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Burn pit exposure in military personnel: is there an effect on sleep-disordered breathing?

  • Epidemiology • Original Article
  • Published:
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Abstract

Purpose

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.

Methods

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).

Results

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).

Conclusions

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.

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References

  1. Smith B, Wong CA, Smith TC, Boyko EJ, Gackstetter GD, Margaret AK (2009) Newly reported respiratory symptoms and conditions among military personnel deployed to Iraq and Afghanistan: a prospective population-based study. Am J Epidemiol 170(11):1433–1442

    PubMed  Google Scholar 

  2. Morris MJ, Dodson DW, Lucero PF, Haislip GD, Gallup RA, Nicholson KL, Zacher LL (2014) Study of active duty military for pulmonary disease related to environmental deployment exposures (STAMPEDE). Am J Respir Crit Care Med 190(1):77–84

    PubMed  Google Scholar 

  3. King MS, Eisenberg R, Newman JH, Tolle JJ, Harrell FE Jr, Nian H, Ninan M, Lambright ES, Sheller JR, Johnson JE, Miller RF (2011) Constrictive bronchiolitis in soldiers returning from Iraq and Afghanistan. N Engl J Med 365(3):222–230

    CAS  PubMed  PubMed Central  Google Scholar 

  4. Baird CP (2012) Review of the institute of medicine report: long-term health consequences of exposure to burn pits in Iraq and Afghanistan. US Army Med Dep J:43–47

  5. Blasch KW, Kolivosky JE, Heller JM (2016) Environmental air sampling near burn pit and incinerator operations at Bagram airfield, Afghanistan. J Occup Environ Med 58(8):S38–S43

    CAS  PubMed  Google Scholar 

  6. Liu J, Lezama N, Gasper J, Kawata J, Morley S, Helmer D, Ciminera P (2016) Burn pit emissions exposure and respiratory and cardiovascular conditions among airborne hazards and open burn pit registry participants. J Occup Environ Med 58(7):e249–e255

    CAS  PubMed  Google Scholar 

  7. Smith B, Wong CA, Boyko EJ, Phillips CJ, Gackstetter GD, Ryan MA, Smith TC, Millennium Cohort Study Team (2012) The effects of exposure to documented open-air burn pits on respiratory health among deployers of the millennium cohort study. J Occup Environ Med 54(6):708–716

    CAS  PubMed  Google Scholar 

  8. Powell TM, Smith TC, Jacobson IG, Boyko EJ, Hooper TI, Gackstetter GD, Phillips CJ, Smith B, Millennium Cohort Study Team (2012) Prospective assessment of chronic multisymptom illness reporting possibly associated with open-air burn pit smoke exposure in Iraq. J Occup Environ Med 54(6):682–688

    CAS  PubMed  Google Scholar 

  9. Armed Forces Health Surveillance Center. Epidemiological studies of health outcomes among troops deployed to burn pit sites. Silver Spring, MD. 2010

  10. Caldwell JA, Knapik JJ, Shing TL, Kardouni JR, Lieberman HR The association of insomnia and sleep apnea with deployment and combat exposure in the entire population of US Army soldiers from 1997-2011: A retrospective cohort investigation. Sleep. In press. https://doi.org/10.1093/sleep/zsz112

  11. Lettieri CJ, Eliasson AH, Andrada T, Khramtsov A, Raphaelson M, Kristo DA (2005) Obstructive sleep apnea syndrome: are we missing an at-risk population? J Clin Sleep Med 1(04):381–385

    PubMed  Google Scholar 

  12. Capaldi VF, Guerrero ML, Killgore WD (2011) Sleep disruptions among returning combat veterans from Iraq and Afghanistan. Mil Med 176(8):879–888

    PubMed  Google Scholar 

  13. Mysliwiec V, McGraw L, Pierce R, Smith P, Trapp B, Roth BJ (2013) Sleep disorders and associated medical comorbidities in active duty military personnel. Sleep. 36(2):167–174

    PubMed  PubMed Central  Google Scholar 

  14. Mysliwiec V, Gill J, Lee H et al (2013) Sleep disorders in U.S. military personnel: a high rate of comorbid insomnia and obstructive sleep apnea. Chest. 144(2):549–557

    PubMed  PubMed Central  Google Scholar 

  15. Caldwell J, Knapik JJ, Lieberman HR (2017) Trends and factors associated with insomnia and sleep apnea in all United States military service members from 2005 to 2014. J Sleep Res 26(5):665–670

    Google Scholar 

  16. Zanobetti A, Redline S, Schwartz J, Rosen D, Patel S, O'Connor GT, Lebowitz M, Coull BA, Gold DR (2010) Associations of PM10 with sleep and sleep-disordered breathing in adults from seven US urban areas. Am J Respir Crit Care Med 182(6):819–825

    PubMed  PubMed Central  Google Scholar 

  17. Shen YL, Liu WT, Lee KY, Chuang HC, Chen HW, Chuang KJ (2018) Association of PM 2.5 with sleep-disordered breathing from a population-based study in Northern Taiwan urban areas. Environ Pollut 233:109–113

    CAS  PubMed  Google Scholar 

  18. Abou-Khadra MK (2013) Association between PM 10 exposure and sleep of Egyptian school children. Sleep Breath 17(2):653–657

    PubMed  Google Scholar 

  19. Chuang HC, Su TY, Chuang KJ, Hsiao TC, Lin HL, Hsu YT, Pan CH, Lee KY, Ho SC, Lai CH (2018) Pulmonary exposure to metal fume particulate matter cause sleep disturbances in shipyard welders. Environ Pollut 232:523–532

    CAS  PubMed  Google Scholar 

  20. Lappharat S, Taneepanichskul N, Reutrakul S, Chirakalwasan N (2018) Effects of bedroom environmental conditions on the severity of obstructive sleep apnea. J Clin Sleep Med 14(04):565–573

    PubMed  PubMed Central  Google Scholar 

  21. Ahuja S, Zhu Z, Shao Y, Berger KI, Reibman J, Ahmed O (2018) Obstructive sleep apnea in community members exposed to world trade center dust and fumes. J Clin Sleep Med 14(05):735–743

    PubMed  PubMed Central  Google Scholar 

  22. Glaser MS, Shah N, Webber MP et al (2014) Obstructive sleep apnea and world trade center exposure. J Occup Environ Med 56:S30–S34

    CAS  PubMed  Google Scholar 

  23. Webber MP, Lee R, Soo J, Gustave J, Hall CB, Kelly K, Prezant D (2011) Prevalence and incidence of high risk for obstructive sleep apnea in world trade center exposed rescue/recovery workers. Sleep Breath 15(3):283–294

    PubMed  Google Scholar 

  24. Lioy PJ, Weisel CP, Millette JR, Eisenreich S, Vallero D, Offenberg J, Buckley B, Turpin B, Zhong M, Cohen MD, Prophete C, Yang I, Stiles R, Chee G, Johnson W, Porcja R, Alimokhtari S, Hale RC, Weschler C, Chen LC (2002) Characterization of the dust/smoke aerosol that settled east of the world trade center (WTC) in lower Manhattan after the collapse of the WTC 11 September 2001. Environ Health Perspect 110(7):703–714

    CAS  PubMed  PubMed Central  Google Scholar 

  25. Abraham JH, Baird CB (2012) A case-crossover study of ambient particulate matter and cardiovascular and respiratory medical encounters among U.S. military personnel deployed to Southwest Asia. J Occup Environ Med 54:733–739

    CAS  PubMed  Google Scholar 

  26. Engelbrecht JP, McDonald EV, Giles JA, Javanty RK, Casuccio G, Gentler AW (2009) Characterizing mineral dusts and other aerosols from the Middle East-part 1: ambient sampling. Inhal Toxicol 21:297–326

    CAS  PubMed  Google Scholar 

  27. Dockery DW, Pope CA (1994) Acute respiratory effects of particulate air pollution. Annu Rev Public Health 15(1):107–132

    CAS  PubMed  Google Scholar 

  28. Johns M (1992) Reliability and factor analysis of the Epworth sleepiness scale. Sleep. 15(4):376–381

    CAS  PubMed  Google Scholar 

  29. Farney RJ, Walker BS, Farney RM, Snow GL, Walker JM (2011) The STOP-BANG equivalent model and prediction of severity of obstructive sleep apnea: relation to polysomnographic measurements of the apnea/hypopnea index. J Clin Sleep Med 7(5):459–465

    PubMed  PubMed Central  Google Scholar 

  30. Butler DA, Styka AN, Savitz DA (2017) Assessment of the Department of Veterans Affairs Airborne Hazards and Open Burn Pit Registry. National Academies Press

  31. Hankinson JL, Odencrantz JR, Fedan KB (1999) Spirometric reference values from a sample of the general U.S. population. Am J Respir Crit Care Med 159(1):179–187

    CAS  PubMed  Google Scholar 

  32. Zinchuk A, Edwards B, Jeon S, Koo BB, Concato J, Sands S, Wellman A, Yaggi HK (2018) Prevalence, associated clinical features, and impact on continuous positive airway pressure use of a low respiratory arousal threshold among male United States veterans with obstructive sleep apnea. J Clin Sleep Med 14(5):809–817

    PubMed  PubMed Central  Google Scholar 

  33. Rogers AE, Stahlman S, Hunt DJ, Oh GT, Clark LL (2016) Obstructive sleep apnea and associated attrition, active component, US Armed Forces, January 2004-May 2016. MSMR. 23(10):2–11

    PubMed  Google Scholar 

  34. Collen J, Orr N, Lettieri CJ, Carter K, Holley AB (2012) Sleep disturbances among soldiers with combat-related traumatic brain injury. Chest. 142(3):622–630

    PubMed  Google Scholar 

  35. McMahon MJ, Sheikh KL, Andrada TF, Holley AB (2017) Using the STOPBANG questionnaire and other pre-test probability tools to predict OSA in younger, thinner patients referred to a sleep medicine clinic. Sleep Breath 21(4):869–876

    PubMed  Google Scholar 

  36. Smith P, Sheikh K, Costan-Toth C, Forsthoefel D, Bridges E, Andrada TF, Holley AB (2017) Eszopiclone and zolpidem do not affect the prevalence of the low arousal threshold phenotype. J Clin Sleep Med 13(1):115–119

    PubMed  PubMed Central  Google Scholar 

  37. Edwards B, Eckert D, McSharry D, Sands SA, Desai A, Kehlmann G, Bakker JP, Genta PR, Owens RL, White DP, Wellman A, Malhotra A (2014) Clinical predictors of the respiratory arousal threshold in patients with obstructive sleep apnea. Am J Resp Crit Care Med 190(11):1293–1300

    PubMed  PubMed Central  Google Scholar 

  38. Edwards B, Andara C, Landry S, Sands SA, Joosten SA, Owens RL, White DP, Hamilton GS, Wellman A (2016) Upper-airway collapsibility and loop gain predict the response to oral appliance therapy in patients with obstructive sleep apnea. Am J Resp Crit Care Med 194(11):1413–1422

    PubMed  PubMed Central  Google Scholar 

  39. Luxton DD, Greenburg D, Ryan J, Niven A, Wheeler G, Mysliwiec V (2011) Prevalence and impact of short sleep duration in redeployed OIF soldiers. Sleep. 34(9):1189–1195

    PubMed  PubMed Central  Google Scholar 

  40. Gadermann A, Engel C, Naifeh J et al (2012) Prevalence of DSM-IV major depression among U.S. military personnel: meta-analysis and simulation. Mil Med 177(8):47–59

    PubMed  Google Scholar 

  41. Aihara K, Oga T, Yoshimura C, Hitomi T, Chihara Y, Harada Y, Murase K, Toyama Y, Tanizawa K, Handa T, Tsuboi T, Mishima M, Chin K (2013) Measurement of dyspnea in patients with obstructive sleep apnea. Sleep Breath 17:753–761

    PubMed  Google Scholar 

  42. Powell TA, Mysliwiec V, Aden JK, Morris MJ (2019) Moderate to severe obstructive sleep apnea in military personnel is not associated with decreased exercise capacity. J Clin Sleep Med 15(6):823–829

    PubMed  PubMed Central  Google Scholar 

  43. Beitler J, Awad K, Bakker J, Edwards BA, DeYoung P, Djonlagic I, Forman DE, Quan SF, Malhotra A (2014) Obstructive sleep apnea is associated with impaired exercise capacity: a cross-sectional study. J Clin Sleep Med 10(11):1199–1204

    PubMed  PubMed Central  Google Scholar 

  44. Lin C, Hsieh W, Chou C, Liaw S (2006) Cardiopulmonary exercise testing in obstructive sleep apnea syndrome. Respir Physiol Neurobiol 150(1):27–34

    PubMed  Google Scholar 

  45. Minai O, Ricaurte B, Kaw R et al (2009) Frequency and impact of pulmonary hypertension in patients with obstructive sleep apnea syndrome. Am J Cardiol 104:1300–1306

    PubMed  Google Scholar 

  46. Aihara K, Oga T, Chihara Y et al (2011) Comparison of biomarkers of subclinical lung injury in obstructive sleep apnea. Respir Med 105(6):939–945

    PubMed  Google Scholar 

  47. Sateia MJ (2009) Update on sleep and psychiatric disorders. Chest. 135:1370–1379

    PubMed  Google Scholar 

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Acknowledgments

The views expressed herein are those of the authors and do not reflect the official policy or position of Brooke Army Medical Center, the US Army Medical Department, the US Army Office of the Surgeon General, the Department of the Army, the Department of the Air Force, and Department of Defense or the US Government.

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Authors and Affiliations

  1. Sleep Medicine Service, Wilford Hall Ambulatory Surgical Center, JBSA Lackland AFB, San Antonio, TX, 78234, USA

    Tyler A. Powell & Vincent Mysliwiec

  2. Graduate Medical Education, Brooke Army Medical Center, JBSA Fort Sam Houston, San Antonio, TX, USA

    James K. Aden & Michael J. Morris

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  1. Tyler A. Powell
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Contributions

Dr. Tyler Powell had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis, including and especially any adverse effects. Tyler Powell, Vincent Mysliwiec, and Michael Morris contributed substantially to the study design, data analysis and interpretation, and the writing of the manuscript. James Aden contributed substantially to the data analysis and interpretation.

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Correspondence to Tyler A. Powell.

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Conflict of interest

All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge, or beliefs) in the subject matter or materials discussed in this manuscript.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. A waiver of informed consent was approved by the Regional Health Command Central Institutional Review Board (C.2019.007d/eIRB Ref #908259).

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Powell, T.A., Mysliwiec, V., Aden, J.K. et al. Burn pit exposure in military personnel: is there an effect on sleep-disordered breathing?. Sleep Breath 25, 479–485 (2021). https://doi.org/10.1007/s11325-020-02060-x

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  • DOI: https://doi.org/10.1007/s11325-020-02060-x

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