The Influence of Smoking on Snoring, Obstructive Sleep Apnea, and Related Comorbidities

Abstract

METHODS: A cross sectional study of OSA among adults with sleep complaints was conducted, from October 2011 to June 2012, in a Sleep Center of Clinical Pneumopthysiology Hospital, Constanta, Romania. All patients referred for snoring and sleep disordered breathing (SDB) underwent attented nocturnal cardiorespiratory poligraphy. Diagnosis of OSA was sustained by apnea-hypopnea index (AHI) of ≥5 obstructive events per hour of sleep. Severity Criteria of OSA, based on the guidelines of American Academy of Sleep Medicine (AASM), Body Mass Index (BMI) and tobacco use were quantified. Eligible subjects inform consented for a self-report questionnaire of night time symptoms and day time sleepiness. The prevalence of moderate-to-severe OSA was assigned among smokers. The interactions between smoking, snoring, and OSA were assessed, using multivariate logistic regression with odds ratios (OR) and 95% confidence intervals (CI) as measures of association. RESULTS: Of 89 adults, mean aged 52.43 ± 15.501 year-old, with male predominance (n=65/89; 73%), 26 were current smokers, 27 former smokers and 36 nonsmokers. The mean of packyear (py) was similar in current smokers (22.62 ± 2.649 py) versus exsmokers (22.44 ± 2.050 py). The mean BMI was 33.35 ± 6.5 kg/m2. A third of subjects (n=27/89) were diagnosed with OSA during the study period and smokers were prevalent (n=21/27. 77.78%). The mean value of AHI was 34.066 ± 23.666. Severe OSA forms were more frequent (n=21/27. 77.8%) than moderate ones (n=6/27. 22.2%). Snoring was more frequent among current and former smokers versus nonsmokers (p= 0.313). OSA risk factors of age ≥ 50 years, gender (male), obesity, increased neck circumference, craniofacial abnormalities were correlated with smoking (p < 0.007). The association of OSA with comorbidities (metabolic syndrome, respiratory, cardiovascular and cerebrovascular diseases) was noticed particularly in smokers, but only congestive heart failure was significantly influenced by smoking (p=0.35). CONCLUSIONS: Smoking remains an inconclusive risk factor of snoring but is strongly associated with OSA and risk factors of OSA. Comorbidities associated with OSA are more frequent among smokers. CLINICAL IMPLICATIONS: All patients with SDB should be screened for smoking and smokers for OSA. Tobacco cessation must be recommended to all smokers.