title: Obstructive sleep apnea and World Trade Center exposure.
abstract: OBJECTIVE
  To describe the proportion of at-risk World Trade Center (WTC)-exposed rescue/recovery workers with polysomnogram-confirmed obstructive sleep apnea (OSA) and examine the relationship between WTC exposure, physician-diagnosed gastroesophageal reflux disease (GERD), and rhinosinusitis and OSA.
  
  
  METHODS
  A total of 636 male participants completed polysomnography from September 24, 2010, to September 23, 2012. Obstructive sleep apnea was classified as mild, moderate, or severe. Associations were tested using nominal polytomous logistic regression.
  
  
  RESULTS
  Eighty-one percent of workers were diagnosed with OSA. Using logistic regression models, severe OSA was associated with WTC exposure on September 11, 2001 (odds ratio, 1.91; 95% confidence interval, 1.15 to 3.17), GERD (odds ratio, 2.75; 95% confidence interval, 1.33 to 5.70), and comorbid GERD/rhinosinusitis (odds ratio, 2.31; 95% confidence interval, 1.22 to 4.40).
  
  
  CONCLUSIONS
  We found significant associations between severe OSA and WTC exposure, and with diseases prevalent in this population. Accordingly, we recommend clinical evaluation, including polysomnography, for patients with high WTC exposure, other OSA risk factors, and a physician diagnosis of GERD or comorbid GERD and rhinosinusitis.
authors.affiliation: From the Department of Medicine (Ms Glaser, Dr Shah, Ms Zeig-Owens, Dr Appel, and Ms Weakley), Montefiore Medical Center, Bronx, NY; Bureau of Health Services (Ms Glaser, Ms Zeig-Owens, Ms Jaber, Ms Weakley, Dr Kelly, and Dr Prezant), Fire Department of the City of New York, Brooklyn, NY; Department of Epidemiology and Population Health (Drs Webber, Hall, and Cohen), Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY; Department of Pulmonary Medicine (Drs Shah, Appel, and Prezant), Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY; and Pulmonary, Critical Care, and Sleep Medicine Department (Dr Shulman), ProHEALTH Care Associates, LLP, Lake Success, NY.
authors.forename: Michelle S
authors.initials: MS
authors.lastname: Glaser
authors.forename: Neomi
authors.initials: N
authors.lastname: Shah
authors.forename: Mayris P
authors.initials: MP
authors.lastname: Webber
authors.forename: Rachel
authors.initials: R
authors.lastname: Zeig-Owens
authors.forename: Nadia
authors.initials: N
authors.lastname: Jaber
authors.forename: David W
authors.initials: DW
authors.lastname: Appel
authors.forename: Charles B
authors.initials: CB
authors.lastname: Hall
authors.forename: Jessica
authors.initials: J
authors.lastname: Weakley
authors.forename: Hillel W
authors.initials: HW
authors.lastname: Cohen
authors.forename: Lawrence
authors.initials: L
authors.lastname: Shulman
authors.forename: Kerry
authors.initials: K
authors.lastname: Kelly
authors.forename: David
authors.initials: D
authors.lastname: Prezant
mesh_terms: D000328:Adult; D015897:Comorbidity; D003430:Cross-Sectional Studies; D060731:Emergency Responders / Q000706:statistics & numerical data; D005764:Gastroesophageal Reflux / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009519:New York City; D016273:Occupational Exposure / Q000009:adverse effects*; D017286:Polysomnography; D018635:Rescue Work; D047851:September 11 Terrorist Attacks; D012852:Sinusitis / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*