Correlation analysis between smoking and obstructive sleep apnea_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

LI Yuning , LIU Xue , FENG Xiaoyu , AN Jinlu , SHI Jiang ,  JIANG Junguang

Elderly Respiratory Sleep Department, The First Affiliated Hospital of Zhengzhou University, Henan Institute of Respiratory Disease, Zhengzhou, Henan 450052, P. R. China;

Corresponding author：

JIANG Junguang, Email: jjg88@sina.com

Keywords：

Smoking; obstructive sleep apnea; smoking cessation; degree of hypoxia

DOI：

10.7507/1671-6205.202303074

Video：

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Objective To study the correlation between smoking and obstructive sleep apnea (OSA). Methods A total of 454 patients from October 2015 to July 2021 were retrospectively collected for nocturnal polysomnography monitoring (no less than 7 hours). The patients were divided into an OSA group (n=405) and a control group (n=49, patients with primary snoring) according to the results of polysomnography monitoring. According to the apnea hypopnea index (AHI) and the lowest oxygen saturation during sleep, the severity of OSA was classified into a mild to moderate group (5 times/h ≤ AHI<30 times/h) and a severe group (AHI ≥30 times/h). The patients were inquired about their smoking history, then the patients diagnosed with OSA were further divided into a smoking group, a smoking cessation group, and a non-smoking group based on their smoking history. Results The smoking rate of the patients in the OSA group was higher than that in the control group (50.9% vs. 32.7%, P<0.05), while the smoking rate in the severe OSA group was higher than that in the mild to moderate group (55.7% vs. 39.8%, P<0.05). Smoking was positively correlated with AHI, cumulative percentages of time spent at oxygen saturation below 90% (Ts90%), and total apnea time (r value was 0.196, 0.197, 0.163, P<0.05), while negatively correlated with the lowest and average SpO₂ during sleep (r value was –0.202, –0.214, P<0.05). The logistic regression analysis with severe OSA as the outcome variable showed that smoking (OR=1.781) and obesity (OR=1.930) were independent risk factors of severe OSA (P<0.05). The comparison between groups of the OSA patients with different smoking states showed that the proportion of severe OSA, AHI, Ts90%, and total apnea time (77.8%, 53.55 times/h, 18.35%, and 111.70 minutes, respectively) of the smoking group were higher than those of the non-smoking group (62.8%, 40.20 times/h, 8.40%, and 76.20 minutes, respectively, P<0.05). The lowest SpO₂ and average SpO₂ during sleep (69.50%, 93.00%, respectively) of the smoking group were lower than those of the non-smoking group (75.00%, 94.00%, respectively, both P<0.05). The average SpO₂ of the smoking cessation group was higher than that of the smoking group (94.00% vs. 93.00%, P<0.05), and the Ts90% of the smoking cessation group was lower than that of the smoking group (6.75% vs. 18.35%, P<0.05). Conclusions Smoking significantly affects the degree of sleep-disordered breathing and may be an independent risk factor for severe OSA. Smoking can exacerbate the severity of OSA and the degree of hypoxia, while smoking cessation can improve the degree of hypoxia in OSA patients.

Citation： LI Yuning, LIU Xue, FENG Xiaoyu, AN Jinlu, SHI Jiang, JIANG Junguang. Correlation analysis between smoking and obstructive sleep apnea. Chinese Journal of Respiratory and Critical Care Medicine, 2023, 22(4): 251-255. doi: 10.7507/1671-6205.202303074 Copy

1.	Huang Q, Ali S, Zhang J. Association between exposure to family environmental tobacco smoke and obstructive sleep apnea hypopnea syndrome. Appl Ecol Env Res, 2019, 17(5): 12615-12622.
2.	刘莺, 屠春林, 姚文飞, 等. 职业驾驶员阻塞性睡眠呼吸暂停低通气综合征的患病率及与交通事故的关系. 中华医学杂志, 2016, 96(48): 3902-3905.
3.	Lyons MM, Bhatt NY, Pack AI, et al. Global burden of sleep-disordered breathing and its implications. Respirology, 2020, 25(7): 690-702.
4.	Deleanu OC, Pocora D, Mihalcuta S, et al. Influence of smoking on sleep and obstructive sleep apnea syndrome. Pneumologia, 2016, 65(1): 28-35.
5.	Trenchea M, Deleanu O, Suta M, et al. Smoking, snoring and obstructive sleep apnea. Pneumologia, 2013, 62(1): 52-55.
6.	中华医学会呼吸病学分会睡眠呼吸障碍学组. 阻塞性睡眠呼吸暂停低通气综合征诊治指南(2011年修订版). 中华结核和呼吸杂志, 2012, 35(1): 9-12.
7.	中华医学会, 中华医学会杂志社, 中华医学会全科医学分会, 等. 成人阻塞性睡眠呼吸暂停基层诊疗指南(实践版·2018). 中华全科医师杂志, 2019, 18(1): 30-35.
8.	Lin YN, Zhou LN, Zhang XJ, et al. Combined effect of obstructive sleep apnea and chronic smoking on cognitive impairment. Sleep Breath, 2016, 20(1): 51-59.
9.	全志豪, 刘建红, 谢宇萍, 等. 吸烟与阻塞性睡眠呼吸暂停低通气综合征的相关性. 中华医学杂志, 2014, 94(10): 733-736.
10.	Zhu HM, Xu HJ, Chen R, et al. Smoking, obstructive sleep apnea syndrome and their combined effects on metabolic parameters: evidence from a large cross-sectional study. Sci Rep, 2017, 7(1): 8851.
11.	Kashyap R, Hock LM, Bowman TJ. Higher prevalence of smoking in patients diagnosed as having obstructive sleep apnea. Sleep Breath, 2001, 5(4): 167-172.
12.	Wetter DW, Young TB, Bidwell TR, et al. Smoking as a risk factor for sleep-disordered breathing. Arch Intern Med, 1994, 154(19): 2219-2224.
13.	Moreno CR, Carvalho FA, Lorenzi C, et al. High risk for obstructive sleep apnea in truck drivers estimated by the Berlin questionnaire: prevalence and associated factor. Chronobiol Int, 2004, 21(6): 871-879.
14.	Kim KS, Kim JH, Park SY, et al. Smoking induces oropharyngeal narrowing and increases the severity of obstructive sleep apnea syndrome. J Clin Sleep Med, 2012, 8(4): 367-374.
15.	Hsu WY, Chiu NY, Chang CC, et al. The association between cigarette smoking and obstructive sleep apnea. Tob Induc Dis, 2019, 17(April): 27.
16.	Lin YN, Li QY, Zhang XJ. Interaction between smoking and obstructive sleep apnea: not just participants. Chin Med J (Engl), 2012, 125(17): 3150-3156.
17.	Larsson LG, Lindberg A, Franklin KA, et al. Obstructive sleep apnoea syndrome is common in subjects with chronic bronchitis. Report from the obstructive lung disease in Northern Sweden studies. Respiration, 2001, 68(3): 250-255.
18.	Haxhiu MA, Van Lunteren E, Van de Graaff WB, et al. Action of nicotine on the respiratory activity of the diaphragm and genioglossus muscles and the nerves that innervate them. Respir Physiol, 1984, 57(2): 153-169.
19.	Gothe B, Strohl KP, Levin S, et al. Nicotine: a different approach to treatment of obstructive sleep apnea. Chest, 1985, 87(1): 11-17.
20.	宋卫卫, 蒋军广, 安金路. 阻塞性睡眠呼吸暂停低通气综合征血脂异常的相关因素. 中国老年学杂志, 2017, 37(7): 1673-1675.
21.	Casasola GG, Álvarez-Sala JL, Marques JA, et al. Cigarette smoking behavior and respiratory alterations during sleep in a healthy population. Sleep Breath, 2002, 6(1): 19-24.
22.	Bonsignore MR, Parati G, Insalaco G, et al. Baroreflex control of heart rate during sleep in severe obstructive sleep apnoea: effects of acute CPAP. Eur Respir J, 2006, 27(1): 128-135.
23.	Lewis KW, Bosque EM. Deficient hypoxia awakening response in infants of smoking mothers: possible relationship to sudden infant death syndrome. J Pediatr, 1995, 127(5): 691-699.
24.	Fewell JE, Smith FG. Perinatal nicotine exposure impairs ability of newborn rats to autoresuscitate from apnea during hypoxia. J Appl Physiol (1985), 1998, 85(6): 2066-2074.
25.	Hafström O, Milerad J, Sundell HW. Prenatal nicotine exposure blunts the cardiorespiratory response to hypoxia in lambs. Am J Respir Crit Care Med, 2002, 166(12): 1544-1549.
26.	Wright JL, Postma DS, Kerstjens HA, et al. Airway remodeling in the smoke exposed guinea pig model. Inhal Toxicol, 2007, 19(11): 915-923.

1. Huang Q, Ali S, Zhang J. Association between exposure to family environmental tobacco smoke and obstructive sleep apnea hypopnea syndrome. Appl Ecol Env Res, 2019, 17(5): 12615-12622.
2. 刘莺, 屠春林, 姚文飞, 等. 职业驾驶员阻塞性睡眠呼吸暂停低通气综合征的患病率及与交通事故的关系. 中华医学杂志, 2016, 96(48): 3902-3905.
3. Lyons MM, Bhatt NY, Pack AI, et al. Global burden of sleep-disordered breathing and its implications. Respirology, 2020, 25(7): 690-702.
4. Deleanu OC, Pocora D, Mihalcuta S, et al. Influence of smoking on sleep and obstructive sleep apnea syndrome. Pneumologia, 2016, 65(1): 28-35.
5. Trenchea M, Deleanu O, Suta M, et al. Smoking, snoring and obstructive sleep apnea. Pneumologia, 2013, 62(1): 52-55.
6. 中华医学会呼吸病学分会睡眠呼吸障碍学组. 阻塞性睡眠呼吸暂停低通气综合征诊治指南(2011年修订版). 中华结核和呼吸杂志, 2012, 35(1): 9-12.
7. 中华医学会, 中华医学会杂志社, 中华医学会全科医学分会, 等. 成人阻塞性睡眠呼吸暂停基层诊疗指南(实践版·2018). 中华全科医师杂志, 2019, 18(1): 30-35.
8. Lin YN, Zhou LN, Zhang XJ, et al. Combined effect of obstructive sleep apnea and chronic smoking on cognitive impairment. Sleep Breath, 2016, 20(1): 51-59.
9. 全志豪, 刘建红, 谢宇萍, 等. 吸烟与阻塞性睡眠呼吸暂停低通气综合征的相关性. 中华医学杂志, 2014, 94(10): 733-736.
10. Zhu HM, Xu HJ, Chen R, et al. Smoking, obstructive sleep apnea syndrome and their combined effects on metabolic parameters: evidence from a large cross-sectional study. Sci Rep, 2017, 7(1): 8851.
11. Kashyap R, Hock LM, Bowman TJ. Higher prevalence of smoking in patients diagnosed as having obstructive sleep apnea. Sleep Breath, 2001, 5(4): 167-172.
12. Wetter DW, Young TB, Bidwell TR, et al. Smoking as a risk factor for sleep-disordered breathing. Arch Intern Med, 1994, 154(19): 2219-2224.
13. Moreno CR, Carvalho FA, Lorenzi C, et al. High risk for obstructive sleep apnea in truck drivers estimated by the Berlin questionnaire: prevalence and associated factor. Chronobiol Int, 2004, 21(6): 871-879.
14. Kim KS, Kim JH, Park SY, et al. Smoking induces oropharyngeal narrowing and increases the severity of obstructive sleep apnea syndrome. J Clin Sleep Med, 2012, 8(4): 367-374.
15. Hsu WY, Chiu NY, Chang CC, et al. The association between cigarette smoking and obstructive sleep apnea. Tob Induc Dis, 2019, 17(April): 27.
16. Lin YN, Li QY, Zhang XJ. Interaction between smoking and obstructive sleep apnea: not just participants. Chin Med J (Engl), 2012, 125(17): 3150-3156.
17. Larsson LG, Lindberg A, Franklin KA, et al. Obstructive sleep apnoea syndrome is common in subjects with chronic bronchitis. Report from the obstructive lung disease in Northern Sweden studies. Respiration, 2001, 68(3): 250-255.
18. Haxhiu MA, Van Lunteren E, Van de Graaff WB, et al. Action of nicotine on the respiratory activity of the diaphragm and genioglossus muscles and the nerves that innervate them. Respir Physiol, 1984, 57(2): 153-169.
19. Gothe B, Strohl KP, Levin S, et al. Nicotine: a different approach to treatment of obstructive sleep apnea. Chest, 1985, 87(1): 11-17.
20. 宋卫卫, 蒋军广, 安金路. 阻塞性睡眠呼吸暂停低通气综合征血脂异常的相关因素. 中国老年学杂志, 2017, 37(7): 1673-1675.
21. Casasola GG, Álvarez-Sala JL, Marques JA, et al. Cigarette smoking behavior and respiratory alterations during sleep in a healthy population. Sleep Breath, 2002, 6(1): 19-24.
22. Bonsignore MR, Parati G, Insalaco G, et al. Baroreflex control of heart rate during sleep in severe obstructive sleep apnoea: effects of acute CPAP. Eur Respir J, 2006, 27(1): 128-135.
23. Lewis KW, Bosque EM. Deficient hypoxia awakening response in infants of smoking mothers: possible relationship to sudden infant death syndrome. J Pediatr, 1995, 127(5): 691-699.
24. Fewell JE, Smith FG. Perinatal nicotine exposure impairs ability of newborn rats to autoresuscitate from apnea during hypoxia. J Appl Physiol (1985), 1998, 85(6): 2066-2074.
25. Hafström O, Milerad J, Sundell HW. Prenatal nicotine exposure blunts the cardiorespiratory response to hypoxia in lambs. Am J Respir Crit Care Med, 2002, 166(12): 1544-1549.
26. Wright JL, Postma DS, Kerstjens HA, et al. Airway remodeling in the smoke exposed guinea pig model. Inhal Toxicol, 2007, 19(11): 915-923.

Chinese Journal of Respiratory and Critical Care Medicine

Correlation analysis between smoking and obstructive sleep apnea

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