Aircraft Cabin Pressurization and Concern for Non-Arteritic Anterior Ischemic Optic Neuropathy

BACKGROUND: Cabin pressurization is the process by which aircraft maintain a comfortable and safe environment for passengers flying at high altitudes. At high altitudes, most patients can tolerate changes in pressurization; however, passengers at high risk of hypoxia may experience ischemic events. The purpose of this study was to evaluate variations in pressurization of commercial aircraft at cruising altitude and describe its relevance in relation to patients with non-arteritic anterior ischemic optic neuropathy (NAION).

METHODS: Altimeters were used to measure altitude and cabin altitude at cruising altitude aboard 113 commercial flights, including 53 narrow-body and 60 wide-body aircraft.

RESULTS: Cabin altitude ranged from 4232 ft to 7956 ft at cruising altitudes ranging from 30,000 ft to 41,000 ft. The mean cabin altitude for all flights was 6309 876 ft. Narrow-body aircraft had a significantly higher mean cabin altitude (6739 829 ft) compared to wide-body aircraft (5929 733 ft). For all flights, the mean cruising altitude was 35,369 2881 ft with narrow-body aircraft cruising at a lower altitude of 34,238 2389 ft compared to wide-body aircraft at 36,369 2925 ft. Newer generation aircraft had a mean cabin altitude of 6066 837 ft, which was lower than the mean cabin altitude of older aircraft (6616 835 ft).

DISCUSSION: Innovation in flight design has offered the ability for aircraft to fly at greater altitudes while maintaining lower cabin altitude. Those at high risk of hypoxia-induced complications may consider aircraft type when air travel is required.

Nazarali S, Liu H, Syed M, Wood T, Asanad S, Sadun AA, Karanjia R. Aircraft cabin pressurization and concern for non-arteritic anterior ischemic optic neuropathy. Aerosp Med Hum Perform. 2020; 91(9):715719.