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.

1 Follower
16 Reads
  • Source
    • "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. "
    [Show abstract] [Hide abstract]
    ABSTRACT: The present review attempts to put together the available evidence and potential research paradigms at the interface of obstructive sleep apnea syndrome (OSAS), sleep micro- and macrostructure, cerebral vasoreactivity and cognitive neuroscience. Besides the significant health-related consequences of OSAS including hypertension, increased risk of cardio- and cerebrovascular events, notable neurocognitive lapses and excessive daytime somnolence are considered as potential burdens. The intermittent nocturnal hypoxia and hypercapnia which occur in OSAS are known to affect cerebral circulation and result in brain hypoperfusion. Arousal instability is then resulted from altered cyclic alternating patterns (CAPs) reflected in sleep EEG. In chronic state, some pathological loss of gray matter may be resulted from obstructive sleep apnea. This is proposed to be related to an upregulated proinflammatory state which may potentially result in apoptotic cell loss in the brain. On this basis, a pragmatic framework of the possible neural mechanisms which underpin obstructive sleep apnea-related neurcognitive decline has been discussed in this review. In addition, the impact of OSAS on cerebral autoregulation and sleep microstructure has been articulated.
    Full-text · Article · Apr 2015 · Journal of Integrative Neuroscience
  • Source
    • "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. "
    [Show abstract] [Hide abstract]
    ABSTRACT: The World Trade Center (WTC) disaster on September 11, 2001 was an unprecedented traumatic event with long-lasting health consequences among the affected populations in the New York metropolitan area. This meta-analysis aimed to estimate the risk of probable posttraumatic stress disorder (PTSD) associated with specific types of WTC exposures. Meta-analytical findings from 10 studies of 3,271 to 20,294 participants yielded 37 relevant associations. The pooled summary odds ratio (OR) was 2.05 (95% confidence interval (CI): 1.82, 2.32), with substantial heterogeneity linked to exposure classification, cohort type, data source, PTSD assessment instrument/criteria, and lapse time since 9/11. In general, responders (e.g. police, firefighters, rescue/recovery workers and volunteers) had a lower probable PTSD risk (OR = 1.61; 95% CI: 1.39, 1.87) compared to civilians (e.g. residents, office workers, and passersby; OR = 2.71, 95% CI: 2.35, 3.12). The differences in ORs between responders and civilians were larger for physical compared to psychosocial exposure types. We also found that injury, lost someone, and witnessed horror were the three (out of six) most pernicious exposures. These findings suggest that these three exposures should be a particular focus in psychological evaluation and treatment programs in WTC intervention and future emergency preparedness efforts.
    Full-text · Article · Jul 2014 · PLoS ONE
  • [Show abstract] [Hide abstract]
    ABSTRACT: More than ten years after the September 11, 2001 World Trade Center (WTC) disaster, 9/11 responders and lower Manhattan community residents still suffer from the adverse health consequences of this horrific event. Upper and lower respiratory conditions such as rhinosinusitis and asthma have been found in a significant number of people in WTC-exposed populations. A lack of appropriate respiratory protection may have contributed to these effects. Other commonly observed physical health conditions include gastro-esophageal reflux disease, obstructive sleep apnea and musculoskeletal injuries. Many WTC-exposed individuals also suffer from mental health conditions, primarily post-traumatic stress disorder, depression, panic disorder, and substantial stress reaction. Recent studies suggest that WTC exposure may increase the risk of cancer and of mortality from cardiac disease. Further research should be conducted to fully understand the impact of the WTC disaster on the health of these populations.
    No preview · Article · Jul 2012 · Fire Technology
Show more