Chronic rhinosinusitis, obstructive sleep apnea common in World Trade Center first responders

DENVER — A considerable percentage of World Trade Center responders have chronic rhinosinusitis and obstructive sleep apnea, according to study results presented at the American Thoracic Society International Conference.

However, there does not appear to be much of a relationship between the two conditions, and they are likely independent of each other.

“What we know now is that at least in this preliminary data, we have a high proportion of people who have sleep apnea and chronic rhinosinusitis, however they don’t seem to be associated with each other,” Jag Sunderram, MD, medical director in the Medical Intensive Care Unit at Robert Wood Johnson University Hospital at Rutgers University, told Healio.com/Pulmonology. “We didn’t see an increase in nasal inflammatory markers in those with symptoms of chronic rhinosinusitis, but what we saw was that, with increasing levels of interluekin-8, we have an increasing level of sleep apnea.”

Sunderram and colleagues assessed the severity of chronic rhinosinusitis (CRS), nasal inflammation and obstructive sleep apnea (OSA) in 304 World Trade Center responders to examine the relationship between levels of interleukin (IL)-6 and IL-8 in nasal lining fluid, chronic rhinosinusitis and post-9/11 OSA.

The researchers used the Nasal Symptom Score to assess symptoms such as facial pain, post nasal drip, sore throat, sneezing and congestion over a period of 8 weeks to determine CRS.

Using a saline solution at room temperature and an ELSIA kit (Biosource), the researchers obtained concentrations of IL-6 and IL-8 to assess nasal inflammation.

Participants underwent a two-night home sleep test using an ARES Unicoder (Watermark Medical), and they answered the Epworth Sleep Scale and the Functional Outcomes of Sleep Questionnaire to assess OSA.

Researchers determined 45% of the responders had CRS and 75% had OSA.

Although a high proportion of OSA and CRS in World Trade Center responders existed, no association was found between CRS and OSA, nor was an association observed between nasal inflammation and CRS.

However, IL-6 and IL-8 in nasal lining fluid appeared highly correlated. IL-8 significantly increased with OSA severity (P < 0.05), but high nasal resistance did not correlate with higher levels of IL-6 or IL-8.

The presence of CRS correlated with significantly higher levels of IL-8 (32 pg/ml in those without CRS vs. 47.52 pg/ml in those with CRS; P < 0.05) but not IL-6.

The results are applicable to the general population, Sunderram told Healio.com/Pulmonology.

“Nasal inflammatory markers are increased with increasing severity of sleep apnea,” he said. “We could be finding a biomarker for sleep apnea and the severity of sleep apnea, but we haven’t measured it in the blood. That would be useful to look at as a biomarker in the general population because we are seeing the signal with IL-8, which is independent of nasal resistance [and] independent of symptoms of chronic rhinosinusitis, so could it just be a biomarker of increasing severity of sleep apnea. That’s a very tantalizing question.” – by Ryan McDonald

Reference:

Sunderram J, et al. Poster 992. Presented at: American Thoracic Society International Conference; May 15-20, 2015; Denver.

Disclosure: Sunderram reports no relevant financial disclosures.