Chronic Rhinosinusitis Is an Independent Risk Factor for OSA in World Trade Center Responders

Abstract

BACKGROUND: Many respiratory conditions have been attributed to toxic dust and fume exposure in World Trade Center (WTC) rescue and recovery workers, who frequently report symptoms of OSA. We examined the prevalence of new-onset OSA and tested if the prevalence and severity of OSA are related to the presence of chronic rhinosinusitis (CRS).METHODS: A total of 601 subjects (83% men; age, 33-87 years; BMI, 29.9 AE 5.5 kg/m 2 ) enrolled in the WTC Health Program, excluding those with significant pre-September 11, 2001, snoring or prior CRS, underwent two nights of home sleep testing. OSA was defined as Apnea Hypopnea Index 4% $ 5 events/h or respiratory disturbance index of $ 15 events/h. CRS was assessed using nasal symptom questionnaires. RESULTS:The prevalence of OSA was 75% (25% no OSA, 46% mild OSA, 19% moderate OSA, and 10% severe OSA), and the prevalence of CRS was 43.5%. Compared with no CRS, new and worsening CRS was a significant risk factor for OSA with an OR of 1.80 (95% CI, 1.18-2.73; P ¼ .006) unadjusted and 1.76 (95% CI, 1.08-2.88; P ¼ .02) after adjustment for age, BMI, sex, gastroesophageal reflux disorder, and alcohol use. CONCLUSIONS:The high prevalence of OSA in WTC responders was not explained fully by obesity and sex. Possible mechanisms for the elevated risk of OSA in subjects with CRS include increased upper airway inflammation and/or elevated nasal/upper airway resistance, but these need confirmation.

The Association between Health Conditions in World Trade Center Responders and Sleep-Related Quality of Life and Sleep Complaints

“…However, the relationship of CRS to poor sleep remained even after controlling for sleep duration. We have shown a relationship of CRS to level of WTC exposure [5], and chronic inflammation has also been shown to be part of CRS; it is possible that systemic mediators of inflammation such as cytokines contribute to sleep disruption [37,39].…”

“…This exposure was associated with an increased risk of developing obstructive sleep apnea (OSA) [2], chronic rhinosinusitis (CRS) [3], post-traumatic stress disorder (PTSD), gastroesophageal reflux disease (GERD), anxiety and depression [4] all of which may be associated with sleep disruption. We recently reported a high prevalence of OSA in WTC responders related to chronic rhinosinusitis [5].…”

Safety, efficacy and airway complications of the flexible laryngeal mask airway in functional endoscopic sinus surgery: A retrospective study of 6661 patients

“…Third, gastric insufflation was excluded after FLMA insertion, but it was not continuously monitored during the operation; thus, asymptomatic gastric insufflation might be underestimated in our study. Fourth, patients with chronic rhinosinusitis are likely to suffer from obstructive sleep apnoea (OSA), possibly due to increased upper airway inflammation and increased upper airway resistance [33,34]. Although many patients reported symptoms of OSA in their medical records, not all of these cases were confirmed by overnight polysomnography.…”

Relationships between chronic rhinosinusitis without nasal polyps and obstructive sleep apnea in male patients: a cross-sectional study

“…[12] Typical characteristics of OSA, such as upper airway collapse, fragmented sleep, and breathing cessation during sleep, have been reported in 49.7% of men and 23.4% of women. [13,14] Sunderram et al [15] reported a strong association between new-onset OSA and new and worsening CRS symptoms, indicating that CRS may be an independent risk factor for OSA, even after adjusting for age, sex, and body mass index (BMI). A large-scale, 10-year follow-up epidemiological study reported a causal relationship between the development of CRS and selfreported sleep problems, such as snoring, insomnia, and difficulty maintaining sleep.…”