Abstract
IntroductionSmoking a cigarette before bed, or first thing in the morning is a common habit. However, the relationship between smoking and sleep disorders has not been investigated sufficiently yet. Many aspects, especially regarding non obstructive sleep apnea–hypopnea (OSA) related disorders, are still to be addressed. Patients with obstructive sleep apnea syndrome may have a different nicotine dependence profile (smoker, non-smoker, ex-smoker, whenever smoker: yes – no, number of cigarettes per day, number of packyears, total score in Fagerström nicotine dependence scale) than those without sleep-disordered breathing. Tobacco smoking disrupts sleep architecture by reducing slow wave and rapid eye movement (REM) sleep and undermining sleep quality. Furthermore, smoking affects sleep-related co-morbidities, such as obstructive sleep apnoea-hypopnea syndrome (OSAHS), insomnia, parasomnias, arousals, bruxism, restless legs but also non-sleep-related conditions such as cardiovascular, me ...
IntroductionSmoking a cigarette before bed, or first thing in the morning is a common habit. However, the relationship between smoking and sleep disorders has not been investigated sufficiently yet. Many aspects, especially regarding non obstructive sleep apnea–hypopnea (OSA) related disorders, are still to be addressed. Patients with obstructive sleep apnea syndrome may have a different nicotine dependence profile (smoker, non-smoker, ex-smoker, whenever smoker: yes – no, number of cigarettes per day, number of packyears, total score in Fagerström nicotine dependence scale) than those without sleep-disordered breathing. Tobacco smoking disrupts sleep architecture by reducing slow wave and rapid eye movement (REM) sleep and undermining sleep quality. Furthermore, smoking affects sleep-related co-morbidities, such as obstructive sleep apnoea-hypopnea syndrome (OSAHS), insomnia, parasomnias, arousals, bruxism, restless legs but also non-sleep-related conditions such as cardiovascular, metabolic, respiratory, neurologic, psychiatric, inflammatory, gynecologic and pediatric, while poor sleep quality also seems to worsen the success chances of a smoking cessation effort. In conclusion, existing literature suggests that there is a harmful relation between smoking and sleep.AimThe aim of this study is to investigate this different nicotine dependence profile in this group of patients. More specifically, the aim of this doctoral thesis is to investigate the relationship between the Fagerström scale and the sleep apnea-hypopnea index (AHI), which is a basic indicator for measuring sleep-disordered breathing, as well as the relationship between the Fagerström scale and the rest of the parameters for measuring sleep-disordered breathing (Epworth sleepiness scale, Berlin sleep apnea questionnaire, STOPbang sleep apnea questionnaire, Athens insomnia scale), as well as the other sleep study parameters, besides AHI. Methods All adult patients who visited a tertiary sleep clinic and provided information about their smoking history were included in this cross-sectional study. A total of 4347 patients were divided into current, former and never smokers, while current and former smokers were also grouped, forming the group of ever smokers. Sleep related characteristics, derived from questionnaires and sleep studies, were compared between those groups. Furthermore, smoking history, measured in packyears of smoking and nicotine dependence, measured with the Fagerström scale, were correlated with various epidemiological and sleep-related variables. Results Ever smokers presented with significantly greater body mass index (BMI), neck and waist circumference and with increased frequency of metabolic and cardiovascular co-morbidities compared to never smokers. They also presented significantly higher apnea–hypopnea index (AHI) compared to never smokers (30.2 (33.2) events / hour vs. 28.4 (33.1) events / hour, p < 0.001) and were diagnosed more frequently with severe and moderate OSA (50.3% vs. 46.9% and 26.2% vs. 24.8% respectively). Epworth sleepiness scale (ESS) did not differ between groups (p = 0.13). Ever smokers, compared to never smokers, presented more frequent episodes of sleeptalking (30.8% vs. 26.6%, p = 0.004), abnormal movements (31.1% vs. 27.7%, p = 0.021), restless sleep (59.1% vs 51.6%, p < 0.001), and legs movements (p = 0.002) during sleep. Those were more evident in current smokers and correlated significantly with increasing AHI. Packyears were positively correlated with Epworth sleepiness scale (ESS) (B = 0.38, p = 0.007), %REM sleep time (B = 0.60, p = 0.042), apnea-hypopnea index (AHI) (B = 0.13, p < 0.001), oxygen desaturation index (ODI) (B = 0.13, p < 0.001), mean and maximum apnea duration (B = 0.42, p < 0.001 and B = 0.14, p < 0.001 respectively), while they were negatively correlated with mean and minimum SpO2 (B = -1.70, p < 0.001 and B = -0.42, p < 0.001 respectively). Furthermore, smoking history exhibited a significantly increasing trend with increasing OSA diagnosis and severity (p < 0.001). Patients with abnormal movements during sleep and those with restless sleep showed a significantly higher nicotine dependence, measured with Fagerström scale, compared to those without abnormal movements or restless sleep (5.4 ± 2.8 vs 4.7 ± 2.8, p = 0.002 and 5.1 ± 2.9 έναντι 4.7 ± 2.7, p = 0.043). Conclusions Smoking history in packyears probably affects OSAHS characteristics, while nicotine dependence seems to be related more with abnormal sleep behaviors. These findings highly suggest the existence of a smoking-induced disturbed sleep pattern.
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