. We derived thresholds for healthy passengers by means of random effects linear and logistic regression analysis. Logistic dose-response curves revealed amplitude/time combinations leading to a certain percentage of passengers perceiving discomfort (e.g. 50% dissatisfied passengers regarding a pressure increase of approximately 30 mbar within 5 s). The findings may help design engineers to meet passengers' comfort requirements.

The effect of sudden depressurization on pilots at cruising altitude.

The standard flight level for commercial airliners is ∼12 km (40 kft; air pressure: ∼ 200 hPa), the maximum certification altitude of modern airliners may be as high as 43-45 kft. Loss of structural integrity of an airplane may result in sudden depressurization of the cabin potentially leading to hypoxia with loss of consciousness of the pilots. Specialized breathing masks supply the pilots with oxygen. The aim of this study was to experimentally simulate such sudden depressurization to maximum design altitude in a pressure chamber while measuring the arterial and brain oxygenation saturation (SaO(2) and StO(2)) of the pilots. Ten healthy subjects with a median age of 50 (range 29-70) years were placed in a pressure chamber, breathing air from a cockpit mask. Pressure was reduced from 753 to 148 hPa within 20 s, and the test mask was switched to pure O(2) within 2 s after initiation of depressurization. During the whole procedure SaO(2) and StO(2) were measured by pulse oximetry, respectively near-infrared spectroscopy (NIRS; in-house built prototype) of the left frontal cortex. During the depressurization the SaO(2) dropped from median 93% (range 91-98%) to 78% (62-92%) by 16% (6-30%), while StO(2) decreased from 62% (47-67%) to 57% (43-62%) by 5% (3-14%). Considerable drops in oxygenation were observed during sudden depressurization. The inter-subject variability was high, for SaO(2) depending on the subjects' ability to preoxygenate before the depressurization. The drop in StO(2) was lower than the one in SaO(2) maybe due to compensation in blood flow.

Continuous assessments of pressure comfort on a train -- a field-laboratory comparison.

Pressure variations on a train predominantly occur while trains are passing through tunnels. These aerodynamic effects may give rise to aural discomfort in railway passengers. We conducted a field study on the high speed railway track Cologne-Frankfurt/Main as well as a simulation study in our pressure chamber TITAN (DLR-Institute of Aerospace Medicine) with 31 subjects (mean age = 37.7, SD = 12.7; 51.6% male) to investigate pressure comfort for passengers. Continuous assessments of pressure events using sliders and retrospective assessments were acquired. Pressure variations were mostly tolerated. A comparison of field and laboratory setting revealed high congruency of continuous as well as retrospective assessments. A generalized estimating equation model identified pressure change attributes contributing to passengers' discomfort. Beside attributes of instantaneous pressure changes (e.g. high amplitudes, short durations), pressure events of the recent past significantly influenced current discomfort. Design engineers may use these findings to improve train and tunnel design.