Smoking Obstructive Sleep Apnea: Arguments for a Distinctive Phenotype and a Personalized Intervention

Abstract

Background: This is the first study that aims to define smoking, with obstructive sleep apnea (OSA), as a phenotype (SOSA). Moreover, we wanted to demonstrate the deleterious effects of the continuation of smoking on OSA. Methods: The cross-sectional study highlighted four dimensions of SOSA: the demographic and anthropometric features, the symptoms, the comorbidities, and the sleep study parameters. This study compared these characteristics between current smokers (CS), those who have never smoked (NS), and ex-smokers (ES) with OSA. Results: More men (83.95% in CS, versus 66.67% in NS) and an earlier onset of OSA (average age = 50.05 in CS, versus 52.26 in NS, p = 0.04) were recorded among CS. The distinguishing symptom of CS was daytime sleepiness, with an Epworth score that was significantly higher than in NS. Chronic obstructive pulmonary disease (COPD) was significantly more prevalent in CS (38.27%) than in NS (1.51%) (p < 0.001). The severity of OSA, consisting of a higher apnea-hypopnea index, a higher oxygen desaturation index, and a longer time spent below 90% oxygen saturation during sleep was significantly influenced by smoking. Conclusions: The SOSA phenotype includes younger male patients with a higher waist circumference, suggesting central obesity. They have a higher prevalence of COPD and a greater severity of OSA, in correlation with the number of pack-years of smoking.

Association between smoking and obstructive sleep apnea based on the STOP-Bang index

“…This phenomenon can also lead to obstruction and difficulty breathing during sleep, resulting in symptoms such as snoring, panting, and interrupted sleep. We also assume that smoking reduces muscle tension in people and causes structural changes in the upper airway by accumulating pharyngeal fat, which can contribute to the severity of OSA symptoms 24 . Finally, it increases oxidative stress and inflammation throughout the body, leading to sleep disorders and the development of an arousal threshold that makes it easier to wake up 25 .…”

The Interactions between Smoking and Sleep

“…As far as the relationship between smoking and OSAHS severity, things are rather clearer. Current smokers seem to present OSAHS earlier than their non-smoking counterparts [80]. Smokers also seem to present more severe OSAHS, at least in the majority of the studies [5,7,[80][81][82][83][84], compared to non-smokers.…”

“…Smokers also seem to present more severe OSAHS, at least in the majority of the studies [5,7,[80][81][82][83][84], compared to non-smokers. Numerous OSA indices were deteriorated in smokers including ODI, mean and minimum SaO2, total sleep time and sleep time ratio with SaO2 below 90%, mean apnoea duration, nocturnal hypoxia index and COHb levels [5,7,[80][81][82][83][84][85][86][87][88][89]. However, the relationship of AHI with smoking is not clear.…”

“…However, the relationship of AHI with smoking is not clear. Many studies concluded that AHI is deteriorated or affected in a dosedependent manner with smoking, even after adjusting for covariates [5,7,[80][81][82][83][84], while in other studies AHI seems not to be related with smoking [85][86][87][88][89][90][91][92]. As far as Epworth sleepiness scale (ESS), the majority of the studies concluded that it is worse in smokers [80,82,85,87], although there were also a few notable exceptions in this topic [7,91].…”

How COVID-19 Pandemics Changed the Treatment Protocols for Patients with Gynecological Tumors

“…Moreover, many are elderly (~ 60 years (25), like in colorectal cancer (26) ) and more susceptible to aggressive coronavirus infection. Some of them could have already respiratory disease, are smokers or former smokers (smoking is a risk factor for cervix cancer( 27) ), with multiple risk factors for severe respiratory complication (28) and outcome (29).…”