Citation

Iyengar-Kapuganti RL, Maceda CS, Croft LB, Sawit ST, Crowley LE, Woodward M, McLaughlin MA. BMJ Open 2022; 12(4): e058366.

Copyright

(Copyright © 2022, BMJ Publishing Group)

DOI

10.1136/bmjopen-2021-058366

PMID

35440460

Abstract

OBJECTIVES: Obstructive sleep apnoea (OSA) is often linked to cardiovascular disease. A limited number of studies have reported an association between OSA and left ventricular diastolic dysfunction (LVDD). However, prior studies were performed on small patient populations. Studies have shown a high prevalence of OSA among first responders to the 9/11 World Trade Center (WTC) terrorist attack. We investigated the relationship between OSA and LVDD in a large population of WTC responders.

DESIGN: Cross-sectional study. SETTING: One-time screening programme as part of the WTC-CHEST Study (NCT10466218), performed at a quaternary medical centre in New York City, from November 2011 to June 2014. PARTICIPANTS: A total of 1007 participants with mean age of 51 years of mostly non-Hispanic white men were evaluated. Patients from the WTC Health Program-Clinical Center of Excellence, who were over the age of 39 years, were eligible to participate.

RESULTS: Evaluation of those without OSA diagnosis showed no significant association with LVDD when comparing those screened (Berlin Questionnaire) as OSA high risk versus OSA low risk (p=0.101). Among those diagnosed with LVDD, there was a significant association when comparing those with and without patient-reported OSA (OR 1.50, 95% CI 1.13 to 2.00, p=0.005), but the significance was not maintained after adjusting for pertinent variables (OR 1.3, 0.94 to 1.75, p=0.119). Notably, comparing those with OSA diagnosis and those low risk of OSA, the OR for LVDD was significant (1.69, 1.24 to 2.31, p=0.001), and after adjusting for waist-hip ratio, diabetes and coronary artery calcium score percentile, the relationship remained significant (OR 1.45, 1.03 to 2.04, p=0.032).

CONCLUSION: The strong association of OSA with LVDD in this population may inform future guidelines to recommend screening for LVDD in high-risk asymptomatic patients with OSA.

Language: en

Keywords

Adult; Humans; Male; Middle Aged; Cross-Sectional Studies; *diastolic dysfunction; *Emergency Responders; *first responders; *September 11 Terrorist Attacks; *sleep apnea; *Sleep Apnea, Obstructive/complications/diagnosis/epidemiology; *Terrorism; *Ventricular Dysfunction, Left; *World Trade Center