Department of Pulmonary and Critical Care, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, Guangdong, China.
Medical Record Management Department, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, Guangdong, China.
Nicotine Tob Res. 2023 Feb 9;25(3):364-371. doi: 10.1093/ntr/ntac126.
To systematically review the association between smoking behavior and obstructive sleep apnea (OSA).
PubMed, Medline, the Cochrane Library, EMBASE, and Scopus databases were used to conduct this review. The two researchers independently screened the literatures, conducted the quality assessment, and data extraction according to the inclusion and exclusion criteria. The RevMan 5.3 was used to analysis the apnea hypopnea index (AHI) index, min saturation of oxyhemoglobin (SaO2), Epworth Sleepiness Scale (ESS) score, and oxygen desaturation index (DOI) and publication bias analysis to assess the effect of smoking on OSA patients. Furthermore, we performed subgroup of the severity of OSA, different countries of sample origin (western countries or eastern countries), and pack-years (PYs < 10 or PYs ≥ 20) to analyze the heterogeneity.
Thirteen studies were included in this analysis that conformed to inclusion criteria and exclusion criteria. Totally 3654 smokers and 9796 non-smokers have participated. The meta-analysis of 13 studies demonstrated that AHI levels were significantly higher in smoker group compared with non-smoker, ESS scores were also significantly higher in smoker group compared with non-smoker, min SaO2 levels were obviously lower in smoker group compared with non-smoker, however, DOI levels hadn't significantly different between two groups. The subgroup analysis showed that there was an association between severe OSA, eastern countries, pack-years, and smoking.
Smoking behavior is a significant association with OSA. Heavy smokers with histories of more than 20 PYs were at a higher risk of OSA. Moreover, patient with severe OSA exhibited a significantly association with smoking compared with patients with mild or moderate OSA.
The relationship between smoking and OSA was controversial, especially, whether smoking increase or aggravate the risk of OSA. In our review and meta-analysis, we demonstrated that smoking behavior is a significant association with OSA. Heavy smokers with histories of more than 20 PYs were at a higher risk of OSA. Moreover, patient with severe OSA exhibited a significant association with smoking compared with patients with mild or moderate OSA. More prospective long-term follow-up studies about effect of quit smoking on OSA are recommended to establish the further relationship.
系统回顾吸烟行为与阻塞性睡眠呼吸暂停（OSA）之间的关联。
使用 PubMed、Medline、Cochrane 图书馆、EMBASE 和 Scopus 数据库进行此项综述。两位研究人员根据纳入和排除标准独立筛选文献、进行质量评估和数据提取。使用 RevMan 5.3 分析呼吸暂停低通气指数（AHI）、最低血氧饱和度（SaO2）、Epworth 睡眠量表（ESS）评分、氧减饱和度指数（DOI）和发表偏倚分析，以评估吸烟对 OSA 患者的影响。此外，我们还进行了 OSA 严重程度、样本来源国家（西方国家或东方国家）和吸烟包年数（PYs<10 或 PYS≥20）的亚组分析，以分析异质性。
符合纳入和排除标准的研究共有 13 项，共纳入 3654 名吸烟者和 9796 名非吸烟者。对 13 项研究的荟萃分析表明，与非吸烟者相比，吸烟者的 AHI 水平显著升高，ESS 评分也显著升高，SaO2 最低水平明显降低，而两组之间的 DOI 水平没有显著差异。亚组分析显示，严重 OSA、东方国家、吸烟包年数和吸烟之间存在关联。
吸烟行为与 OSA 显著相关。有 20 年以上吸烟史的重度吸烟者患 OSA 的风险更高。此外，与轻度或中度 OSA 患者相比，重度 OSA 患者与吸烟之间存在显著关联。
吸烟与 OSA 之间的关系存在争议，特别是吸烟是否会增加或加重 OSA 的风险。在我们的综述和荟萃分析中，我们表明吸烟行为与 OSA 显著相关。有 20 年以上吸烟史的重度吸烟者患 OSA 的风险更高。此外，与轻度或中度 OSA 患者相比，重度 OSA 患者与吸烟之间存在显著关联。建议进行更多关于戒烟对 OSA 影响的前瞻性长期随访研究，以进一步建立两者之间的关系。
