Indu Ayappa, Robert Laumbach, Kathleen Black, Michael Weintraub, Priya Agarwala, Akosua Twumasi, Haley Sanders, Iris Udasin, Denise Harrison, Rafael E de la Hoz, Yingfeng Chen, Nishay Chitkara, Anna E Mullins, Horacio Romero Castillo, David M Rapoport, Shou-En Lu, Jag Sunderram
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To understand the mechanism(s) for the elevated risk of OSA observed in World Trade Center responders with CRS symptoms we examined if elevated awake supine nasal resistance was associated with OSA, CRS and/or nasal inflammatory biomarkers.</p><p><strong>Methods: </strong>A total of 601 individuals (83% male, average age 53 years, body mass index = 29.9 ± 5.5 kg/m<sup>2</sup>) enrolled in the World Trade Center Health Program and without significant snoring prior to September 11, 2001 underwent 2 nights of home sleep apnea testing, measurements of anterior rhinomanometry in the supine position, and nasal lavage.</p><p><strong>Results: </strong>Awake supine nasal resistance was not associated with OSA; 74.8% and 74.4% of the participants with low and high nasal resistance respectively, had OSA. Patients with CRS had elevated nasal inflammatory markers (interleukin 6, interleukin 8, eosinophilic cationic protein, and neutrophil) but did not have high nasal resistance. Nasal inflammatory markers were not correlated with nasal resistance.</p><p><strong>Conclusions: </strong>As awake nasal resistance did not explain the relationship of CRS to OSA in this large and well characterized dataset, our findings suggest that either \"sleep\" nasal resistance or other factors such as increased supraglottic inflammation, perhaps through impairing upper airway reflex mechanisms, or systemic inflammation are involved in the pathophysiology of OSA in the World Trade Center population.</p><p><strong>Citation: </strong>Ayappa I, Laumbach R, Black K, et al. 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Nasal inflammation and/or elevated awake nasal resistance that carried over into sleep could explain this association. To understand the mechanism(s) for the elevated risk of OSA observed in World Trade Center responders with CRS symptoms we examined if elevated awake supine nasal resistance was associated with OSA, CRS and/or nasal inflammatory biomarkers.</p><p><strong>Methods: </strong>A total of 601 individuals (83% male, average age 53 years, body mass index = 29.9 ± 5.5 kg/m<sup>2</sup>) enrolled in the World Trade Center Health Program and without significant snoring prior to September 11, 2001 underwent 2 nights of home sleep apnea testing, measurements of anterior rhinomanometry in the supine position, and nasal lavage.</p><p><strong>Results: </strong>Awake supine nasal resistance was not associated with OSA; 74.8% and 74.4% of the participants with low and high nasal resistance respectively, had OSA. 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引用次数: 0
摘要
研究目的：我们曾估计，世贸中心（WTC）救援和恢复人员中阻塞性睡眠呼吸暂停（OSA）的发病率为 75%，并确定慢性鼻炎（CRS）症状是这一人群中 OSA 的独立危险因素。鼻腔炎症和/或清醒时鼻腔阻力升高会影响睡眠，这可以解释这种关联。为了了解在有慢性鼻炎（CRS）症状的永利国际娱乐反应者中观察到的 OSA 风险升高的机制，我们研究了清醒时仰卧鼻阻力升高是否与 OSA、CRS 和/或鼻腔炎症生物标志物有关。方法：601 人（83% 为男性，平均年龄 53 岁，体重指数（BMI）= 29.9 ± 5.5 kg/m2）参加了世界贸易中心健康计划，9/11 前无明显打鼾，接受了两晚家庭睡眠呼吸暂停测试、仰卧位前鼻压测量和鼻腔灌洗：清醒时仰卧位鼻阻力与 OSA 无关；分别有 74.8% 和 74.4% 的低鼻阻力和高鼻阻力参与者患有 OSA（P=NS）。CRS 患者的鼻腔炎症指标（IL6、IL8、ECP 和 Neut）升高，但鼻腔阻力并不高。鼻腔炎症标记物与鼻阻力无关：我们的研究结果表明，"睡眠 "鼻阻力或其他因素（如声门上炎症增加（可能通过损害上气道反射机制）或全身炎症）参与了永利国际娱乐人群 OSA 的病理生理学。
Nasal resistance and inflammation: mechanisms for obstructive sleep apnea from chronic rhinosinusitis.
Study objectives: We have previously estimated that the prevalence of obstructive sleep apnea (OSA) among World Trade Center rescue and recovery workers is 75% and identified that having symptoms of chronic rhinosinusitis (CRS) is an independent risk factor for OSA in this population. Nasal inflammation and/or elevated awake nasal resistance that carried over into sleep could explain this association. To understand the mechanism(s) for the elevated risk of OSA observed in World Trade Center responders with CRS symptoms we examined if elevated awake supine nasal resistance was associated with OSA, CRS and/or nasal inflammatory biomarkers.
Methods: A total of 601 individuals (83% male, average age 53 years, body mass index = 29.9 ± 5.5 kg/m2) enrolled in the World Trade Center Health Program and without significant snoring prior to September 11, 2001 underwent 2 nights of home sleep apnea testing, measurements of anterior rhinomanometry in the supine position, and nasal lavage.
Results: Awake supine nasal resistance was not associated with OSA; 74.8% and 74.4% of the participants with low and high nasal resistance respectively, had OSA. Patients with CRS had elevated nasal inflammatory markers (interleukin 6, interleukin 8, eosinophilic cationic protein, and neutrophil) but did not have high nasal resistance. Nasal inflammatory markers were not correlated with nasal resistance.
Conclusions: As awake nasal resistance did not explain the relationship of CRS to OSA in this large and well characterized dataset, our findings suggest that either "sleep" nasal resistance or other factors such as increased supraglottic inflammation, perhaps through impairing upper airway reflex mechanisms, or systemic inflammation are involved in the pathophysiology of OSA in the World Trade Center population.
Citation: Ayappa I, Laumbach R, Black K, et al. Nasal resistance and inflammation: mechanisms for obstructive sleep apnea from chronic rhinosinusitis. J Clin Sleep Med. 2024;20(10):1627-1636.
期刊介绍：
Journal of Clinical Sleep Medicine focuses on clinical sleep medicine. Its emphasis is publication of papers with direct applicability and/or relevance to the clinical practice of sleep medicine. This includes clinical trials, clinical reviews, clinical commentary and debate, medical economic/practice perspectives, case series and novel/interesting case reports. In addition, the journal will publish proceedings from conferences, workshops and symposia sponsored by the American Academy of Sleep Medicine or other organizations related to improving the practice of sleep medicine.
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