Flying With POTS Science

Many diagnosed with POTS find that their symptoms can worsen during flights. We wanted to take a look at the science to help us determine why this is the case! Our proposed theories backed by research are below:

  • The cabin pressure on commercial aircrafts is adjusted to barometric pressure roughly equivalent to an altitude of 1500-2500m above sea level (5000-8000 feet on land and the humidity is lower so it can be more difficult to maintain blood pressure). Therefore, that decrease in pressure impacts the gas & air in the body cavities, affecting the autonomic nervous system as well [1,2,3].

  • Furthermore, for patients that have long-COVID, one of the underlying mechanisms that has been found in research is chronic cellular hypoxia. In normal healthy individuals, our O2 levels drop from 98% to 92% when flying because of the elevation. This can lead to hypobaric hypoxemia [4-7].

  • We believe that the atmospheric changes that occur during flights, and associated effects on the autonomic nervous system, are impacting individuals with POTS. This is something that providers do need to be aware of, as preventative measures and plans ahead of flying are important.

Written By: Dr. Sujana Reddy, VP and Medical Board Leader

Sources:

1.     Muhm JM, Rock PB, McMullin DL, et al. Effect of aircraft-cabin altitude on passenger discomfort. N Engl J Med. 2007;357(1):18-27. doi:10.1056/NEJMoa062770

2.     Graf J, Stüben U, Pump S. In-flight medical emergencies. Dtsch Arztebl Int. 2012;109(37):591-602. doi:10.3238/arztebl.2012.0591

3.     Hampson NB, Kregenow DA, Mahoney AM, et al. Altitude exposures during commercial flight: a reappraisal. Aviat Space Environ Med. 2013;84(1):27-31. doi:10.3357/asem.3438.2013

4.     Silverman D, Gendreau M. Medical issues associated with commercial flights. Lancet. 2009;373(9680):2067-2077. doi:10.1016/S0140-6736(09)60209-9

5.     Sánchez-Borges, M., Cardona, V., Worm, M. et al. In-flight allergic emergencies. World Allergy Organ J 10, 15 (2017). https://doi.org/10.1186/s40413-017-0148-1

6.     Dillard TA, Berg BW, Rajagopal KR, Dooley JW, Mehm WJ. Hypoxemia during air travel in patients with chronic obstructive pulmonary disease. Ann Intern Med. 1989;111(5):362-367.

doi:10.7326/0003-4819-111-5-362

7.     Gendreau MA, DeJohn C. Responding to Medical Events During Commercial Airline Flights. N Engl J Med 2022 346:1067-1073