People with obstructive sleep apnea may be at greater risk for heart troubles during air travel, a new study shows.
Travelers with sleep apnea face higher heart risks. (Noah Berger/Associated Press)Sleep apnea is a common condition characterized by temporary breathing interruptions during sleep, often due to an upper airway obstruction. People with sleep apnea often snore loudly and gasp for air during sleep.
In a new study, Australian researchers looked at oxygen levels and breathing patterns in healthy people and in 22 people with severe sleep apnea during a simulated flight. All study subjects were awake, and the conditions in the simulator mimicked oxygen and pressure levels typically found on commercial airline flights.
The researchers found that people with obstructive sleep apnea had lower levels of oxygen in their blood before and during the simulated flight. People with apnea experienced higher heart rates, physiological stress and demand for oxygen than healthy people, according to the findings, presented this weekend at the American Thoracic Society’s 2008 International Conference in Toronto.
“We addressed obstructive sleep apnea because it is becoming so much more common as obesity increases and there are greater numbers of obese passengers on commercial flights,” said lead researcher Leigh Seccombe, a senior scientist in the department of thoracic medicine at Concord Repatriation General Hospital in Sydney.
The results suggest patients with obstructive sleep apnea are at higher risk for heart problems during air travel, and raise questions about whether patients with severe apnea should travel with supplemental oxygen, the way patients with lung diseases do.
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From 1 to 25 of 42 Comments
If oxygen is lacking, the next study if not done already is one that will show a high correlation of apnea to cancer. Maybe as much as smoking tobacco is to lung cancer.
That intuitive surmise is based on the work of Otto Warburg, M.D., two time Noble Laureate.
Please look him up on Goggle.
Here is a tease of one site and then the link:
“German biochemist Otto Warburg earned double doctorates in chemistry and medicine, and won the Nobel Prize in 1931, for his research into cellular respiration, showing that cancer thrives in anaerobic (without oxygen) or acidic conditions. His father was a highly respected physicist, and in Warburg’s childhood such luminaries as Albert Einstein, Max Planck, Emil Fischer, and Walther Nernst were frequent dinner guests.
In his research into cancer, Warburg showed the carcinogenic nature of food additives and smoking cigarettes, and demonstrated that cancer cells can be destroyed by radiation. He argued that anaerobiosis was a primary cause of cancer, and his own research into carcinogens made him fearful of processed foods. Toward the end of his life he would only eat bread and butter if he could ascertain that both were fully organic. His mid-1960s announcement that cancer prevention and treatment should be built around respiratory enzymes, iron and the B vitamins, is often cited by advocates of alternative treatment. His “Warburg effect” asserts that even when oxygen is plentiful, cancer cells continue to use glycolysis (a secondary system of producing energy, employed by normal cells only when oxygen is in short supply). This theory has long been dismissed by mainstream medicine, but it was brought back to the forefront by 2007 research into a simple, small molecule called dichloroacetate (DCA), now believed to hold great promise in the war on cancer.”
Now the link: http://www.nndb.com/people/682/000127301/
Should that fail, just enter otto warburg md. A trove of gold awaits!
You won’t be wasting your time and it might just bring your breathing back to normal.
— healthinfoHmmm … Patients with obstructive sleep apnea do not require oxygen. They use a CPAP machine, which controls air pressure, but (exept in unusual cases)does not add supplemental oxygen.
— Tom SPoint 1.: do not trust healthinfo: he/she has been a consistent source of misinformation on this blog… Warburg was a great chemist/biochemist, but his research is about as dated as you can get. Nobody really cares whether apnea causes cancer, anyway; the immediate problems it causes are much more, well, immediate.
— Anonymous MDPoint 2: no, with sleep apnea you don’t generally need supplemental oxygen; what you need is positive pressure to keep the nasopharyngeal airway open during sleep. The primary theory about sleep apnea is that those tissues are “floppy” or redundant in sufferers (who are almost always obese.) Sleep apnea leads to an increase in blood pressure, blood count, and many other problems. Hypoxia is present (at night), but it’s not due to poor lung function– rather poor air flow. According to the report, these people had hypoxia even while awake. Why sleep apnea would cause increased risk in airplanes is somewhat open to question. Perhaps these people are already under stress before being subjected to a simulated 7,000 foot altitude(yes, airplane cabins are “pressurized”, but NOT to sea level–too expensive; and NOT to adequate fresh air volume/flow– too expensive.)
The problem with flying on airplanes for people with apnea is that there are no outlets to allow you to plug in the CPAP. Even on long distance flights when in business class the power outlets cycle on and off so if you have purchased an expensive seat to reply on the power you are still at risk.
The airlines need to provide a consistent energy source for those passengers who need it or the CPAP manufacturers come up with an alternative power source for people with apnea that can be easily used on an airplane.
My husband has apnea and I will be tested for it next week, Scary to be a on plane without a CPAP and with heart disease!
— SusanThis article does not give enough data and raises concern and fear of death to those diagnosed with sleep apnea who fly frequently (my husband, among them). The study talks about obesity being the cause of most cases of sleep apnea. Were the patients in the study obese? Did they have any underlying cardiac or pulmonary issues? How do they define “lower levels of oxygen”? Using a pulse oximeter with a reading of what? How many flights have resulted in passengers having an MI or sudden death? How would they know how much O2 is necessary to provide to passengers, using what criteria? This study really raises more questions than it answers. I cannot help but continue to believe that this type of media coverage fuels fear while risk remains minimal. (No offense to you TPP, I really like this blog and think it is quite informative)
— Janice NelsonFROM TPP — I agree the study does raise more questions than it answers, and it doesn’t yield enough information to give passengers conclusive advice. However, I did find it newsworthy that sleep apnea patients may face certain aditional risks even while awake. Ultimately, the data will be used to issue new guidelines about health during air travel and passengers with severe apnea may be advised to travel with oxygen. I do think patients with obesity and severe apnea should talk to their doctors about risks associated with air travel.
To Tom S.,
Yes, people with Sleep Apnea/Hypopnea do need an increase of oxygen. The reason why the CPAP machines work, using air pressure, is because the stopping of breathing is overcome because of this increased pressure. When a person stops breathing or has slow and/or shallow breathing (Hypopnea), such as I, the blood oxygen levels drop. Very significantly I might add. Mine was 82% the last time it was checked.
— plb4333To Susan,
The best accomodation for people with sleep apnea on airplanes would be to provide oxygen supplementation. This would be the simplest and comes to the same desired result. The CPAP works, but it serves no other beneficial purpose than to increase the blood oxygen level by keeping the breathing normal, with no interruptions.
— plb4333Re: Anonymous MD’s repeated comment (re healthinfo # 1) from the Low Fat Diet May Cut Prostate Cancer blog 3. May 19th, 2008 7:08 pm Point 1.:
Here is the relevant section of Anonymous MD’s comments:
“do not trust healthinfo: he/she has been a consistent source of misinformation on this blog. Warburg was a great chemist/biochemist, but his research is about as dated as you can get. Nobody really cares whether apnea causes cancer, anyway; the immediate problems it causes are much more, well, immediate.”
Here is what Anonymous MD wrote in another Well blog in response to a comment about niacin made by healthinfo:
“In fact, niacin is full of nasty effects in a large persentage of patients- unlike atorvastatin for example, which has very beneficial effects on cardiovascular disease and stroke, and rare side effects….”
Here is what the MayoClinic.com site says about niacin:
“Rated A: Strong scientific evidence for this use…
Niacin is a well accepted treatment for high cholesterol…..with better results than prescription drugs such as “statins” like atorvastatin (Lipitor (R)).” and,
“Rated B: Good scientific evidence for this use)
“Prevention of second heart attack (niacin) Niacin decreases …..which can reduce the risk of heart disease….”
Any one interested in side effects of Anonymous MD’s favorite statin can go to: http//pfizer.com/files/products/uspi_lipitor.pdf for the 13 pages of warnings that start on page 15 of the Physician Prescribing Information.
Lipitor(R), the preferrd statin of Anonymous MD is atorvastatin, a fact s/he apparently overlooked in her/his rush to judgment about the comments related to the value of niacin. Pfizor, had to end the $348 million Jarvic advertisement campaign for Lipitor(R) which was designed to convince the public and medical doctors not to prescribe or use now available generic equivalents (and niacin). Congress is now starting investigations about that ad campaign.
Now the judgmental comments by Anonymous MD are against the incredible science of a man dead for some years and unable to defend himself. And in her/his efforts to discredit comments made in #1, offhandily comments that “….nobody really cares whether apnea causes cancer, anyway;…”
Nobody? I wonder if any oncologists care about a potential cure for cancer? Similar thoughts seem appropriate about the many cancer people in America. I wonder what they think?
A mind is a terrible thing to waste. In this case an apparently anonymous, seemingly insensitive medical doctor mind might be better used reading carefully what was said: “…a high correlation of apnea to cancer…” not that apnea causes cancer.
This article says, “Sleep apnea is a common condition characterized by temporary breathing interruptions during sleep, often due to an upper airway obstruction. People with sleep apnea often snore loudly and gasp for air during sleep.” Seems we have an oxygen problem that raises heart risk.
The reason to suggest a simple study is to learn if apnea which causes breathing issues for people might also be associated with cancer, just as smoking is associated with cancer. We know that what medicine has as treatment for cancer is not consistently effective, is costly and becoming unaffordable and often harmful. Should Warburg’s thinking be helpful, although dated, would that not be wonderful?
the “Low Fat Diet May Cut Prostate Cancer” blog relates a story about a once discarded fat diet and its application today to epilepsy. It seems the measuring rod for research should be its usefulness and ability to meet the needs of patients, not the date the medical profession first rejected it or the date that special interest or secret agenda of some providers of medical services and products decided to try to discredit it.
But we need to thank Anonymous MD. Her/his comments encouraged Healthinfo to look further into the validity of this effort of character assination of Otto Warburg, M.D., double doctorate in chemistry and medicine, two time Nobel Laureate and former director of the Max Plank Institute.
It appears that there is a medical discussion about dichloroacetate, a chemical that seems to have some positive potential in the “war on cancer” going on, but mostly in other countries. Please Google that drug and warburg, md and look for yourself. While some sites seem a little diffuse, Wikipedea has a rather neutral approach with many verifiable references. In its text is one possible explanation why my new mystery friend is so anxious to take her/his time to be judgmental of healthinfo.
It seems this chemical cannot easily be patented by drug companies. As such, should it prove valuable, it might not be profitable for drug companies to research and seek FDA apporval. Implied in this text is that if a cheap alternative to expensive drugs could be realized, other cancer drugs might be used less. First, the secret comentator makes a recommendation to use atorvastatin (aka Lipitor(R)) without mentioning the brand label and then he is ready to kill the new non-patentable drug during gestation.
Readers can decide whom to trust and their motives. I have no connection to the drug industry or to any group that opposes it. I have no affiliation to any political party, person or program. Would Anonymous MD provide full disclosure of his affiliations with the drug industry and political connections for the benefit of the readers? I think the issue of disclosure was alos raised in another blog. So it might have meaning here.
Healthinfo does ask readers not to trust our typing. As for the rest, we urge consideration and respect of others’ thoughts.
— healthinfoNo Anonymous MD, sleep apnea is not only in people that are “almost always obese.” Sleep Apnea affects all types of people… including athletes, professional singers and the normal Joe and Suzie Smith. I’m not fat, just have the genetics that make me have severe apnea.
As for airplanes. Well, it’s almost impossible to sleep in coach on a long flight. For business and first travellers, they can take their CPAP machines and plug them into the seats. I’ve done it. No big deal.
— JohnSince Airplanes are pressurized to approx 8000 ft. altitude, I wonder if the same results are true of people with apnea at altitude on land. I live at 7000 feet and there are many people with apnea in my town but we do not have a higher rate of heart attack. Would be interesting to look into.
— CarrieRe: Sleep Apnea and longs flights . . . . Early into a flight to Ireland from Atlanta, GA, I fainted in the aisle. When I came to, they had an oxygen mask on me. After helping me to my seat and determining that I’d had an episode of orthostatic hypotension, the oxygen mask was left on. The flight attendant woke me just prior to landing in Dublin (I’d slept through breakfast!) and I hit the ground running. No jet lag! This happened a few months prior to being diagnosed with OSA. The O2 somehow compensated for the sleep apnea and I got a good night’s sleep. Some airlines will allow you to buy a tank for around $80 (last time I checked). FYI.
— Eliza-Posted by Eliza
What about the risk snoring Apnea sufferers face from fellow passengers stuffing a pillow down their throat to shut them up!
— GateurI always find myself waking up abruptly while flying, almost gasping for breath, whereas I don’t suffer from sleep apnea on th ground. I was just remarking on this last week while flying, strange.
— HizhinezzThank you for that clarification, John. My husband has apnea, and he is the complete opposite of obese, not to mention he is very physically fit. Further, we know a number of people who have been diagnosed with severe apnea, and not one of them are obese. I know that obesity increases the risk, but it is not a pre-requisite.
— wellsieHi from the American Thoracic Society Meeting in Toronto! Just a couple of points to clarify– This is a very small study in patients with severe sleep apnea. The patients were awake during the study, so a CPAP machine which keeps collapsing airways open during sleep wouldn’t help with the lowered blood oxygen levels. There’s still a lot of questions on how much to trust the current guidelines for receiving supplemental oxygen. So I’d make sure you get treatment if you have (or suspect you have) sleep apnea, but I don’t think anyone is recommending supplemental oxygen during flight for patients with sleep apnea.
FROM TPP — Thanks for the additional input.
— BarryYes, obesity is not always implicated in sleep apnea, nor is snoring. For years I thought post-nasal drip was causing my repeated and abrupt violent fits of coughing in the night. It was very disruptive and interfered with my sleep as well as my husband’s. I’m normal weight, don’t snore, sleep on my side mostly, and sleep with my mouth closed. Turns out I was hypothryoid and sleep apnea is a common hypothyroid symptom (due to the slower letabolism, and the reduced energy to the soft palate muscles, I guess). Now that I recognize what is happening, I know apnea has happened a few times when I was awake, too. The sleep apnea and most of the other hypothyroidism symptoms go away when I am on the right dose of replacement T4-T3 thryoid hormone and come back in the fall when I need a slight T4 dose increase.
— AnnaHi, Timely article. I just took a flight to San Francisco and tried to get oxygen for the flight. I have had “diagnosed” sleep apnea for 7 years and undiagnosed for many years prior. I, even with treatment, now have pulmonary hypertension. I am to keep my oxygen saturation above 90%. Getting through the Denver airport required supplemental oxygen and that was not a problem. I found it near impossible to get oxygen for the flight. I tried 2 airlines. On Frontier I could carry a portable concentrator..hard to locate. I could rent for $75/week but required a longer notification time than I had or buy for $3-4,000. United would have furnished oxygen for a fee-$100/one way flight-if I could have gotten a straight answer from any staff at United. I did ok, but would like to have had the option. I hope this is an easier option in the future.
— Lorna ClarkIt’s important for people to realize that you can have sleep apnea without being overweight. My husband is extremely fit, has never been overweight, but has had sleep apnea for years, and uses a CPAP.
— apnea wifeI have recently been diagnosed with sleep apnea and my current pulmonary specialist says that the latest research indicates that sleep apnea is the underlying cause of a lot of conditions (including obesity because apnea causes insulin resistance). We are born with apnea and it shows up usually during puberty and gets worse over time. The conditions I have that most doctors attribute to obesity are actually symptoms of apnea, such as high blood pressure, acid reflux and obesity.
— terryI have been so conditioned to be defensive with doctors about my weight and it being the cause of all my problems, that my new doctor told me to quit beating myself up for being overweight and start congratulating myself for still being a nice person after not having enough sleep for 30 years!!
There are still a lot of myths surrounding Sleep apnea. Number one is the myth that sleep apnea happens only to obese people. But the fact is that by the time sleep apnea is diagnosed in a person who has been suffering for years, the lack of sleep and fatigue brings on the obesity that is incorrectly believed to be the cause. When I was diagnosed with sleep apnea, after being waved away by several doctors, I had a BMI of 20. Years of fatigue and insufficient sleep has brought it up to 26. There are several studies which show that lack of sleep causes obesity. In my family, sleep apnea is genetic, and many of my suffering relatives manage to keep their weight in check through sheer will-power. But it is very tough.
The other myth is that sleep apnea is a male disease. Couldn’t be further from the truth. Female OSA sufferers are simply told that they cannot sleep because they are depressive, when a simple overnight sleep study can reveal the real cause. A lot of my female relatives have OSA.
— Sufferingin response to #20- BMI is not a good/reliable way to determine level of fitness or health. It is a height to weight ratio and can be skewed if an individual has significant muscle mass.
— susanWell, geez, i’m just not fit to contest these blog wars. i’lll try to be more like a mouse and less like a moose from now on.
healthinfo: you are the most irrational, hypersensitive, etc.
You make hay of my being “anonymous” when you are equally “anonymous” with your name. What kind of argument is that? An invalid one.
You make all kinds of invalid leaps in your statements–I’m really shocked at how irrational you are. I can’t even begin to summon the energy you have expended in trying to shoot down the straw dog you have created around my warning about you– it must be 5,000 words you have written in response to my 50 word comment!
The straw dog simile I think is particularly telling– you have created all sorts of positions on issues that you claim I hew to when I’ve never even mentioned any of them!
You call me “insensitive”– you mean in my not keeping silent about your nonsensical positions that you have spewed for months in this blog? I don’t care about your feelings, but I do care about the people who read this blog and are being misled by your misinformation.
You claim that I’ve indulged in “character assassination” against Dr. Warburg–give me a break. I said he was great but he lived 80 years ago, so obviously he’s out of date. You are the one who is “character assassinating” ME!
I’m tired of this nonsense. I’m not listening to you anyway. I just wanted the other readers to know that you’re an idiot.
FROM TPP — You kids are getting on my nerves. No more posts for either of you (unless you stop fighting - nobody else can even tell what you are arguing about anymore.)
— Anonymous MD=====================================================================PS I did NOT say that NO-ONE who is NOT obese can have sleep apnea– I said “almost all” or something like that. Obviously there are those who are NOT obese who have severe OSA, it’s just that it is MUCH less common. Give me a break, guys.
— Anonymous MDThere are battery-operated CPAP machines. Go to cpaptalk.com for more resources. (I realize that, as previously pointed out, CPAP on planes isn’t indicated by this study, but the need for an electrical supply has been mentioned more than once.)
I only recently learned (after using my own pulse oxymeter on a commercial flight) that planes are only pressurized to 8000′, as mentioned in another post. I am amazed that more people don’t have problems due to this. A sudden change from sea level to 8000′ is enough to bring on AMS (acute mountain sickness) in susceptible people — check any of the standard references on high-altitude medicine or widerness medicine.
TPP, one thing which other news reports pointed out and you failed to mention was that in the study, the OSA subjects had an average BMI of 36 and the control subjects 24. There was no control for BMI. So the results could be purely due to BMI rather than OSA, and this is a reasonable possibility given the researchers’ finding that stress and initial hypoxia seemed to play a part. In fact, one reported interviewed the lead investigator, who specifically stated that the results might be due to obesity rather than OSA and that it was too soon to draw any conclusions. Thus I find that using “sleep disorder” in the title of your post is a misreading of the research paper.
— Edward ReidI was diagnosed with sleep apnea just three months ago. My sleep specialist physician said that I probably have not had a good night’s sleep in ten years. Despite my sleep apnea, I’m slim, fit and muscular. I exercise vigorously and regularly, and am careful about nutrition. In fact, I’ve heard that only 40% of sleep apnea patients are obese. So, maybe a study of obese people with sleep apnea is not pertinent to thin people with sleep apnea. In my case, the CPAP has made a big difference in how I feel, but it is a little hard to get used to for both me and my wife. Now, this study makes me anxious that the CPAP isn’t quite enough therapy, because evidently sleep apnea patients, even when awake on airplanes, are still having adverse effects. We need guidance to know what all this means and how it should affect our actions. Clearly, more research is needed.
— An MD’s husband