Exploring Mechanisms of Obstructive Sleep Apnea (OSA) in WTC Responders

Details

• Personal Author:
  Ayappa IA ; Lu S-E ; Rapoport D ; Sunderram J ; Udasin IG
• Description:
  The underlying causes of obstructive sleep apnea (OSA) are multifactorial and include impaired upper airway anatomy, low arousal threshold, respiratory control instability, and/or altered neuro-muscular control of upper airway muscles. The relative contribution of each of these components can be obtained from a sleep study and may define a physiologic trait. WTC dust-exposed subjects have a high prevalence of chronic rhinosinusitis (CRS), gastroesophageal reflux disease, post-traumatic stress disorder and obesity that increase risk for OSA. Our goals are to define how these comorbid conditions might act via individual pathophysiologic mechanisms. Our prior data in > 600 WTC responders shows an extraordinary prevalence of OSA of 74%. We have also found an independent association between new/worsening CRS symptoms since 9/11 and OSA. This association is not explained by increased nasal resistance in those with CRS, suggesting other mechanisms could impact upper airway function in CRS including neuropathy, fibrosis and reduced upper airway sensitivity. Furthermore, the high prevalence of OSA even in subjects without CRS highlights the need to identify the mechanisms of OSA in WTC responders. This proposal provides insight into the pathophysiologic mechanisms and mechanistic components of OSA in WTC Responders using novel methodology to help identify groups responding to non-PAP therapies and contribute to a more rational approach to developing and combining non-CPAP therapies. In this project, we analyzed sleep data from WTC responders with and without OSA and a matched group of sleep clinic controls with OSA at ISMMS and Rutgers RWJMS. All subjects underwent overnight sleep studies and assessment of symptoms of chronic rhinosinusitis. We assessed upper airway sensitivity in WTC responders. These were some of our main findings: Although WTC responders have significant OSA and CRS, contrary to our expectation, we did not see a relationship between OSA and upper airway sensitivity or CRS and upper airway sensitivity. Subjects with OSA and CRS did not have lower upper airway sensitivity compared to subjects without OSA or CRS, suggesting that other factors need to be assessed to explain the higher risk of OSA in subjects with CRS. We see greater subjective sleep disturbances (sleepiness, insomnia and impact of sleepiness on activities of daily living) in WTC responders with CRS compared to those without CRS. We did not find objective sleep measures that explained these differences in subjective complaints, and future research will examine measures such as intermittent hypoxemia, or general inflammation which likely play a role in CRS and sleep disturbance in this population. In WTC subjects with OSA, we did not find significant differences in pathophysiology (causes for OSA) between those with and without CRS. When comparing WTC responders and non-WTC controls with OSA, we observe differences in the mechanisms underlying OSA although some of these differences may be explained by differences in severity of OSA between the groups. This information could help in personalizing treatments for OSA in WTC responders. [Description provided by NIOSH]
• Subjects:
  Dust Emergency Responders Occupational Health Respiratory System Safety September 11 Terrorist Attacks
• Keywords:
  Airway Obstruction Disaster Response Dust Exposure Emergency Responders Physiological Effects Respiratory Function Sleep Apnea World Trade Center WTC
• Series:
  Grant Final Reports
• Publisher:
  National Institute for Occupational Safety and Health
• Document Type:
  Text
• Funding:
  Cooperative Agreement
• Genre:
  Final Cooperative Agreement Report
• Place as Subject:
  New York ; OSHA Region 2
• CIO:
  National Institute for Occupational Safety and Health (NIOSH)
• Division:
  OEP - Office of Extramural Programs
• Topic:
  Workplace Safety & Health
• Location:
  North America
• Pages in Document:
  1-21
• NIOSHTIC Number:
  nn:20066243
• Citation:
  Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, U01-OH-011481, 2022 Sep; :1-21
• Email:
  indu.ayappa@mssm.edu
• Federal Fiscal Year:
  2022
• Performing Organization:
  Icahn School of Medicine at Mount Sinai, New York
• Peer Reviewed:
  False
• Start Date:
  20180701
• Source Full Name:
  National Institute for Occupational Safety and Health
• End Date:
  20210630
• Collection(s):
  National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:6bb6622044b0d39a09df374b48d90dc04757af951c174bd105b64b34344e1c53562ef6daa74e7d67dd75ec0daa2cb7360c970246001333bb307f6543c0ae7eb1
• Download URL:
  https://stacks.cdc.gov/view/cdc/219149/cdc_219149_DS1.pdf
• File Type:
  [PDF - 1.44 MB ]