Smoking Induces Oropharyngeal Narrowing and Increases the Severity of Obstructive Sleep Apnea Syndrome

Abstract

anatomic factor for OSAS. [11][12][13] Pathological conditions such as a redundant or long uvula and enlarged tonsils are thought to be the predominant causes of upper airway collapse during sleep and are indications for surgery to decrease snoring, apnea, and snoring-related cardinal symptoms. The upper airway mucosa can be easily affected by smoking, and longer exposure to smoking may cause abnormal histological changes to the upper airway mucosa. Therefore, evaluation of the uvular changes after exposure to smoking is important for understanding how smoking directly affects the uvular mucosa.This study was designed to determine the relationship between smoking and OSAS. We reviewed the sleep studies of smokers and nonsmokers who were diagnosed with OSAS to Objective: Smoking is a known risk factor for snoring, and is reported to be associated with an increased prevalence of obstructive sleep apnea syndrome (OSAS). The purpose of this was to determine the relationship of smoking to the severity of OSAS and examine what local histological changes in the uvular mucosa of OSAS patients might infl uence this relationship. Study Design and Methods: Fifty-seven OSAS subjects were included and classifi ed according to smoking history and OSAS severity. Twenty-eight subjects were heavy smokers and 29 were nonsmokers; these 57 patients were divided according to moderate or severe OSAS. Histologic changes in the uvular mucosa were evaluated in all subjects as well as smoking duration and OSAS severity. Results: Among smokers, moderate-to-severe OSAS was more common, and apnea, hypopnea, and oxygen desaturation indices were higher. Moreover, smoking duration and OSAS severity were signifi cantly correlated. Increased thickness and edema of the uvular mucosa lamina propria were observed in moderate and severe OSAS patients, and only smokers had signifi cant changes in uvular mucosa histology. Positive staining for calcitonin gene-related peptide (CGRP), a neuroinfl ammatory marker for peripheral nerves, was increased in the uvular mucosa of smokers. Conclusions: Our results suggest that smoking may worsen OSAS through exacerbation of upper airway collapse at the level of the uvula, and that histological changes of the uvular mucosa correlated with smoking might be due to increased CGRP-related neurogenic infl ammation. S C I E N T I F I C I N V E S T I G A T I O N SO bstructive sleep apnea syndrome (OSAS) is a complex, chronic disorder characterized by snoring, periodic apnea, hypoxemia during sleep, and daytime hypersomnolence.1 Its prevalence is 16% to 33% in men and 8% to 19% in women. 2,3 OSAS has been shown to increase the risk of hypertension, stroke, and cardiovascular disease. [4][5][6] In addition, clinical studies have reported that OSAS increases morbidity from crashes caused by daytime somnolence, and have focused on the diagnosis, treatment, and prevention of OSAS. Obesity, male sex, older age, alcohol use, genetic factors, and a narrowed upper airway are well-known risk factors for OSAS, and smoking may be ...

Distúrbios do sono em adultos de uma cidade do Estado de São Paulo

“…This study did not identify smoking as a risk factor to sleep disorders, as oppose to the others 13,14 . In the study of Kim et al 13 , it was observed that smoking may trigger sleep disorders and even be a risk factor to the obstructive sleep apnea syndrome.…”

“…In the study of Kim et al 13 , it was observed that smoking may trigger sleep disorders and even be a risk factor to the obstructive sleep apnea syndrome. This way, the differences observes between these studies may be explained, at least …”

“…Studies carried out in São Paulo show that 32% of São Paulo's citizens presented symptoms of insomnia 8 , as well as that, between 1987 and 2007, the percentage of paulistanos who had "trouble sleeping", "maintaining the sleep throughout the night" and "waking up" increased significantly 9 . Besides that, recent studies have identified an association between sleep disorders, metabolic and cardiovascular diseases (hypertension, dyslipidemia and diabetes mellitus) [10][11][12] , risk behaviors (smoking) 13,14 and the presence of overweight and/or obesity 15 . Sleep disorders, as well as the shorter duration of sleep, are associated to weight gain 16,17 , and the decrease in the quality of sleep seems to be associated to higher food intake and alcohol consumption 18 .…”

Sleep Disorders in Chronic Obstructive Pulmonary Disease: Etiology, Impact, and Management

“…128 Both OSA and COPD are associated with inflammatory cell activation and hypoxia. 113 These may lead to endothelial dysfunction, and consequently several adverse outcomes.…”

Sleep Hygiene Behaviors Among Midlife Women with Insomnia or Sleep-Disordered Breathing: The SWAN Sleep Study

“…16,17 For instance, in those with existing SDB, alcohol use, or smoking may exacerbate SDB severity by depressing upper airway dilator tone or causing upper airway inflammation, respectively. 18,19 Moreover, exercising, maintaining a regular out-ofbed time, refraining from evening caffeine, and/or minimizing daytime napping could facilitate better sleep quality (e.g., more slow-wave sleep, less fragmentation), which is protective against SDB. 20,21 Because of the possible utility of sleep hygiene education for the behavioral management of insomnia or SDB, determining the frequency of these behaviors could inform future interventions to improve sleep in midlife women.…”