• Daniel Rooney, Simon Herkenrath, Christina Priegnitz, Matthias Putzke, Marcel Treml, Jürgen Wenzel, Daniel Aeschbach, and Winfried Randerath.
• Department of Sleep and Human Factors Research, Institute of Aerospace Medicine, German Aerospace Center (DLR), Cologne, Germany. Electronic address: daniel.rooney@dlr.de.
• Chest. 2019 Nov 1; 156 (5): 926-932.

BackgroundAir travel is physically demanding and, because obesity is rising, physicians increasingly need to assess whether such patients can fly safely. Our aim was to compare the diagnostic accuracy of two routinely used exercise tests, 50-m walk test and 6-min walk test, and hypoxic challenge testing (HCT) in obese individuals. We further explored the diagnostic potential of perceived dyspnea as measured with the Borg scale because this is often recorded subsequent to walking tests.MethodsIn this prospective study, we examined 21 obese participants (10 women, age 51 ± 15 [mean  ±  SD], BMI 36 ± 5  kg/m2). The most prevalent comorbidity was COPD (n = 11). The reference standard for in-flight hypoxia, defined as oxygen saturation below 90%, was established in an altitude chamber. Diagnostic accuracy of each index test was estimated by area under the receiver operating characteristic curve (AUC).ResultsOf the 21 participants, 13 (9 with COPD) were identified with in-flight hypoxia. HCT was the only test separating the reference groups significantly with AUC 0.87 (95% CI,  0.62-0.96). Neither of the walking tests predicted noticeably above chance level: 50 m walk test had an AUC of 0.63 (0.36-0.84) and 6MWT had an AUC of 0.64 (0.35-0.86). We further observed good prognostic ability of subjective dyspnea assessment when recorded after 6MWT with an AUC of 0.80 (0.55-0.93).ConclusionsIn-flight hypoxia in obese individuals can be predicted by HCT but not by simple walking tests.Copyright © 2019 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

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