Study On The Correlation Between Smoking And Obstructive Sleep Apnea Hypopnea Syndrome

Background and ObjectiveObstructive sleep apnea hypopnea syndrome is a disease with high incidence of abnormal respiratory rhythm and ventilatory function during sleep.It is a clinical syndrome with repeated hypopnea and respiratory interruption during sleep for a variety of reasons,causing chronic intermittent hypoxemia with hypercapnia and sleep structure disorder,resulting in a series of pathophysiological changes in the body.The main clinical manifestations are snoring with apnea during sleep,daytime excessive sleepiness,fatigue,memory loss and so on.Patients with OSAHS always undergo a series of target organ dysfunction,such as hypertension,coronary heart disease,type 2 diabetes,ischemic or hemorrhagic stroke,metabolic syndrome,psychological abnormality,mood disorder and so on,due to recurrent nocturnal intermittent hypoxia and sleep structure damage.In the past,it was considered that age,gender,obesity and anatomical abnormality of upper airway were the main risk factors of OSAHS.In recent years,smoking as a risk factor of respiratory and cardiovascular diseases,more and more attention has been paid to the relationship between it and OSAHS.Some studies have shown that smoking is related to sleep structure disorder,and there is a synergistic effect between smoking and OSAHS,both of them can increase the incidence of cardiovascular diseases.Through the study on the correlation between smoking and OSAHS,the purpose of this study is to determine whether there is a correlation between smoking and OSAHS,and whether smokers will show a more serious degree of OSAHS than non-smokers,so as to provide a basis for the prevention,diagnosis and treatment of OSAHS.Subjects and MethodA total of 451 patients with sleep disorders who admitted to Sleep Diagnosis and Treatment Center of the Geriatric Respiratory and Sleep Department of the First Affiliated Hospital of Zhengzhou University from October 2015 to October 2019 were included.All patients underwent overnight polysomnography(PSG),finally 403 patients were diagnosed with OSAHS and 48 patients were diagnosed with simple snoring.All patients with OSAHS were divided into two groups according to apnea hypopnea index(AHI),there were 280 patients with severe OSAHS and 123 patients with mild to moderate OSAHS.On the day of PSG monitoring,physical examination was carried out,height and weight measurements were completed,and body mass index(BMI)was calculated to determine obesity by BMI?28Kg/m2.Before monitoring,patients' gender,age,hypertension and other complications,Epworth sleepiness scale score(ESS score),drinking history,smoking history(including whether smok:ing,the number of years of smoking,the average number of cigarettes per day,whether quit smoking,smoking cessation time)of patients were recorded by questionnaire,the smoking index was calculated.All patients with OSAHS were divided into three groups according to smoking status:non-quitting smoking group(continue smoking for at least 1 year),quitting smoking group(those who have a history of continuous smoking for at least 1 year and quit smoking at least half a year before participating in this study),non-smoking group(those who never smoke).According to the smoking index,non-quitting smokers were divided into heavy smoking group(smoking index>400)and non-heavy smoking group(smoking index ?400).After monitoring,the related parameters of PSG were recorded in detail,including apnea hypopnea index(AHI),lowest oxygen saturation(LSaO2),mean oxygen saturation(MSaO2),cumulative percentages of time spent at oxygen saturation below 90%(CT90%),total apnea time,maximum apnea time and so on.SPSS 22.0 statistical software was used for statistical analysis to compare the differences of gender,age BMI,obesity,smoking history,drinking history,hypertension,and PSG related parameters among the related groups.Correlation analysis was used to explore the correlation between smoking degree and PSG parameters.Binary logistic regression analysis was performed with severe OSAHS as outcome variable.The test level was ?=0.05.Results:1.The age,BMI,smoking rate,drinking rate and prevalence of hypertension in OSAHS group were significantly higher than those in simple snoring group,the differences were statistically significant(P<0.05),the difference of gender in two groups was not statistically significant(P>0.05).2.The proportion of males,smoking rate,drinking rate,obesity rate and BMI in severe OSAHS group were higher than those in mild-moderate OSAHS group,and the differences were statistically significantly(P<0.05).The difference of age in the two groups was not statistically significant(P>0.05).3.AHI,CT90%,total apnea time and maximum apnea time in severe OSAHS group were higher than those in mild-moderate OSAHS group,LSaO2 and MSaO2 were lower than those in mild-moderate OSAHS group,the differences were statistically significant(P<0.05).4.There were statistically significance in differences of the proportion of severe OSAHS,AHI,LSaO2,MSaO2,CT90%and total apnea time among heavy smoking group,non-heavy smoking group and non-smoking group(P<0.05),while differences of maximum apnea time among the three groups were not statistically significant(P>0.05).The proportion of severe OSAHS in heavy smoking group was higher than that in non-smoking group(P<0.05),there was no statistically significance in differences of the proportion of severe OSAHS between non-heavy smoking group and non-smong group(P>0.05);AHI,CT90%,and total apnea time in heavy smoking group and non-heavy smoking group were significantly higher than those in non-smoking group,LSaO2 and MSaO2 in heavy smoking group and non-heavy smoking group were lower than those in non-smoking group,the differences were statistically significant(P<0.05);there was no statistical significance in differences of AHI?LSaO2?MSaO2?CT90%?total apnea time,maximum apnea time between heavy smoking group and non-heavy smoking group(P>0.05).5.smoking degree was positively correlated with AHI(r=0.197 P=0.0000),CT90%(r=0.200 P=0.000),and total apnea time(r=0.160 P=0.002),while negatively correlated with LSaO2(r=-0.201 P=0.000)and MSaO2(r=-0.217 P=0.000).6.Taking severe OSAHS as outcome variable,and age,gender,smoking,drinking,obesity as independent variables,Logistic regression analysis was performed The results showed that smoking and obesity were risk factors of severe OSAHS,the regression coefficients were 0.564(P=0.034)and 0.669(P=0.004),respectively,and OR values were 1.757?1.953.7.There were statistically significance in differences of age,gender,prevalence of hypertension,proportion of severe OSAHS,AHI,LSaO2,MSaO2,CT90%and total apnea time among non-quitting smoking group,quitting smoking group and non-smoking group(P<0.05).The age of non-quitting smoking group is younger than that of quiting smoking group and non-smoking group,the age of quitting smoking group is older than that of non-quitting smoking group and non-smoking group(P<0.05);the proportion of male in non-quitting smoking group was higher than that in quitting smoking group and non-smoking group,and the proportion of male in quitting smoking group was higher than that in non-smoking group(P<0.05;the prevalence of hypertension in quitting smoking group was higher than that in non-smoking group(P<0.05);the proportion of severe OSAHS in non-quitting smoking group was higher than that in non-smoking group(P<0.05);the AHI,CT90%and total apnea time of the non-quitting smoking group were higher than those of the non-smoking group,while the LSaO2 and MSaO2 of non-quitting smoking group were lower than those of the non-smoking group(P<0.05);the MSaO2 of the quitting smoking group was higher than that of the non-quitting group,and the CT90%of the quitting smoking group was lower than that of non-quitting smoking group(P<0.05),there was no statistically significance in differences of PSG parameters between the quitting smoking group and non-smoking group(P>0.05).Conclusion:1.There is a significant correlation between smoking and OSAHS,and smoking can aggravate the severity of OSAHS.2.Smoking can aggravate nocturnal hypoxia in patients with OSAHS,and quitting smoking may improve nocturnal hypoxia in patients with OSAHS.3.Smoking may be independent risk factors for severe OSAHS.