Skip to main content
SpringerLink
Log in

Correlations of sleep disorders with severity of obstructive airway disease in mustard gas-injured patients

  • Original Article
  • Published:
Sleep and Breathing Aims and scope Submit manuscript

Abstract

Introduction

Mustard gas has serious adverse effects on several organs and functions in humans. In this study, we analyzed potential correlations between obstructive airway disease and sleep disorders in Iranian mustard gas-injured patients.

Methods

We enrolled 30 male mustard gas-injured veterans and civilians from the Chemical Warfare Exposure Clinic at Baqiyatallah Hospital, Tehran. All the subjects underwent comprehensive polysomnographic and spirometric evaluations for diagnosis of sleep disorders. Patients were categorized into three groups according to the severity of their obstructive airway disease based on the Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria: group 1 (GOLD I and II), group 2 (GOLD III), and group 3 (GOLD IV).

Results

Patients with less severe obstructive airway disease had significantly higher rate of hypopnea (p = 0.05) and AHI (p = 0.05). The number of REM events was significantly higher in patients with less severe airway disease (p = 0.028). Stage 1 sleep among patients with higher FEV1 significantly constituted a higher proportion of sleep, and stage 4 sleep was significantly longer in patients with higher DLCO (p = 0.043, both).

Conclusion

We found that sleep parameters in SM-exposed patients have some relations with spirometric parameters. Future studies with large patient populations are needed for confirmation of our results, and therapeutic interventions are needed to evaluate endeavors we can do to enhance health and quality of life in our mustard gas-injured population.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Abbreviations

FEV1:

Forced expiratory volume within the first second

FVC:

Forced vital capacity

RV:

Residual volume

TLC:

Total lung capacity

MEF:

Maximum expiratory flow

OSA:

Obstructive sleep apnea

CSA:

Central sleep apnea

AHI:

Apnea–hypopnea index

RDI:

Respiratory disturbance index

OAD:

Obstructive airway disease

MSA:

Mixed sleep apnea

References

  1. United Nations Security Council (1984) Report of the specialists appointed by the Secretary-General to investigate allegations by the Islamic Republic of Iran concerning the use of chemical weapons. Arch Belg; 302–310

  2. Fidder A, Noort D, De Jong AL, Trap HC, De Jong LP, Benschop HP (1996) Monitoring of in vitro and in vivo exposure to sulfur mustard by GC/MS determination of the N-terminal valine adduct in hemoglobin after a modified Edman degradation. Chem Res Toxicol 9:788–792

    Article  PubMed  CAS  Google Scholar 

  3. Noort D, Hulst AG, Trap HC, De Jong LP, Benschop HP (1997) Synthesis and mass spectrometric identification of the major amino acid adducts formed between sulphur mustard and haemoglobin in human blood. Arch Toxicol 71:171–178

    Article  PubMed  CAS  Google Scholar 

  4. Bijani Kh, Moghadamnia AA (2002) Long-term effects of chemical weapons on respiratory tract in Iraq–Iran war victims living in Babol (North of Iran). Ecotoxicol Environ Saf 53(3):422–424

    Article  PubMed  CAS  Google Scholar 

  5. Ghanei M, Mokhtari M, Mir Mohammad M, Aslani J (2004) Bronchiolitis obliterans following exposure to sulfur mustard: chest high resolution computed tomography. Eur J Radiol 52:164–169

    Article  PubMed  Google Scholar 

  6. Bagheri MH, Hosseini SK, Mostafavi SH, Alavi SA (2003) High-resolution CT in chronic pulmonary changes after mustard gas exposure. Acta Radiol 44(3):241–245

    PubMed  CAS  Google Scholar 

  7. Kachuee H, Ameli J, Taheri S, Assari S, Riahipour F, Khedmat H, Saadat AR (2007) Sleep quality and its correlates in renal transplant patients. Transplant Proc 39(4):1095–1097

    Article  PubMed  CAS  Google Scholar 

  8. Montplaisir J, Walsh J, Mao JL (1982) Nocturnal asthma: features of attacks, sleep and breathing patterns. Am Rev Respir Dis 125:18–22

    PubMed  CAS  Google Scholar 

  9. Fleetham J, West P, Mezon B (1982) Sleep, arousals, and oxygen desaturation in chronic obstructive pulmonary disease. Am Rev Respir Dis 126:429–433

    PubMed  CAS  Google Scholar 

  10. Kinsman BA, Yaroush BA, Fernandez E, Dirks JF, Schocket M, Fukuhara J (1983) Symptoms and experiences in chronic bronchitis and emphysema. Chest 83:755–761

    Article  PubMed  CAS  Google Scholar 

  11. Rechtschaffen A, Kales A (1968) A manual of standardized techniques and scoring system for sleep stages in human subjects. US Department of Health, Education, and Welfare, Bethesda, NIH Publication No. 204

    Google Scholar 

  12. No authors listed (1999) Sleep-related breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clinical research. The Report of an American Academy of Sleep Medicine Task Force. Sleep 23(2):151, 153

    Google Scholar 

  13. Iber C, Ancoli-Israel S, Chesson A, Quan S (2007) For the American Academy of Sleep Medicine. The AASM manual for the scoring of sleep and associated events: rules, terminology and technical specifications, 1st edn. American Academy of Sleep Medicine, Westchester

    Google Scholar 

  14. No authors listed (1992) EEG arousals: scoring rules and examples: a preliminary report from the Sleep Disorders Atlas Task Force of the American Sleep Disorders Association. Sleep 15:173–84

    Google Scholar 

  15. American Thoracic Society (1995) Standardization of spirometry, 1994 update. American thoracic society. Am J Respir Crit Care Med 152(3):1107–1136

    Google Scholar 

  16. Quanjer PhH, Tammeling GJ, Cotes JE, Pedersen OF, Peslin R, Yernault J-C (1993) Lung volumes and forced ventilatory flows. Report Working Party Standardization of Lung Function Tests, European Community for Steel and Coal. Eur Respir J 6(suppl 16):5–40

    Google Scholar 

  17. Ghanei M, Moqadam FA, Mohammad MM, Aslani J (2006) Tracheobronchomalacia and air trapping after mustard gas exposure. Am J Respir Crit Care Med 173(3):304–309

    Article  PubMed  Google Scholar 

  18. Winternitz MC, Finney WP (1920) The pathology of mustard poisoning. In: Winternitz MC (ed) Pathology of war gas poisoning. Yale University Press, New Haven

    Google Scholar 

  19. Ghanei M, Akhlaghpoor Sh, Mir Mohammad M, Aslani J (2004) Tracheobronchial stenosis following sulfur mustard inhalation. Inhal Toxicol 16:845–849

    Article  PubMed  CAS  Google Scholar 

  20. Freitag L, Firusian N, Stamatis G, Greschuchna D (1991) The role of bronchoscopy in pulmonary complications due to mustard gas inhalation. Chest 100:1436–1441

    Article  PubMed  CAS  Google Scholar 

  21. Emad A, Rezaian GR (1997) The diversity of the effects of sulfur mustard gas inhalation on respiratory system 10 years after a single, heavy exposure. Chest 112:734–830

    Article  PubMed  CAS  Google Scholar 

  22. Ghanei M, Hosseini AR, Arabbaferani Z, Shahkarami E (2005) Evaluation of chronic cough in chemical chronic bronchitis patients. Environ Toxicol Pharmacol 20:6–10

    Article  PubMed  CAS  Google Scholar 

  23. Fletcher EC, Donner CF, Midgren B, Zielinski J, Levi-Valensi P, Braghiroli A, Rida Z, Miller CC (1992) Survival in COPD patients with a daytime PaO2 greater than 60 mmHg with and without nocturnal oxyhemoglobin desaturation. Chest 101:649–655

    Article  PubMed  CAS  Google Scholar 

  24. Newman AB, Enright PL, Manolio TA, Haponik EF, Wahl PW (1997) Sleep disturbance, psychosocial correlates, and cardiovascular disease in 5201 older adults: the cardiovascular health study. J Am Geriatr Soc 45:1–7

    PubMed  CAS  Google Scholar 

  25. Littner MR, McGinty DJ, Arand DL (1980) Determinants of oxygen desaturation in the course of ventilation during sleep in COPD. Am Rev Respir Dis 122:849–857

    PubMed  CAS  Google Scholar 

  26. Wynne JW, Block AJ, Boysen PC (1980) Oxygen desaturation in sleep: sleep apnea and COPD. Hosp Pract 15:77–85

    PubMed  CAS  Google Scholar 

  27. Smith PEM, Calverley PMA, Edwards RHT (1988) Hypoxemia during sleep in Duchenne muscular dystrophy. Am Rev Respir Dis 137:884–888

    PubMed  CAS  Google Scholar 

  28. Kutty K (2004) Sleep and chronic obstructive pulmonary disease. Curr Opin Pulm Med 10(2):104–112

    Article  PubMed  Google Scholar 

  29. Berthon-Jones M, Sullivan CE (1982) Ventilatory and arousal response to hypoxia in sleeping humans. Am Rev Respir Dis 125:632–639

    PubMed  CAS  Google Scholar 

  30. Tusiewicz K, Moldofsky H, Bryan A, Bryan M (1977) Mechanics of the rib cage and diaphragm during sleep. J Appl Physiol Respirat Environ Exerc Physiol 43:600–602

    CAS  Google Scholar 

  31. Barbé F, Quera-Salva MA, McCann C, Gajdos Ph, Raphael JC, de Lattre J, Agustí AG (1994) Sleep-related respiratory disturbances in patients with Duchenne muscular dystrophy. Eur Respir J 7(8):1403–1408

    Article  PubMed  Google Scholar 

  32. Koo KW, Sax DS, Snider GL (1975) Arterial blood gases and pH during sleep in chronic obstructive pulmonary disease. Am J Med 58:663–670

    Article  PubMed  CAS  Google Scholar 

  33. Agusti AGN (2005) Systemic effects of chronic obstructive pulmonary disease. Proc Am Thorac Soc 2:367–370

    Article  PubMed  Google Scholar 

  34. Le Bon O, Hoffmann G, Tecco J, Staner L, Noseda A, Pelc I, Linkowski P (2000) Mild to moderate sleep respiratory events: one negative night may not be enough. Chest 118:353–359

    Article  PubMed  Google Scholar 

  35. Gottlieb DJ, Whitney CW, Bonekat WH, Iber C, James GD, Lebowitz M, Nieto FJ, Rosenberg CE (1999) Relation of sleepiness to respiratory disturbance index: the sleep heart health study. Am J Respir Crit Care Med 159(2):502–507

    PubMed  CAS  Google Scholar 

Download references

Conflict of interest

All financial funds for this study were provided by the Chemical Injury Research Center, Baqiyatallah University of Medical Sciences. No conflict of interest exists on this report.

Author information

Authors and Affiliations

  1. Chemical Injury Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran

    Ensieh Vahedi, Farshid Alaedini, Zohreh Poursaleh, Javad Ameli & Mostafa Ghanei

  2. Dr. Taheri Medical Research Group, Chemical Injury Research Center, Baqiyatallah Hospital, Mollasadra Street, Tehran, Iran

    Saeed Taheri

Authors
  1. Ensieh Vahedi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Saeed Taheri
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Farshid Alaedini
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Zohreh Poursaleh
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Javad Ameli
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Mostafa Ghanei
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Mostafa Ghanei.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Vahedi, E., Taheri, S., Alaedini, F. et al. Correlations of sleep disorders with severity of obstructive airway disease in mustard gas-injured patients. Sleep Breath 16, 443–451 (2012). https://doi.org/10.1007/s11325-011-0522-0

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11325-011-0522-0

Keywords

Search

Navigation