Where There Is Smoke...There Is Sleep Apnea: Exploring the Relationship Between Smoking and Sleep Apnea | Journal Scan

Krishnan V, Dixon-Williams S, Thornton JD.
Chest 2014;146:1673-1680.
The following are 10 points to remember about the relationship between smoking and sleep apnea:

1. This is the 50th anniversary of the Surgeon General’s report on Smoking and Health. In that time, smoking prevalence in the United States has fallen from 43% to 18% among adults. Still, some 40 million Americans smoke.

2. Cigarette smoking is the leading cause of preventable death in the United States.

3. Smoking increases the all-cause mortality rate almost threefold over those who never smoked.

4. A strong association between obstructive sleep apnea (OSA) and smoking has been reported in observational studies. The Wisconsin Sleep Cohort reported current smokers had greater odds of being diagnosed with moderate or severe OSA compared to nonsmokers (odds ratio, 4.4; 95% confidence interval, 1.5-13).

5. The Wisconsin Sleep Cohort reported that former smoking was not associated with OSA. The effect of smoking on OSA may be short-term, but this needs further study.

6. Not all studies have shown that smoking makes OSA worse. Few studies have addressed the association between chewing tobacco or exposure to second-hand smoke and OSA.

7. Self-reported surveys of smokers (National Health and Nutrition Examination, and Sleep Heart Health Study) suggest that smoking cigarettes reduces sleep quality.

8. Current evidence suggests an association between smoking and sleep quality, which some view as an intermediate step toward OSA.

9. Acutely, nicotine withdraw may lead to insomnia and irritability, mimicking OSA symptoms. Little evidence is available to suggest that smoking cessation will improve OSA.

10. Very little evidence exists on impact of nicotine gum or transdermal patches, on sleep-disordered breathing.
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