Higher Prevalence of Smoking in Patients Diagnosed as Having Obstructive Sleep Apnea

Abstract

Nightly nicotine withdrawal as well as other respiratory and pulmonary effects of smoking may result in sleep-disordered breathing, especially obstructive sleep apnea (OSA). We hypothesize that there is higher prevalence of smoking in patients with OSA. We also hypothesize that smoking is an independent risk factor for OSA. The aim of this study is to determine whether there is a higher prevalence of smoking in patients with OSA compared with patients who do not have OSA. To investigate this, we randomly selected a group of 108 patients who were diagnosed as having OSA, defined by an apnea-hypopnea index (AHI) of greater than 10 events per hour. We compared their smoking history with another randomly selected group of 106 patients without OSA, defined by an AHI of less than five events per hour. The prevalence of smoking in patients with OSA was found to be 35%, whereas it was only 18% in patients without OSA. Logistic regression analyses were performed to investigate the effects of smoking while adjusting for age, gender, body mass index (BMI), and number of alcoholic drinks per week. While holding fixed the BMI, gender, age, and number of alcoholic drinks per week, current smokers were found to be 2.5 times more likely to have OSA than former smokers and nonsmokers combined (odds ratio = 2.5, CI 1.3-4.7, p = 0.0049), and 2.8 times more likely to have OSA than former smokers alone (odds ratio = 2.8, CI = 1.4-5.4, p = 0.0028). Adjusted for BMI, gender, age, and number of alcoholic drinks per week, former smokers were not more likely than never smokers to have OSA (odds ratio = 1.2, CI = 0.55-2.7, p = 0.64). We conclude that cigarette smoke may be an independent risk factor for OSA in this referral population.

Obstructive sleep apnea syndrome: natural history, diagnosis, and emerging treatment options

“…In the Wisconsin Sleep Cohort Study, a higher risk of snoring and OSA was noted in smokers compared with never-smokers or former smokers with an odds ratio of 2.29 and 4.44, respectively 109. This finding was confirmed by another study reporting that current smokers were 2.5 times more likely to have OSA than former and nonsmokers combined and 2.8 times more likely to have OSA than former smokers alone 110. This effect is noticeable on passive smokers who have a high risk for habitual snoring 111.…”

Risk of obstructive sleep apnea in African American patients with chronic rhinosinusitis

“…24,25 Future studies are needed to investigate whether the increased risk of OSA in the setting of CRS is linked to any of these genetic alterations. Furthermore, other lifestyle risk factors for OSA, such as smoking, 26,27 which is also a major risk factor for CRS 28 and is more commonly practiced and sustained into adulthood among African Americans, 29 might be playing a role in this increased risk. The burden of sleep symptoms and risk of hypertension in the setting of OSA is higher among African Americans compared with other races.…”

Trajectories of cigarette smoking in adulthood predict insomnia among women in late mid-life

“…Similarly, medical problems may also play a role in the relationship between smoking and insomnia. Smokers are at greater risk than non- or former smokers for respiratory and other medical conditions (e.g., COPD, OSA, pain) [45,53,54,91–93], many of which are associated with sleep problems [89,92,94]. However, our analysis was one of few studies on smoking and sleep that controlled for health conditions, depression, and BMI, in addition to educational level (a proxy for SES), and marital status.…”

“…Electroencephalographic measures have also demonstrated differences in the brain waves of smokers versus non-smokers during sleep [50], such as increased alpha-power waves in smokers, suggesting greater arousal [50,51]. Furthermore, smoking may adversely impact sleep through its association with respiratory and other medical conditions, such as chronic obstructive pulmonary disease (COPD) [39,52], and obstructive sleep apnea (OSA) [53,54]. …”