The association between health conditions in world trade center responders and sleep-related quality of life and sleep complaints

Indu Ayappa, Yingfeng Chen, Nisha Bagchi, Haley Sanders, Kathleen Black, Akosua Twumasi, David M. Rapoport, Shou En Lu, Jag Sunderram

Research output: Contribution to journalArticlepeer-review

8 Scopus citations


Background: World Trade Center (WTC) dust-exposed subjects have multiple comorbidities that affect sleep. These include obstructive sleep apnea (OSA), chronic rhinosinusitis (CRS), gastroesophageal-reflux disorder (GERD) and post-traumatic stress disorder (PTSD). We examined the impact of these conditions to sleep-related outcomes. Methods: Demographics, co-morbidities and symptoms were obtained from 626 WTC (109F/517M), 33–87years, BMI = 29.96 ± 5.53 kg/m2) subjects. OSA diagnosis was from a 2-night home sleep test (ARES™). Subjective sleep quality, sleep-related quality of life (QOL, Functional Outcomes of Sleep Questionnaire), excessive daytime sleepiness (Epworth Sleepiness Scale), sleep duration and sleep onset and maintenance complaints were assessed. Results: Poor sleep quality and complaints were reported by 19–70% of subjects and average sleep duration was 6.4 h. 74.8% of subjects had OSA. OSA diagnosis/severity was not associated with any sleep-related outcomes. Sleep duration was lower in subjects with all conditions (p < 0.05) except OSA. CRS was a significant risk factor for poor sleep-related QOL, sleepiness, sleep quality and insomnia; PTSD for poor sleep-related QOL and insomnia; GERD for poor sleep quality. These associations remained significant after adjustment for, age, BMI, gender, sleep duration and other comorbidities. Conclusions: Sleep complaints are common and related to several health conditions seen in WTC responders. Initial interventions in symptomatic patients with both OSA and comorbid conditions may need to be directed at sleep duration, insomnia or the comorbid condition itself, in combination with intervention for OSA.

Original languageEnglish
Article number1229
JournalInternational Journal of Environmental Research and Public Health
Issue number7
StatePublished - 1 Apr 2019


  • Chronic sinusitis
  • Comorbid insomnia
  • Obstructive sleep apnea
  • Sleep-related quality of life
  • Sleepiness
  • WTC responders


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