The impact of smoking status on obstructive sleep apnea (OSA) severity.

Abstract

Background: Smoking is a risk factor for obstructive sleep apnea (OSA), however, little is known about the impact of smoking on OSA symptoms.

Aim: Analysis of OSA severity in relation to smoking status.

Material and methods: We enrolled consecutive patients referred to our outpatient clinic between 2007 and 2017 due to snoring and sleepiness and in whom OSA was confirmed in polysomnography. The Epworth Sleepiness Scale (ESS) was used to evaluate daytime somnolence. A self-administered questionnaire was used to assess smoking status. Current smoking was defined as smoking of any amount of nicotine containing products such as cigarettes, cigars etc. Patients who had not smoked for at least 50 weeks were considered non-smokers. All parameters were assessed prior to the onset of any OSA treatment.

Results: The study included 3613 patients with OSA (1016 F, 2597 M) with a mean ESS score of 11.1±5.5 points. Of these 796 (22%) were current smokers. This group was characterized by a larger proportion of men (77.9% vs 70.2%, p<0.005), younger age and higher AHI, ESS score and mean SpO2 during sleep. The comparison between the two groups is shown below:

Current smoker Non-smokers p

Age [years] 53.8±8.0 58.6±9.5 <0.001

BMI [kg/m2 ] 31.5±6.3 31.5±5.8 ns

ESS 11.7±5.5 11.0±5.5 <0.001

AHI [n per hour] 31.9±25.8 29.2±22.6 <0.05

BMI – body mass index, ESS - Epworth Sleepiness Scale score, AHI- apnea-hypopnea index, ns – not significant

Conclusions: Our results suggest that active smokers may develop OSA earlier and OSA in current smokers may be more severe.