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

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 +/- 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 =.006) unadjusted and 1.76 (95% CI, 1.08-2.88; P =.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.