Powell Tyler A, Mysliwiec Vincent, Aden James K, Morris Michael J
Sleep Medicine Service, Wilford Hall Ambulatory Surgical Center, JBSA Lackland AFB, San Antonio, TX, 78234, USA.
Graduate Medical Education, Brooke Army Medical Center, JBSA Fort Sam Houston, San Antonio, TX, USA.
Sleep Breath. 2021 Mar;25(1):479-485. doi: 10.1007/s11325-020-02060-x. Epub 2020 Mar 17.
Exposure to elevated concentrations of respirable particulate matter (< 10 μm) may influence sleep-disordered breathing. Burn pits as utilized by the US military in the Middle East until 2011 produced elevated particle matter concentrations. We seek to determine if subjective exposure to burn pits during deployment affects prevalence or severity of obstructive sleep apnea (OSA) in military personnel.
As part of a prospective observational study of previously deployed military personnel with exertional dyspnea (n = 145), all patients underwent pulmonary function testing, screening for burn pit exposure, and if warranted by questionnaires, overnight polysomnography. A total of 100 patients completed all testing. For analysis, patients were classified into a burn pit exposure group (45 patients) and a no exposure group (55 patients). Additional analyses were performed on those endorsing burn pit maintenance during deployment (25 patients) and those with > 12 h of daily exposure (17 patients).
The prevalence of OSA, defined by apnea-hypopnea index (AHI) > 5/h, was similarly high in both groups (69% vs. 71%, p = 0.83). Surprisingly, the mean AHI was lower in the exposed group (12.8/h vs. 19.7/h, p = 0.04) while nadir of oxygen saturation was similar (87% vs. 86%, p = 0.39). Subgroup analyses revealed similar findings in those who performed burn pit maintenance (prevalence = 80%, p = 0.58; AHI = 14.8, p = 0.16) and those with > 12 h of daily exposure (prevalence = 88%, p = 0.33; AHI = 18.0, p = 0.62).
Subjective burn pit exposure does not appear to influence OSA development in previously deployed military personnel. Given the high rate of OSA in this cohort, continued investigation of deployment exposures which may influence sleep-disordered breathing is recommended.
暴露于高浓度的可吸入颗粒物（<10微米）可能会影响睡眠呼吸紊乱。美国军队在中东地区直至2011年使用的燃烧坑产生了较高的颗粒物浓度。我们试图确定在部署期间主观暴露于燃烧坑是否会影响军事人员阻塞性睡眠呼吸暂停（OSA）的患病率或严重程度。
作为对先前部署的有运动性呼吸困难的军事人员（n = 145）进行的前瞻性观察研究的一部分，所有患者均接受了肺功能测试、燃烧坑暴露筛查，并且根据问卷调查情况必要时进行整夜多导睡眠图检查。共有100名患者完成了所有测试。为进行分析，将患者分为燃烧坑暴露组（45名患者）和非暴露组（55名患者）。对那些在部署期间认可参与燃烧坑维护的患者（25名患者）以及每日暴露超过12小时的患者（17名患者）进行了额外分析。
两组中，由呼吸暂停低通气指数（AHI）>5次/小时定义的OSA患病率相似（69%对71%，p = 0.83）。令人惊讶的是，暴露组的平均AHI较低（12.8次/小时对19.7次/小时，p = 0.04），而氧饱和度最低点相似（87%对86%，p = 0.39）。亚组分析显示，在参与燃烧坑维护的患者（患病率 = 80%，p = 0.58；AHI = 14.8，p = 0.16）和每日暴露超过12小时的患者（患病率 = 88%，p = 0.33；AHI = 18.0，p = 0.62）中也有类似发现。
主观暴露于燃烧坑似乎不会影响先前部署的军事人员中OSA的发展。鉴于该队列中OSA的高发生率，建议继续调查可能影响睡眠呼吸紊乱的部署暴露情况。
