The Impact of Obstructive Sleep Apnea and Tobacco Smoking on Endothelial Function

Abstract

Background: Endothelial dysfunction has been recognized to occur in the context of obstructive sleep apnea (OSA) or tobacco smoking. However, the deleterious effect on vascular function with concurrence of both conditions is largely unknown. Objective: To investigate whether the concurrence of OSA and smoking poses an additive detriment to endothelial dysfunction. Methods: Chinese men without a history of chronic medical illness were invited to complete a questionnaire including smoking pack-year exposure, polysomnography and peripheral arterial tonometry (PAT) for endothelial function. Serum 8-isoprostane, advanced oxidation protein products (AOPP) and monocyte chemo-attractant protein-1 (MCP-1) were measured. Results: 114 men were successfully enrolled. PAT ratio, adjusted for age and body mass index, correlated inversely with overall severity of OSA: apnea-hypopnea index (AHI), r = -0.160 (p = 0.092); oxygen desaturation index, r = -0.214 (p = 0.024); duration of oxygen saturation <90%, r = -0.219 (p = 0.020); and minimum oxygen saturation, r = 0.250 (p = 0.008). The PAT ratio decreased with increasing pack-year group (p = 0.018). It was lower with concurrent smoking history and moderate-severe OSA (AHI ≥15/h) compared to having one or neither factor (p = 0.011). Serum levels of 8-isoprostane and AOPP were positively related to severity of OSA, while MCP-1 correlated with smoking quantity. Multiple linear regression analyses showed that severity of intermittent hypoxia, MCP-1 and pack-year exposure were independent predictors of PAT ratio. Conclusion: While OSA, in particular intermittent hypoxemia, and tobacco smoking were independent risk factors, the concurrence of moderate-severe OSA and smoking was associated with the most severe impairment in endothelial function.

Association between obstructive sleep apnea and alcohol, caffeine and tobacco: A meta‐analysis

“…This meta‐analysis investigated the available evidence on the association between OSA and alcohol, caffeine and tobacco. Studies indicate associations between tobacco and OSA, and alcohol and OSA, however, conclusive evidence was not found until now. Based on the current available literature and on the eligibility criteria established for this systematic review, results indicate OSA is to be associated with the use of alcohol, but there is not enough scientific evidence to confirm the association between OSA and tobacco.…”

“…It is worth noting that the question “was the follow‐up carried out over a sufficient time period?” was considered not applicable for the included studies, since none of them proposed longitudinal results. Of the 11 studies included had moderate risk of bias, and 2 as low risk of bias . Decisions regarding individual domains within the ‘Risk of bias’ tool were observed in Figure .…”

Smoking, obstructive sleep apnea syndrome and their combined effects on metabolic parameters: Evidence from a large cross-sectional study

“…As OSAS and smoking often co-occur, they may share common oxidative and inflammatory pathways that contribute to lipid and glucose metabolic dysfunction 4 . Several previous cross-sectional studies have shown that the interaction between smoking and OSAS leads to increased endothelial dysfunction 17 , cognitive impairment 18 , and cardiovascular risk 19 . However, no study has explored the interaction between OSAS and smoking on glucose and lipid abnormalities.…”

Smoking history and its relationship with comorbidities in patients with obstructive sleep apnea

“…Studies by Zhu et al 13 have shown that smoking and OSA jointly cause insulin resistance and have synergistic effects on metabolic disorders. Lui et al 14 have also suggested that the coexistence of CIH and smoking causes severe endothelial dysfunction. Studies have also suggested that coexistence of both OSA and smoking leads to more severe cognitive dysfunction than any single factor 15 .…”