Smoking and Sleep-Disordered Breathing Linked in Younger Hispanic Women

woman smoking cigarette

There was no statistically significant association between smoking and sleep-disordered breathing (SDB) in US Hispanics/Latinos, but there was a novel association after stratifying for sex and age between smoking and SDB in Hispanic women smokers aged 35 to 54 years, according to a study recently published in CHEST.

In this cross-sectional analysis, investigators utilized the large, multicenter population-based Hispanic Community Health Study/Study of Latinos cohort study of self-identified Hispanics/Latinos aged 18 to 76 years (N=16,415). Participants underwent in-person clinical examinations and overnight home sleep studies. Moderate to severe SDB was defined as apnea-hypopnea index ≥15 events per hour. Respiratory events were defined by a ≥50% reduction in airflow for ≥10 seconds, with an associated ≥3% oxygen desaturation. Patients provided subjective sleep duration data with questionnaires; Epworth Sleepiness Scale scores provided objective quantification for excessive daytime sleepiness. Smoking status, determined with responses by questionnaire, was defined as 3 groups of former, current, and never smokers (<100 lifetime cigarettes).

There was no independent and statistically significant association between smoking and moderate to severe SDB (odds ratio [OR], 1.02; 95% CI, 0.85-1.22; P =.085), according to multivariable adjusted logistic regression models. No statistically significant association was found between smoking intensity or pack-years and SDB. Stratified analysis by sex revealed that women ever smokers had 30% higher odds of having SDB compared with women never smokers (OR, 1.30; 95% CI, 0.97-1.73; P =.07).

Current women smokers who smoked ≥10 cigarettes per day had 80% higher odds of SDB than women never smokers (OR, 1.80; 95% CI, 1.05-3.09; P =.03). There was a significant effect modifier when considering age. There was a higher risk for SDB in younger women who were ever smokers aged 35 to 54 years compared with younger women never smokers (OR, 1.83; 95% CI, 1.19-2.81; P =.01). Use of ≥10 cigarettes per day conferred an almost 3 times higher odds of SDB in younger women smokers compared with younger women never smokers (OR, 2.72; 95% CI, 1.45-5.12; P <.01).

Limitations of this study included the possible underestimation of the severity of SDB by home sleep study data, which may have affected the prevalence of the disease. Also, the cross-sectional design limited the ability to infer a causal relationship between smoking and SDB.

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These findings contrast with previous findings that have demonstrated an independent association between smoking and SDB in the general US population. Future research on age- and sex-specific phenotypes of SDB are needed for targeted SDB screening and treatment.

Disclosures: Multiple authors declare affiliations with the pharmaceutical industry. Please refer to reference for a complete list of authors’ disclosures.


Cohen O, Strizich GM, Ramos AR, et al. Sex differences in the association between smoking and sleep disordered breathing in the Hispanic Community Health Study/Study of Latinos [published online May 16, 2019]. CHEST. doi:10.1016/j.chest.2019.04.106