Abstract
Background: World Trade Center (WTC) dust-exposed subjects have multiple comorbidities that affect sleep. These include obstructive sleep apnea (OSA), chronic rhinosinusitis (CRS), gastroesophageal-reflux disorder (GERD) and post-traumatic stress disorder (PTSD). We examined the impact of these conditions to sleep-related outcomes. Methods: Demographics, co-morbidities and symptoms were obtained from 626 WTC (109F/517M), 33–87years, BMI = 29.96 ± 5.53 kg/m2) subjects. OSA diagnosis was from a 2-night home sleep test (ARESTM). Subjective sleep quality, sleep-related quality of life (QOL, Functional Outcomes of Sleep Questionnaire), excessive daytime sleepiness (Epworth Sleepiness Scale), sleep duration and sleep onset and maintenance complaints were assessed. Results: Poor sleep quality and complaints were reported by 19–70% of subjects and average sleep duration was 6.4 h. 74.8% of subjects had OSA. OSA diagnosis/severity was not associated with any sleep-related outcomes. Sleep duration was lower in subjects with all conditions (p < 0.05) except OSA. CRS was a significant risk factor for poor sleep-related QOL, sleepiness, sleep quality and insomnia; PTSD for poor sleep-related QOL and insomnia; GERD for poor sleep quality. These associations remained significant after adjustment for, age, BMI, gender, sleep duration and other comorbidities. Conclusions: Sleep complaints are common and related to several health conditions seen in WTC responders. Initial interventions in symptomatic patients with both OSA and comorbid conditions may need to be directed at sleep duration, insomnia or the comorbid condition itself, in combination with intervention for OSA.
Highlights
IntroductionFollowing the World Trade Center (WTC) disaster, many responders who worked in rescue, recovery and debris removal were exposed to high concentrations (greater than 100,000 μm/m3 total particles) of debris [1]
Following the World Trade Center (WTC) disaster, many responders who worked in rescue, recovery and debris removal were exposed to high concentrations of debris [1]
The demographic data, sleep duration, sleep-related quality of life and sleep complaints are provided in Table 1. 74.8% of subjects had obstructive sleep apnea (OSA) diagnosed by home monitoring, predominantly mild OSA. 47.1% of the subjects were identified as chronic rhinosinusitis (CRS)+ by questionnaire, 19.3% had depression, 23.5% had PTSD, 23.5% had anxiety/panic and 52% had GERD
Summary
Following the World Trade Center (WTC) disaster, many responders who worked in rescue, recovery and debris removal were exposed to high concentrations (greater than 100,000 μm/m3 total particles) of debris [1] This exposure was associated with an increased risk of developing obstructive sleep apnea (OSA) [2], chronic rhinosinusitis (CRS) [3], post-traumatic stress disorder. World Trade Center (WTC) dust-exposed subjects have multiple comorbidities that affect sleep These include obstructive sleep apnea (OSA), chronic rhinosinusitis (CRS), gastroesophageal-reflux disorder (GERD) and post-traumatic stress disorder (PTSD). CRS was a significant risk factor for poor sleep-related QOL, sleepiness, sleep quality and insomnia; PTSD for poor sleep-related QOL and insomnia; GERD for poor sleep quality These associations remained significant after adjustment for, age, BMI, gender, sleep duration and other comorbidities. Initial interventions in symptomatic patients with both OSA and comorbid conditions may need to be directed at sleep duration, insomnia or the comorbid condition itself, in combination with intervention for OSA
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