Obstructive sleep apnea (OSA) is a highly prevalent disorder with significant morbidity and impact on quality of life that can be improved by treatment with continuous positive airway pressure (CPAP). This study will examine the role of nasal pathology in World Trade Center (WTC) responders in the development of OSA and its impact on their ability to use CPAP. The present study contributes to understanding the relationship of nasal /upper airway mechanisms to the development of sleep apnea in this population and explores the possibility of improving comfort and adherence to CPAP treatment by modifying how CPAP is delivered.
In WTC responders we hypothesized that chronic rhinosinusitis (CRS) would be associated with increased prevalence and severity of obstructive sleep apnea (OSA), mediated by elevated total nasal resistance (TNR). We report on the first 201 subjects (170M/31F, 34-77years, BMI 31.1+/-4.9 kg/m2). CRS was defined by =3 nasal/upper airway symptoms over the prior 8 weeks. TNR was measured with 4-phase Rhinomanometry in sitting and supine positions, pre and post nasal decongestion and high TNR defined as LogTNR =0.8. Epworth Sleepiness Scale (ESS) and Functional Outcome of Sleep Questionnaire (FOSQ) measured subjective sleepiness. OSA was assessed with two nights of limited-channel home sleep monitoring (ARES unicorder). Apnea+Hypopneas with 4% desaturation (AHI4) and 1% desaturation/arousal surrogate (RDI) were obtained and OSA defined as AHI4 =5/hr or RDI =15/hr.
Identification of obstructive sleep apnea (OSA) in this population that is at high risk for OSA due to traditional risk factors and in addition due to upper airway inflammation.
Determining factors that are mainly responsible for this high risk for OSA including factors such as nasal symptoms, nasal inflammation and nasal resistance.
Determining the comparative effectiveness of CPAP versus CPAPflex in those subjects with OSA who have high nasal resistance through increasing adherence to therapy, thus allowing the WTC Health Program to make appropriate treatment decision with regard to these responders.
Identification and treatment of OSA will ultimately result in reduction of long term consequences of OSA such as cardiovascular co-morbidities and could potentially benefit those subjects with mood disorders and PTSD.
Rutgers Robert Wood Johnson Medical School: Howard Kipen, M.D., M.P.H; Iris Udasin, M.D.; Shou-en Lu, PhD.; Robert Laumbach, M.D., M.P.H.; Jeffrey L. Carson, M.D; Kathleen Black, PhD.
New York University School of Medicine: David M. Rapoport, M.D.; Nishay Chitkara, M.D.; Denise Harrison, M.D.; AkosuaTwumasi, B.S.
Gumb T, Twumasi A, Alimokhtari S, Perez A, Black K, Rapoport DM, Sunderram J, Ayappa, I. 2017. Comparison of two home sleep testing devices with different strategies for diagnosis of OSA. Sleep Breath. Published online August 2017
Ayappa I*, Sunderram J*, Black K, Twumasi A, Udasin I, Harrison D, CarsonJL, Lu S-E and Rapoport DM. 2015. A comparison of CPAP and CPAPFLEX in the treatment of obstructive sleep apnea in World Trade Center responders: study protocol for a randomized controlled trial. Trials. 16:403.
* Contributed equally
Wu BG, Sulaiman I, Wang J, et al. 2018. Severe obstructive sleep apnea is associated with alterations in the nasal microbiome and increase in inflammation. American Journal of Respiratory and Critical Care Medicine.
