Sleep breath. Prevalence and incidence of high risk for obstructive sleep apnea in World Trade Center-exposed rescue/recovery workers

Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA.
Sleep And Breathing (Impact Factor: 2.48). 09/2011; 15(3):283-94. DOI: 10.1007/s11325-010-0379-7
Source: PubMed


World Trade Center (WTC)-exposed rescue/recovery workers continue to have high rates of gastroesophageal reflux disease (GERD), chronic rhinosinusitis, and posttraumatic stress disorder (PTSD) symptoms. This study examines the relationship between these WTC-related conditions and being at high risk for obstructive sleep apnea (OSA).
The Fire Department of the City of New York (FDNY) performs periodic health evaluations on FDNY members every 12 to 18 months. Evaluations consist of physician examinations and self-administered health questionnaires, which, since 2005, have incorporated questions about sleep problems that were adapted from the Berlin Questionnaire. The study population consisted of 11,701 male firefighters and emergency medical service personnel. Incidence analyses were limited to a cohort (n = 4,576) who did not meet the criterion for being at high risk for OSA at baseline (between September 12, 2005 and September 8, 2006) and had at least one follow-up assessment, on average, 1.4 (±0.5) years later.
The baseline prevalence of high risk for OSA was 36.5%. By follow-up, 16.9% of those not at high risk initially became at high risk for OSA. In multivariable logistic regression models predicting incident high risk for OSA, independent predictors included: earlier time of arrival at the WTC site, GERD, chronic rhinosinusitis, PTSD symptoms, self-assessed fair/poor health, low body mass index (BMI < 18.5 kg/m(2)), and, as expected, BMI > 30 kg/m(2) and weight gain of ≥10 lb (4.5 kg).
We found significant associations between being at high risk for OSA and common WTC-related conditions, although the responsible causative mechanisms remain unknown. Since the etiology of OSA is likely multifactorial, improvement may require successful treatment of both OSA and its comorbid conditions.

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    • "In addition , weight loss is known to result in decreased cardiovascular morbidity and risk when CPAP is prescribed in these patients (Basner, 2014; Gottlieb et al., 2014). Since the prevalence of OSAS is on the rise (Webber et al., 2011; Guralnick, 2013), practice protocols should be de¯ned to widely screen, timely diagnose and treat this condition in outpatient settings. Moreover, studies on neurocognitive de¯cits in OSAS are obviously required as the condition impacts a growing number of subjects. "
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    • "specific type, duration, and severity of trauma exposure) and in the status of the affected individuals (e.g. age when exposure occurred, sex, education, occupation, psychiatric and physical comorbidity, coping mechanisms and capability, etc.) may influence the PTSD outcome [5][7][9][11][13][31]. In terms of characterizing the WTC exposure, given the magnitude of the impact of 9/11 and the diverse population affected by the event, it is not surprising that we found diverse exposure types across the relevant studies. "
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