nach oben

Sleep and Breathing

Erschienen in:

17.03.2020 | Epidemiology • Original Article

Burn pit exposure in military personnel: is there an effect on sleep-disordered breathing?

verfasst von: Tyler A. Powell, Vincent Mysliwiec, James K. Aden, Michael J. Morris

Erschienen in: Sleep and Breathing | Ausgabe 1/2021

Einloggen, um Zugang zu erhalten

Abstract

Purpose

Exposure to elevated concentrations of respirable particulate matter (< 10 μm) may influence sleep-disordered breathing. Burn pits as utilized by the US military in the Middle East until 2011 produced elevated particle matter concentrations. We seek to determine if subjective exposure to burn pits during deployment affects prevalence or severity of obstructive sleep apnea (OSA) in military personnel.

Methods

As part of a prospective observational study of previously deployed military personnel with exertional dyspnea (n = 145), all patients underwent pulmonary function testing, screening for burn pit exposure, and if warranted by questionnaires, overnight polysomnography. A total of 100 patients completed all testing. For analysis, patients were classified into a burn pit exposure group (45 patients) and a no exposure group (55 patients). Additional analyses were performed on those endorsing burn pit maintenance during deployment (25 patients) and those with > 12 h of daily exposure (17 patients).

Results

The prevalence of OSA, defined by apnea-hypopnea index (AHI) > 5/h, was similarly high in both groups (69% vs. 71%, p = 0.83). Surprisingly, the mean AHI was lower in the exposed group (12.8/h vs. 19.7/h, p = 0.04) while nadir of oxygen saturation was similar (87% vs. 86%, p = 0.39). Subgroup analyses revealed similar findings in those who performed burn pit maintenance (prevalence = 80%, p = 0.58; AHI = 14.8, p = 0.16) and those with > 12 h of daily exposure (prevalence = 88%, p = 0.33; AHI = 18.0, p = 0.62).

Conclusions

Subjective burn pit exposure does not appear to influence OSA development in previously deployed military personnel. Given the high rate of OSA in this cohort, continued investigation of deployment exposures which may influence sleep-disordered breathing is recommended.

Smith B, Wong CA, Smith TC, Boyko EJ, Gackstetter GD, Margaret AK (2009) Newly reported respiratory symptoms and conditions among military personnel deployed to Iraq and Afghanistan: a prospective population-based study. Am J Epidemiol 170(11):1433–1442PubMed

Morris MJ, Dodson DW, Lucero PF, Haislip GD, Gallup RA, Nicholson KL, Zacher LL (2014) Study of active duty military for pulmonary disease related to environmental deployment exposures (STAMPEDE). Am J Respir Crit Care Med 190(1):77–84PubMed

King MS, Eisenberg R, Newman JH, Tolle JJ, Harrell FE Jr, Nian H, Ninan M, Lambright ES, Sheller JR, Johnson JE, Miller RF (2011) Constrictive bronchiolitis in soldiers returning from Iraq and Afghanistan. N Engl J Med 365(3):222–230PubMedPubMedCentral

Baird CP (2012) Review of the institute of medicine report: long-term health consequences of exposure to burn pits in Iraq and Afghanistan. US Army Med Dep J:43–47

Blasch KW, Kolivosky JE, Heller JM (2016) Environmental air sampling near burn pit and incinerator operations at Bagram airfield, Afghanistan. J Occup Environ Med 58(8):S38–S43PubMed

Liu J, Lezama N, Gasper J, Kawata J, Morley S, Helmer D, Ciminera P (2016) Burn pit emissions exposure and respiratory and cardiovascular conditions among airborne hazards and open burn pit registry participants. J Occup Environ Med 58(7):e249–e255PubMed

Smith B, Wong CA, Boyko EJ, Phillips CJ, Gackstetter GD, Ryan MA, Smith TC, Millennium Cohort Study Team (2012) The effects of exposure to documented open-air burn pits on respiratory health among deployers of the millennium cohort study. J Occup Environ Med 54(6):708–716PubMed

Powell TM, Smith TC, Jacobson IG, Boyko EJ, Hooper TI, Gackstetter GD, Phillips CJ, Smith B, Millennium Cohort Study Team (2012) Prospective assessment of chronic multisymptom illness reporting possibly associated with open-air burn pit smoke exposure in Iraq. J Occup Environ Med 54(6):682–688PubMed

Armed Forces Health Surveillance Center. Epidemiological studies of health outcomes among troops deployed to burn pit sites. Silver Spring, MD. 2010

10.

Caldwell JA, Knapik JJ, Shing TL, Kardouni JR, Lieberman HR The association of insomnia and sleep apnea with deployment and combat exposure in the entire population of US Army soldiers from 1997-2011: A retrospective cohort investigation. Sleep. In press. https://doi.org/10.1093/sleep/zsz112

11.

Lettieri CJ, Eliasson AH, Andrada T, Khramtsov A, Raphaelson M, Kristo DA (2005) Obstructive sleep apnea syndrome: are we missing an at-risk population? J Clin Sleep Med 1(04):381–385PubMed

12.

Capaldi VF, Guerrero ML, Killgore WD (2011) Sleep disruptions among returning combat veterans from Iraq and Afghanistan. Mil Med 176(8):879–888PubMed

13.

Mysliwiec V, McGraw L, Pierce R, Smith P, Trapp B, Roth BJ (2013) Sleep disorders and associated medical comorbidities in active duty military personnel. Sleep. 36(2):167–174PubMedPubMedCentral

14.

Mysliwiec V, Gill J, Lee H et al (2013) Sleep disorders in U.S. military personnel: a high rate of comorbid insomnia and obstructive sleep apnea. Chest. 144(2):549–557PubMedPubMedCentral

15.

Caldwell J, Knapik JJ, Lieberman HR (2017) Trends and factors associated with insomnia and sleep apnea in all United States military service members from 2005 to 2014. J Sleep Res 26(5):665–670

16.

Zanobetti A, Redline S, Schwartz J, Rosen D, Patel S, O'Connor GT, Lebowitz M, Coull BA, Gold DR (2010) Associations of PM10 with sleep and sleep-disordered breathing in adults from seven US urban areas. Am J Respir Crit Care Med 182(6):819–825PubMedPubMedCentral

17.

Shen YL, Liu WT, Lee KY, Chuang HC, Chen HW, Chuang KJ (2018) Association of PM 2.5 with sleep-disordered breathing from a population-based study in Northern Taiwan urban areas. Environ Pollut 233:109–113PubMed

18.

Abou-Khadra MK (2013) Association between PM 10 exposure and sleep of Egyptian school children. Sleep Breath 17(2):653–657PubMed

19.

Chuang HC, Su TY, Chuang KJ, Hsiao TC, Lin HL, Hsu YT, Pan CH, Lee KY, Ho SC, Lai CH (2018) Pulmonary exposure to metal fume particulate matter cause sleep disturbances in shipyard welders. Environ Pollut 232:523–532PubMed

20.

Lappharat S, Taneepanichskul N, Reutrakul S, Chirakalwasan N (2018) Effects of bedroom environmental conditions on the severity of obstructive sleep apnea. J Clin Sleep Med 14(04):565–573PubMedPubMedCentral

21.

Ahuja S, Zhu Z, Shao Y, Berger KI, Reibman J, Ahmed O (2018) Obstructive sleep apnea in community members exposed to world trade center dust and fumes. J Clin Sleep Med 14(05):735–743PubMedPubMedCentral

22.

Glaser MS, Shah N, Webber MP et al (2014) Obstructive sleep apnea and world trade center exposure. J Occup Environ Med 56:S30–S34PubMed

23.

Webber MP, Lee R, Soo J, Gustave J, Hall CB, Kelly K, Prezant D (2011) Prevalence and incidence of high risk for obstructive sleep apnea in world trade center exposed rescue/recovery workers. Sleep Breath 15(3):283–294PubMed

24.

Lioy PJ, Weisel CP, Millette JR, Eisenreich S, Vallero D, Offenberg J, Buckley B, Turpin B, Zhong M, Cohen MD, Prophete C, Yang I, Stiles R, Chee G, Johnson W, Porcja R, Alimokhtari S, Hale RC, Weschler C, Chen LC (2002) Characterization of the dust/smoke aerosol that settled east of the world trade center (WTC) in lower Manhattan after the collapse of the WTC 11 September 2001. Environ Health Perspect 110(7):703–714PubMedPubMedCentral

25.

Abraham JH, Baird CB (2012) A case-crossover study of ambient particulate matter and cardiovascular and respiratory medical encounters among U.S. military personnel deployed to Southwest Asia. J Occup Environ Med 54:733–739PubMed

26.

Engelbrecht JP, McDonald EV, Giles JA, Javanty RK, Casuccio G, Gentler AW (2009) Characterizing mineral dusts and other aerosols from the Middle East-part 1: ambient sampling. Inhal Toxicol 21:297–326PubMed

27.

Dockery DW, Pope CA (1994) Acute respiratory effects of particulate air pollution. Annu Rev Public Health 15(1):107–132PubMed

28.

Johns M (1992) Reliability and factor analysis of the Epworth sleepiness scale. Sleep. 15(4):376–381PubMed

29.

Farney RJ, Walker BS, Farney RM, Snow GL, Walker JM (2011) The STOP-BANG equivalent model and prediction of severity of obstructive sleep apnea: relation to polysomnographic measurements of the apnea/hypopnea index. J Clin Sleep Med 7(5):459–465PubMedPubMedCentral

30.

Butler DA, Styka AN, Savitz DA (2017) Assessment of the Department of Veterans Affairs Airborne Hazards and Open Burn Pit Registry. National Academies Press

31.

Hankinson JL, Odencrantz JR, Fedan KB (1999) Spirometric reference values from a sample of the general U.S. population. Am J Respir Crit Care Med 159(1):179–187PubMed

32.

Zinchuk A, Edwards B, Jeon S, Koo BB, Concato J, Sands S, Wellman A, Yaggi HK (2018) Prevalence, associated clinical features, and impact on continuous positive airway pressure use of a low respiratory arousal threshold among male United States veterans with obstructive sleep apnea. J Clin Sleep Med 14(5):809–817PubMedPubMedCentral

33.

Rogers AE, Stahlman S, Hunt DJ, Oh GT, Clark LL (2016) Obstructive sleep apnea and associated attrition, active component, US Armed Forces, January 2004-May 2016. MSMR. 23(10):2–11PubMed

34.

Collen J, Orr N, Lettieri CJ, Carter K, Holley AB (2012) Sleep disturbances among soldiers with combat-related traumatic brain injury. Chest. 142(3):622–630PubMed

35.

McMahon MJ, Sheikh KL, Andrada TF, Holley AB (2017) Using the STOPBANG questionnaire and other pre-test probability tools to predict OSA in younger, thinner patients referred to a sleep medicine clinic. Sleep Breath 21(4):869–876PubMed

36.

Smith P, Sheikh K, Costan-Toth C, Forsthoefel D, Bridges E, Andrada TF, Holley AB (2017) Eszopiclone and zolpidem do not affect the prevalence of the low arousal threshold phenotype. J Clin Sleep Med 13(1):115–119PubMedPubMedCentral

37.

Edwards B, Eckert D, McSharry D, Sands SA, Desai A, Kehlmann G, Bakker JP, Genta PR, Owens RL, White DP, Wellman A, Malhotra A (2014) Clinical predictors of the respiratory arousal threshold in patients with obstructive sleep apnea. Am J Resp Crit Care Med 190(11):1293–1300PubMedPubMedCentral

38.

Edwards B, Andara C, Landry S, Sands SA, Joosten SA, Owens RL, White DP, Hamilton GS, Wellman A (2016) Upper-airway collapsibility and loop gain predict the response to oral appliance therapy in patients with obstructive sleep apnea. Am J Resp Crit Care Med 194(11):1413–1422PubMedPubMedCentral

39.

Luxton DD, Greenburg D, Ryan J, Niven A, Wheeler G, Mysliwiec V (2011) Prevalence and impact of short sleep duration in redeployed OIF soldiers. Sleep. 34(9):1189–1195PubMedPubMedCentral

40.

Gadermann A, Engel C, Naifeh J et al (2012) Prevalence of DSM-IV major depression among U.S. military personnel: meta-analysis and simulation. Mil Med 177(8):47–59PubMed

41.

Aihara K, Oga T, Yoshimura C, Hitomi T, Chihara Y, Harada Y, Murase K, Toyama Y, Tanizawa K, Handa T, Tsuboi T, Mishima M, Chin K (2013) Measurement of dyspnea in patients with obstructive sleep apnea. Sleep Breath 17:753–761PubMed

42.

Powell TA, Mysliwiec V, Aden JK, Morris MJ (2019) Moderate to severe obstructive sleep apnea in military personnel is not associated with decreased exercise capacity. J Clin Sleep Med 15(6):823–829PubMedPubMedCentral

43.

Beitler J, Awad K, Bakker J, Edwards BA, DeYoung P, Djonlagic I, Forman DE, Quan SF, Malhotra A (2014) Obstructive sleep apnea is associated with impaired exercise capacity: a cross-sectional study. J Clin Sleep Med 10(11):1199–1204PubMedPubMedCentral

44.

Lin C, Hsieh W, Chou C, Liaw S (2006) Cardiopulmonary exercise testing in obstructive sleep apnea syndrome. Respir Physiol Neurobiol 150(1):27–34PubMed

45.

Minai O, Ricaurte B, Kaw R et al (2009) Frequency and impact of pulmonary hypertension in patients with obstructive sleep apnea syndrome. Am J Cardiol 104:1300–1306PubMed

46.

Aihara K, Oga T, Chihara Y et al (2011) Comparison of biomarkers of subclinical lung injury in obstructive sleep apnea. Respir Med 105(6):939–945PubMed

47.

Sateia MJ (2009) Update on sleep and psychiatric disorders. Chest. 135:1370–1379PubMed

Titel: Burn pit exposure in military personnel: is there an effect on sleep-disordered breathing?
verfasst von: Tyler A. Powell
Vincent Mysliwiec
James K. Aden
Michael J. Morris
Publikationsdatum: 17.03.2020
Verlag: Springer International Publishing
Erschienen in: Sleep and Breathing / Ausgabe 1/2021
Print ISSN: 1520-9512
Elektronische ISSN: 1522-1709
DOI: https://doi.org/10.1007/s11325-020-02060-x

Leitlinien kompakt für die Innere Medizin

Mit medbee Pocketcards sicher entscheiden.

^{Seit 2022 gehört die medbee GmbH zum Springer Medizin Verlag}

Kostenlos registrieren

Neu im Fachgebiet Innere Medizin

Notfall-TEP der Hüfte ist auch bei 90-Jährigen machbar

26.04.2024 Hüft-TEP Nachrichten

Ob bei einer Notfalloperation nach Schenkelhalsfraktur eine Hemiarthroplastik oder eine totale Endoprothese (TEP) eingebaut wird, sollte nicht allein vom Alter der Patientinnen und Patienten abhängen. Auch über 90-Jährige können von der TEP profitieren.

Niedriger diastolischer Blutdruck erhöht Risiko für schwere kardiovaskuläre Komplikationen

25.04.2024 Hypotonie Nachrichten

Wenn unter einer medikamentösen Hochdrucktherapie der diastolische Blutdruck in den Keller geht, steigt das Risiko für schwere kardiovaskuläre Ereignisse: Darauf deutet eine Sekundäranalyse der SPRINT-Studie hin.

Bei schweren Reaktionen auf Insektenstiche empfiehlt sich eine spezifische Immuntherapie

25.04.2024 Allergien und Intoleranzreaktionen Nachrichten

Insektenstiche sind bei Erwachsenen die häufigsten Auslöser einer Anaphylaxie. Einen wirksamen Schutz vor schweren anaphylaktischen Reaktionen bietet die allergenspezifische Immuntherapie. Jedoch kommt sie noch viel zu selten zum Einsatz.

Therapiestart mit Blutdrucksenkern erhöht Frakturrisiko

25.04.2024 Hypertonie Nachrichten

Beginnen ältere Männer im Pflegeheim eine Antihypertensiva-Therapie, dann ist die Frakturrate in den folgenden 30 Tagen mehr als verdoppelt. Besonders häufig stürzen Demenzkranke und Männer, die erstmals Blutdrucksenker nehmen. Dafür spricht eine Analyse unter US-Veteranen.

Update Innere Medizin

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Springer Medizin

Abstract

Purpose

Methods

Results

Conclusions

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 1/2021

Sleep quality and its association with health-related quality of life of patients on lung transplantation waitlist in Japan

Validity and reliability of the Persian version of the Insomnia Diurnal Impact Scale (IDIS)

Clinical features and risk factors in patients with asthma complicated with obstructive sleep apnea-hypopnea syndrome: a hospital-based study

Increased frequency of obstructive sleep apnea in the patients with systemic sclerosis

Impact of concomitant obstructive sleep apnea on pulmonary involvement and main pulmonary artery diameter in adults with scleroderma