Is exposure to contaminated water at Camp Lejeune linked to an increased risk of Obstructive Sleep Apnea (OSA)?

Camp Lejeune Water Contamination and Obstructive Sleep Apnea: Evidence Assessment

There is no established link between Camp Lejeune water contamination and obstructive sleep apnea based on the available research evidence.

Background on Camp Lejeune Contamination

Camp Lejeune's drinking water systems were contaminated with industrial solvents between the 1950s and 1985, including:

• Trichloroethylene (TCE)
• Tetrachloroethylene (PCE)
• Vinyl chloride
• Benzene

These contaminants reached significant levels in the drinking water supply:

• PCE concentrations reached maximum monthly averages of 183 μg/L 1
• TCE concentrations reached maximum monthly averages of 783 μg/L 1
• These levels substantially exceeded current EPA maximum contaminant levels

Health Conditions Linked to Camp Lejeune Exposure

Research has identified associations between Camp Lejeune water contamination and several health conditions, but obstructive sleep apnea is not among them.

Established Cancer Associations:

• Kidney cancer (HR = 1.35,95% CI: 0.84,2.16) 2
• Liver cancer (HR = 1.42,95% CI: 0.92,2.20) 2
• Esophageal cancer (HR = 1.43,95% CI: 0.85,2.38) 2
• Multiple myeloma (HR = 1.68,95% CI: 0.76,3.72) 2
• Leukemias (HR = 1.59,95% CI: 0.66,3.84) 3
• Acute myeloid leukemia (HR = 1.38,95% CI: 1.03,1.85) 4
• Thyroid cancer (HR = 1.22,95% CI: 1.03,1.45) 4

Other Associated Conditions:

• Parkinson's disease (HR = 3.13,95% CI: 0.76,12.81) 3
• Amyotrophic Lateral Sclerosis (ALS) with high vinyl chloride exposure (HR = 2.21,95% CI: 0.71,6.86) 2

Assessment for Obstructive Sleep Apnea Connection

None of the comprehensive mortality and cancer incidence studies conducted on Camp Lejeune populations have identified obstructive sleep apnea as an associated condition:

1. The 2014 mortality study of Marines and Navy personnel 2 did not identify OSA as an outcome.
2. The 2014 mortality study of civilian employees 3 did not report OSA associations.
3. The 2024 cancer incidence study 4, which is the most recent and comprehensive analysis, did not include OSA among reported outcomes.
4. The case series report 5 focused on cancer patients and did not mention OSA.

Clinical Implications

For patients with history of Camp Lejeune exposure:

1. Focus screening and monitoring on established associated conditions:

   • Various cancers (kidney, liver, esophageal, hematologic malignancies)
   • Neurological conditions (Parkinson's, ALS)

2. For patients with OSA symptoms and Camp Lejeune exposure:

   • Evaluate and treat OSA according to standard clinical guidelines
   • Consider the established risk factors for OSA (obesity, craniofacial abnormalities, smoking, etc.)
   • Do not attribute OSA directly to Camp Lejeune exposure based on current evidence

3. Patient education:

   • Inform patients that while many conditions are linked to Camp Lejeune water contamination, OSA has not been established as one of them
   • Encourage appropriate screening for the conditions that are associated with the exposure

Conclusion for Providers

While Camp Lejeune water contamination has been linked to numerous serious health conditions including multiple types of cancer and neurological diseases, there is no established evidence connecting this exposure to obstructive sleep apnea. Clinicians should focus on screening for the well-documented associated conditions while managing OSA according to standard clinical guidelines.