Sleep and Breathing

, Volume 15, Issue 3, pp 283–294 | Cite as

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

  • Mayris P. Webber
  • Roy Lee
  • Jackie Soo
  • Jackson Gustave
  • Charles B. Hall
  • Kerry Kelly
  • David Prezant
Original Article

Abstract

Purpose

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).

Materials and methods

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.

Results

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/m2), and, as expected, BMI > 30 kg/m2 and weight gain of ≥10 lb (4.5 kg).

Conclusions

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.

Keywords

World Trade Center Sleep disordered breathing Obstructive sleep apnea Firefighters GERD Rhinosinusitis Snoring 

Reference

  1. 1.
    Tishler PV, Larkin EK, Schluchter MD, Redline S (2003) Incidence of sleep-disordered breathing in an urban adult population: the relative importance of risk factors in the development of sleep-disordered breathing. JAMA 289(17):2230–2237PubMedCrossRefGoogle Scholar
  2. 2.
    Huang QR, Qin Z, Zhang S, Chow CM (2008) Clinical patterns of obstructive sleep apnea and its comorbid conditions: a data mining approach. J Clin Sleep Med 4(6):543–550PubMedGoogle Scholar
  3. 3.
    Young T, Peppard PE, Gottlieb DJ (2002) Epidemiology of obstructive sleep apnea: a population health perspective. Am J Respir Crit Care Med 165(9):1217–1239PubMedCrossRefGoogle Scholar
  4. 4.
    Hiestand DM, Britz P, Goldman M, Phillips B (2006) Prevalence of symptoms and risk of sleep apnea in the US population: results from the national sleep foundation sleep in America 2005 poll. Chest 130(3):780–786PubMedCrossRefGoogle Scholar
  5. 5.
    Young T, Evans L, Finn L, Palta M (1997) Estimation of the clinically diagnosed proportion of sleep apnea syndrome in middle-aged men and women. Sleep 20(9):705–706PubMedGoogle Scholar
  6. 6.
    Kapur V, Strohl KP, Redline S, Iber C, O’Connor G, Nieto J (2002) Underdiagnosis of sleep apnea syndrome in U.S. communities. Sleep Breath 6(2):49–54PubMedCrossRefGoogle Scholar
  7. 7.
    Findley L, Smith C, Hooper J, Dineen M, Suratt PM (2000) Treatment with nasal CPAP decreases automobile accidents in patients with sleep apnea. Am J Respir Crit Care Med 161(3 Pt 1):857–859PubMedGoogle Scholar
  8. 8.
    Sjosten N, Vahtera J, Salo P, Oksanen T, Saaresranta T, Virtanen M, Pentti J, Kivimaki M (2009) Increased risk of lost workdays prior to the diagnosis of sleep apnea. Chest 136(1):130–136PubMedCrossRefGoogle Scholar
  9. 9.
    Sjosten N, Kivimaki M, Oksanen T, Salo P, Saaresranta T, Virtanen M, Pentti J, Vahtera J (2009) Obstructive sleep apnoea syndrome as a predictor of work disability. Respir Med 103(7):1047–1055PubMedCrossRefGoogle Scholar
  10. 10.
    Peppard PE, Young T, Palta M, Skatrud J (2000) Prospective study of the association between sleep-disordered breathing and hypertension. N Engl J Med 342(19):1378–1384PubMedCrossRefGoogle Scholar
  11. 11.
    Punjabi NM, Caffo BS, Goodwin JL, Gottlieb DJ, Newman AB, O'Connor GT, Rapoport DM, Redline S, Resnick HE, Robbins JA, Shahar E, Unruh ML, Samet JM (2009) Sleep-disordered breathing and mortality: a prospective cohort study. PLoS Med 6(8):e1000132PubMedCrossRefGoogle Scholar
  12. 12.
    Yaggi HK, Concato J, Kernan WN, Lichtman JH, Brass LM, Mohsenin V (2005) Obstructive sleep apnea as a risk factor for stroke and death. N Engl J Med 353(19):2034–2041PubMedCrossRefGoogle Scholar
  13. 13.
    Punjabi NM, Sorkin JD, Katzel LI, Goldberg AP, Schwartz AR, Smith PL (2002) Sleep-disordered breathing and insulin resistance in middle-aged and overweight men. Am J Respir Crit Care Med 165(5):677–682PubMedGoogle Scholar
  14. 14.
    Punjabi NM, Shahar E, Redline S, Gottlieb DJ, Givelber R, Resnick HE (2004) Sleep-disordered breathing, glucose intolerance, and insulin resistance: the Sleep Heart Health Study. Am J Epidemiol 160(6):521–530PubMedCrossRefGoogle Scholar
  15. 15.
    Sharafkhaneh A, Giray N, Richardson P, Young T, Hirshkowitz M (2005) Association of psychiatric disorders and sleep apnea in a large cohort. Sleep 28(11):1405–1411PubMedGoogle Scholar
  16. 16.
    Young T, Finn L, Peppard PE, Szklo-Coxe M, Austin D, Nieto FJ, Stubbs R, Hla KM (2008) Sleep disordered breathing and mortality: eighteen-year follow-up of the Wisconsin sleep cohort. Sleep 31(8):1071–1078PubMedGoogle Scholar
  17. 17.
    Webber MP, Gustave J, Lee R, Niles JK, Kelly K, Cohen HW, Prezant DJ (2009) Trends in respiratory symptoms of firefighters exposed to the world trade center disaster: 2001–2005. Environ Health Perspect 117(6):975–980PubMedCrossRefGoogle Scholar
  18. 18.
    Berninger A, Webber MP, Cohen HW, Gustave J, Lee R, Niles JK, Chiu S, Zeig-Owens R, Kelly K, Prezant DJ (2009) Trends of elevated PTSD risk in firefighters exposed to the World Trade Center Disaster: 2001–2005Google Scholar
  19. 19.
    Gislason T, Janson C, Vermeire P, Plaschke P, Bjornsson E, Gislason D, Boman G (2002) Respiratory symptoms and nocturnal gastroesophageal reflux: a population-based study of young adults in three European countries. Chest 121(1):158–163PubMedCrossRefGoogle Scholar
  20. 20.
    Prezant DJ, Weiden M, Banauch GI, McGuinness G, Rom WN, Aldrich TK, Kelly KJ (2002) Cough and bronchial responsiveness in firefighters at the World Trade Center site. N Engl J Med 347(11):806–815PubMedCrossRefGoogle Scholar
  21. 21.
    Ware J Jr, Kosinski M, Keller SD (1996) A 12-item short-form health survey: construction of scales and preliminary tests of reliability and validity. Med Care 34(3):220–233PubMedCrossRefGoogle Scholar
  22. 22.
    Forbes D, Creamer M, Biddle D (2001) The validity of the PTSD checklist as a measure of symptomatic change in combat-related PTSD. Behav Res Ther 39(8):977–986PubMedCrossRefGoogle Scholar
  23. 23.
    Terhakopian A, Sinaii N, Engel CC, Schnurr PP, Hoge CW (2008) Estimating population prevalence of posttraumatic stress disorder: an example using the PTSD checklist. J Trauma Stress 21(3):290–300PubMedCrossRefGoogle Scholar
  24. 24.
    Perrin MA, DiGrande L, Wheeler K, Thorpe L, Farfel M, Brackbill R (2007) Differences in PTSD prevalence and associated risk factors among World Trade Center disaster rescue and recovery workers. Am J Psychiatry 164(9):1385–1394PubMedCrossRefGoogle Scholar
  25. 25.
    Netzer NC, Stoohs RA, Netzer CM, Clark K, Strohl KP (1999) Using the Berlin Questionnaire to identify patients at risk for the sleep apnea syndrome. Ann Intern Med 131(7):485–491PubMedGoogle Scholar
  26. 26.
    Young T, Palta M, Dempsey J, Skatrud J, Weber S, Badr S (1993) The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med 328(17):1230–1235PubMedCrossRefGoogle Scholar
  27. 27.
    Finn L, Young T, Palta M, Fryback DG (1998) Sleep-disordered breathing and self-reported general health status in the Wisconsin Sleep Cohort Study. Sleep 21(7):701–706PubMedGoogle Scholar
  28. 28.
    Silva GE, An MW, Goodwin JL, Shahar E, Redline S, Resnick H, Baldwin CM, Quan SF (2009) Longitudinal evaluation of sleep-disordered breathing and sleep symptoms with change in quality of life: the Sleep Heart Health Study (SHHS). Sleep 32(8):1049–1057PubMedGoogle Scholar
  29. 29.
    Wannamethee G, Shaper AG (1991) Self-assessment of health status and mortality in middle-aged British men. Int J Epidemiol 20(1):239–245PubMedCrossRefGoogle Scholar
  30. 30.
    de la Hoz RE, Aurora RN, Landsbergis P, Bienenfeld LA, Afilaka AA, Herbert R (2010) Snoring and obstructive sleep apnea among former World Trade Center rescue workers and volunteers. J Occup Environ Med 52(1):29–32PubMedCrossRefGoogle Scholar
  31. 31.
    Klenk J, Nagel G, Ulmer H, Strasak A, Concin H, Diem G, Rapp K (2009) Body mass index and mortality: results of a cohort of 184, 697 adults in Austria. Eur J Epidemiol 24(2):83–91PubMedCrossRefGoogle Scholar
  32. 32.
    Jecker P, Orloff LA, Mann WJ (2005) Extraesophageal reflux and upper aerodigestive tract diseases. ORL J Otorhinolaryngol Relat Spec 67(4):185–191PubMedCrossRefGoogle Scholar
  33. 33.
    Eskiizmir G, Kezirian E (2009) Is there a vicious cycle between obstructive sleep apnea and laryngopharyngeal reflux disease? Med Hypotheses 73(5):706–708PubMedCrossRefGoogle Scholar
  34. 34.
    Graf KI, Karaus M, Heinemann S, Korber S, Dorow P, Hampel KE (1995) Gastroesophageal reflux in patients with sleep apnea syndrome. Z Gastroenterol 33(12):689–693PubMedGoogle Scholar
  35. 35.
    Ing AJ, Ngu MC, Breslin AB (2000) Obstructive sleep apnea and gastroesophageal reflux. Am J Med 108(Suppl 4a):120S–125SPubMedCrossRefGoogle Scholar
  36. 36.
    Friedman M, Gurpinar B, Lin HC, Schalch P, Joseph NJ (2007) Impact of treatment of gastroesophageal reflux on obstructive sleep apnea–hypopnea syndrome. Ann Otol Rhinol Laryngol 116(11):805–811PubMedGoogle Scholar
  37. 37.
    Shaheen NJ, Madanick RD, Alattar M, Morgan DR, Davis PH, Galanko JA, Spacek MB, Vaughn BV (2008) Gastroesophageal reflux disease as an etiology of sleep disturbance in subjects with insomnia and minimal reflux symptoms: a pilot study of prevalence and response to therapy. Dig Dis Sci 53(6):1493–1499PubMedCrossRefGoogle Scholar
  38. 38.
    Craig TJ, Ferguson BJ, Krouse JH (2008) Sleep impairment in allergic rhinitis, rhinosinusitis, and nasal polyposis. Am J Otolaryngol 29(3):209–217PubMedCrossRefGoogle Scholar
  39. 39.
    Young T, Finn L, Kim H (1997) Nasal obstruction as a risk factor for sleep-disordered breathing. The University of Wisconsin Sleep and Respiratory Research Group. J Allergy Clin Immunol 99(2):S757–S762PubMedCrossRefGoogle Scholar
  40. 40.
    Corey JP, Houser SM, Ng BA (2000) Nasal congestion: a review of its etiology, evaluation, and treatment. Ear Nose Throat J 79(9):690–693, 696, 698PubMedGoogle Scholar
  41. 41.
    Tosun F, Kemikli K, Yetkin S, Ozgen F, Durmaz A, Gerek M (2009) Impact of endoscopic sinus surgery on sleep quality in patients with chronic nasal obstruction due to nasal polyposis. J Craniofac Surg 20(2):446–449PubMedCrossRefGoogle Scholar
  42. 42.
    Friedman M, Tanyeri H, Lim JW, Landsberg R, Vaidyanathan K, Caldarelli D (2000) Effect of improved nasal breathing on obstructive sleep apnea. Otolaryngol Head Neck Surg 122(1):71–74PubMedCrossRefGoogle Scholar
  43. 43.
    Ross RJ, Ball WA, Dinges DF, Kribbs NB, Morrison AR, Silver SM, Mulvaney FD (1994) Rapid eye movement sleep disturbance in posttraumatic stress disorder. Biol Psychiatry 35(3):195–202PubMedCrossRefGoogle Scholar
  44. 44.
    Mellman TA, Kumar A, Kulick-Bell R, Kumar M, Nolan B (1995) Nocturnal/daytime urine noradrenergic measures and sleep in combat-related PTSD. Biol Psychiatry 38(3):174–179PubMedCrossRefGoogle Scholar
  45. 45.
    Dow BM, Kelsoe JR Jr, Gillin JC (1996) Sleep and dreams in Vietnam PTSD and depression. Biol Psychiatry 39(1):42–50PubMedCrossRefGoogle Scholar
  46. 46.
    Sateia MJ (2009) Update on sleep and psychiatric disorders. Chest 135(5):1370–1379PubMedCrossRefGoogle Scholar
  47. 47.
    Babson KA, Feldner MT (2010) Temporal relations between sleep problems and both traumatic event exposure and PTSD: a critical review of the empirical literature. J Anxiety Disord 24:1–15PubMedCrossRefGoogle Scholar
  48. 48.
    Neylan TC, Metzler TJ, Schoenfeld FB, Weiss DS, Lenoci M, Best SR, Lipsey TL, Marmar CR (2001) Fluvoxamine and sleep disturbances in posttraumatic stress disorder. J Trauma Stress 14(3):461–467PubMedCrossRefGoogle Scholar
  49. 49.
    Teodorescu M, Consens FB, Bria WF, Coffey MJ, McMorris MS, Weatherwax KJ, Palmisano J, Senger CM, Ye Y, Kalbfleisch JD, Chervin RD (2009) Predictors of habitual snoring and obstructive sleep apnea risk in patients with asthma. Chest 135(5):1125–1132PubMedCrossRefGoogle Scholar
  50. 50.
    de Niet GJ, Tiemens BG, Lendemeijer HH, Hutschemaekers GJ (2008) Perceived sleep quality of psychiatric patients. J Psychiatr Ment Health Nurs 15(6):465–470PubMedCrossRefGoogle Scholar
  51. 51.
    Tuomilehto HP, Seppa JM, Partinen MM, Peltonen M, Gylling H, Tuomilehto JO, Vanninen EJ, Kokkarinen J, Sahlman JK, Martikainen T, Soini EJ, Randell J, Tukiainen H, Uusitupa M (2009) Lifestyle intervention with weight reduction: first-line treatment in mild obstructive sleep apnea. Am J Respir Crit Care Med 179(4):320–327PubMedCrossRefGoogle Scholar
  52. 52.
    Galovski TE, Monson C, Bruce SE, Resick PA (2009) Does cognitive-behavioral therapy for PTSD improve perceived health and sleep impairment? J Trauma Stress 22(3):197–204PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • Mayris P. Webber
    • 1
    • 2
  • Roy Lee
    • 2
  • Jackie Soo
    • 2
    • 3
  • Jackson Gustave
    • 2
  • Charles B. Hall
    • 4
  • Kerry Kelly
    • 2
  • David Prezant
    • 2
    • 5
  1. 1.Department of Epidemiology and Population HealthMontefiore Medical Center and Albert Einstein College of MedicineBronxUSA
  2. 2.Bureau of Health ServicesFire Department of the City of New YorkBrooklynUSA
  3. 3.Department of MedicineMontefiore Medical CenterBronxUSA
  4. 4.Department of Epidemiology and Population HealthAlbert Einstein College of MedicineBronxUSA
  5. 5.Department of MedicineMontefiore Medical Center and Albert Einstein College of MedicineBronxUSA

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