Smoking and Sleep-Disordered Breathing Linked in Younger Hispanic Women

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.

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.

Reference

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