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The role of nasal resistance in CPAP adherence in the World Trade Center first responder cohort.

Agarwala P; Ducca E; Gumb T; Twumasi A; Black K; Lewis C; Alimokhtari S; Perez A; Lu S-E; Chitkara N; Harrison D; Udasin I; Sunderram J; Rapoport D; Ayappa IA
Am J Respir Crit Care Med 2016 May; 193(Abstract Issue):A7456
Introduction: Continuous positive airway pressure (CPAP) is the most effective treatment for obstructive sleep apnea (OSA). Despite this, CPAP adherence reported in the literature is only two to four hours per night. Difficulty with exhalation is often cited as a reason for difficulty tolerating CPAP. It is possible that patients with high total nasal resistance (TNR) or symptoms of chronic rhinosinusitis (CRS) experience increased pressure on exhalation and this contributes to decreased adherence. The World Trade Center (WTC) First Responder cohort has a high prevalence of subjects with nasal complaints providing a unique population to understand the relationship of OSA to this condition. Methods: Subjects were enrolled from the WTC Health Program who reported no snoring in the year prior to 9/11. Subjects answered a nasal symptom questionnaire for rhinosinusitis over the previous eight weeks: facial pain/pressure, post nasal drip, sore throat, sneezing, congestion/runny nose, blocked nose or loss of smell. CRS was defined as present when there were three or more positive responses. Subjects underwent measurement of total nasal resistance via rhinomanometry and had OSA assessed with home sleep testing (ARESTM). Subjects with OSA (AHI4>5/hr or AHI4A>15/hr) were randomized to a double-blind crossover 4 week trial with CPAP or CPAP with C-Flex. CPAP adherence was monitored nightly and uploaded via modem. Adherence (hours/night and %nights >4 hours) was averaged for 2 weeks after at least 2 weeks of habituation. Data are presented here only for the first treatment period (data pooled for CPAP and C-Flex). Results: 476 subjects underwent home sleep testing, of which 359 were diagnosed with OSA. 248 subjects have undergone randomization; data from the first 182 subjects (24F/158M) are presented here. Overall CPAP compliance was poor (table 1). Gender, OSA severity or Epworth Sleepiness Score (ESS) did not affect CPAP adherence although age did (table). 48% had presence of CRS and 44% had high nasal resistance. Symptoms of CRS and nasal resistance variables did not show a statistically significant effect on CPAP adherence. However, in the small number of women (24), CRS symptoms were associated with lower adherence (p<0.05). Conclusions: Overall prevalence of OSA, CRS, and elevated nasal resistance are high in the WTC Responder population. Thus far we show no effect of awake elevated nasal resistance or CRS on CPAP adherence (CPAP and Cflex data are currently still blinded). However, we have not evaluated sleep nasal resistance as a contributing factor in CPAP adherence.
Rescue workers; Emergency responders; Nasal cavity; Nasal disorders; First responders; World Trade Center; WTC; Sleep; Sleep disorders; Breathing apparatus; Questionnaires; Age factors; Humans; Men; Women
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American Journal of Respiratory and Critical Care Medicine
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RBHS-Robert Wood Johnson Medical School, Piscataway, New Jersey
Page last reviewed: May 11, 2023
Content source: National Institute for Occupational Safety and Health Education and Information Division