The association between cigarette smoking and obstructive sleep apnea

Abstract

INTRODUCTIONObstructive sleep apnea (OSA) is a serious sleep disorder characterized by repetitive episodes of paused or shallow breathing during sleep. Patients with OSA often have excessive daytime sleepiness. The role of cigarette smoking in OSA remains controversial. The aim of this study was to examine the relationship between cigarette smoking and OSA.METHODSIn this retrospective chart review, we reviewed 18-month sleep laboratory charts in central Taiwan. We collected data regarding sleep, current cigarette smoking status, sex, age, body mass index (BMI), neck circumference, Epworth Sleepiness Scale score, and polysomnographic sleep parameters. In total, 733 subjects were recruited; among these, 151 were smokers and 582 were non-smokers.RESULTSSmokers had significantly higher apnea–hypopnea index (p<0.001) for non-rapid eye movement sleep stage, higher apnea–hypopnea index (p<0.001) for total sleep time, and higher snore frequency (p<0.001) in t-test analysis. They also demonstrated higher Epworth Sleepiness Scale scores, shorter sleep times, lower percentage of slow-wave (deep) sleep, and longer snore times. However, no significant association was found between cigarette smoking and OSA after adjusting for sex, age, and BMI (OR=1.02, 95% CI: 0.66–1.57).CONCLUSIONSWe did not find any significant association between cigarette smoking and OSA after adjusting for age, sex, and BMI. Further well-designed prospective controlled cohort studies might clarify the relationship between cigarette smoking and OSA.

Smoking history and its relationship with comorbidities in patients with obstructive sleep apnea

“…Our results were consistent with the findings of the above studies. Like the studies of Hsu et al 7 and Casasola et al 8 , this study did not show an association between smoking history and the severity of OSA as represented by AHI; however, the ESS score of current/former smokers was slightly higher than in non-smokers. Daytime sleepiness is related to a variety of factors.…”

“…The mucosa of the upper respiratory tract is easily affected by smoke. Long-term smoking causes edema, hyperplasia, hypertrophy, and ciliary dysfunction of mucosa of the upper airway 7,36 , leading to chronic inflammation of the upper airway, which in turn changes the biomechanical properties of the upper airway 37 , increasing its instability. In addition, nicotine damages the neuromuscular protective reflex 7 .…”

“…This phenomenon was more severe in OSA patients who were heavy smokers. In contrast, Hsu et al 7 and Casasola et al 8 showed that smoking had no correlation with OSA. A recent meta-analysis of a total of 5264 participants in 14 studies suggested that smoking was not related to OSA, but the level of evidence in the included studies was low 9 .…”

Environmental Factors as Modulators of the Relationship between Obstructive Sleep Apnea and Lesions in the Circulatory System

“…A study performed on over 5000 patients demonstrated that cigarette smoking correlates with a more severe form of obstructive sleep apnea and greater daytime sleepiness [58]. Similar results were obtained in a study by Hsu et al, where it was additionally found that smokers with OSA have a shorter total sleep time, reduced deep sleep and longer snoring period [59]. One should also note the synergic, adverse effect of obstructive sleep apnea and tobacco smoking on the circulatory system.…”

Obstructive Sleep Apnea among the Lebanese general population: Prevalence, associated factors and knowledge

“…Our results showed that a higher number of cigarettes smoked per day was significantly associated with higher daytime sleepiness, in agreement with previous studies 52,53 . While the association between cigarette smoking and OSA is plausible, the evidence is less than conclusive 54 . Cigarette smoking may worsen swelling and inflammation in the upper airway, affecting the neuromuscular function, and making snoring worse 55 .…”