Study Details Link Between Cigarette Use, Obstructive Sleep Apnea

Obstructive sleep apnea (OSA) is more common among conventional cigarette smokers than among nonsmokers, according to new results of a cross-sectional study published in Archives of Public Health.

However, researchers found no significant difference in the prevalence of OSA between e-cigarette smokers and nonsmokers. Individuals who smoked both e-cigarettes and conventional cigarettes had the highest prevalence of the condition compared with those who used one form or the other and nonsmokers.

OSA is increasingly common and is considered a top public health issue, affecting between 5% and 15% of the overall population. Although obesity and male sex serve as the main risk factors for OSA, study results have also shown smoking increases the risk of the condition.

E-cigarettes, or inhalable aerosol devices that are produced by electrical heating, have gained popularity in recent years and “are promoted as a less harmful and more fashionable smoking tool,” the authors wrote.

To better understand any potential link between different smoking patterns and OSA, researchers assessed data from the 2015-2018 cycle of the National Health and Nutrition Examination Survey.

A total of 11,248 participants were included in the current study. Individuals were divided into 4 groups based on their smoking habits: noncurrent smokers (n = 8959), current e-cigarette users only (n = 264), current conventional cigarettes users only (n = 1718), and dual users (n=307).

In addition to a higher prevalence of OSA found among smokers compared with nonsmokers, data also revealed:

• An increased prevalence of OSA with conventional cigarette use alone (odds ratio [OR], 1.38; 95% CI, 1.17-1.63) and dual users (OR, 1.78; 95% CI, 1.37-2.32) compared with nonsmoking participants
• There was no significant difference with e-cigarette use when it came to OSA prevalence compared with nonsmokers (OR, 0.84; 95% CI, 0.52-1.37)
• Multivariate logistic regression analysis showed the prevalence of OSA is highest in dual users (OR, 1.93; 95% CI, 1.39-2.69) than nonsmokers

Smoking can influence the risk of OSA in several ways. For one, the habit changes the sleep structure of the patient and reduces sleep stability, the authors wrote. In addition, nicotine in tobacco can leave muscles in the upper respiratory tract loose, weaken nerve reactions, and make the respiratory tract more susceptible to collapse.

Men and those aged 18 to 40 years were more likely to use e-cigarettes, although smoking combustible cigarettes remained the most popular smoking habit. Those over age 40 were also more likely to be dual users. Body mass index, marital status, and alcohol consumption were independent influences of OSA, but no significant associations were found between education level, average household income, and ethnicity and the condition.

“Despite the great progress made in the past in the recognition of OSA, 70% to 80% are still undiagnosed,” authors explained. “Since patients are often unaware of their symptoms while sleeping, they are usually detected by their bed partners or family members, missing the best time for early intervention, which can lead to serious complications.”

Exposure to second-hand smoke has also been independently linked with OSA.

Memory bias may have been present in the current study, marking a limitation. The researchers were also unable to exclude all confounding factors that may play a role on OSA prevalence, such as lifestyle factors or geographical locations. Differences in gender and age distribution between the groups may have also affected results, they concluded.

Reference

Zhu H, and Wu M. A cross-sectional study on the relationship between electronic cigarette and combustible cigarette use with obstructive sleep apnea among U.S. adults: result from NHANES 2015–2018. Arch Public Health. Published online April 13, 2023. doi:10.1186/s13690-023-01083-6