title: Prevalence and incidence of high risk for obstructive sleep apnea in World Trade Center-exposed rescue/recovery workers.
abstract: OBJECTIVE
  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).
  
  
  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/m(2)), and, as expected, BMI > 30 kg/m(2) 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.
authors.affiliation: Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA. webberm@fdny.nyc.gov
authors.forename: Mayris P
authors.initials: MP
authors.lastname: Webber
authors.forename: Roy
authors.initials: R
authors.lastname: Lee
authors.forename: Jackie
authors.initials: J
authors.lastname: Soo
authors.forename: Jackson
authors.initials: J
authors.lastname: Gustave
authors.forename: Charles B
authors.initials: CB
authors.lastname: Hall
authors.forename: Kerry
authors.initials: K
authors.lastname: Kelly
authors.forename: David
authors.initials: D
authors.lastname: Prezant
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015984:Causality; D015331:Cohort Studies; D015897:Comorbidity; D003430:Cross-Sectional Studies; D004634:Emergency Medical Technicians / Q000706:statistics & numerical data*; D061388:Firefighters / Q000706:statistics & numerical data*; D005500:Follow-Up Studies; D005764:Gastroesophageal Reflux / Q000453:epidemiology; D006304:Health Status; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009519:New York City; D009784:Occupational Diseases / Q000453:epidemiology*; D016273:Occupational Exposure / Q000009:adverse effects; D012066:Relief Work / Q000706:statistics & numerical data*; D012307:Risk Factors; D047851:September 11 Terrorist Attacks; D020181:Sleep Apnea, Obstructive / Q000453:epidemiology*; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology; D011795:Surveys and Questionnaires; D055815:Young Adult