The impact of alcohol on breathing parameters during sleep: A systematic review and meta-analysis

Abstract

Alcohol, a muscle relaxant, can potentially worsen obstructive sleep apnea (OSA) but the literature on the effects of alcohol on OSA is conflicting. This systematic review and meta-analysis of randomized controlled trials examined the impact of alcohol on breathing parameters during sleep. Ovid Medline, Embase and PsycINFO databases were queried through November 1, 2017 for studies that reported objective measures of breathing during sleep, prior to and after alcohol administration. Weighted mean differences (WMD) and 95% confidence intervals (CI) were calculated for apnea-hypopnea index (AHI) and mean oxyhemoglobin saturation (SpO2). Secondary outcome measures were examined where available. The meta-analysis of 14 eligible studies (n = 422; 71.9% male) found that AHI increased significantly after alcohol administration (WMD = 2.33; 95% CI = 1.41 to 3.25, I = 62%) and mean SpO2 was significantly reduced (WMD = -0.60; 95% CI = -0.72 to -0.49, I = 0%). The increase in AHI was greater in snorers (WMD = 4.20; 95% CI = 1.19 to 6.50, I = 0%) and those with a diagnosis of OSA (WMD = 7.10; 95% CI = 3.59 to 10.61, I = 0%). Additionally, a significant increase in respiratory event duration (WMD = 0.86; 95% CI = 0.18 to 1.55, I = 19%) and decrease in nadir SpO2 (WMD = -1.25; 95% CI = -2.00 to -0.50, I = 25%) were noted. Alcohol is a modifiable risk factor that can result in the development or worsening of OSA.

Weight loss and lifestyle interventions for obstructive sleep apnoea in adults: Systematic review and meta‐analysis

“…Surprisingly, we did not find any study actively addressing the tobacco and/or alcohol consumption in these patients. This result may be concerning because smoking and alcohol intake are common in patients with OSA and both have been related to a higher risk and worsening of this condition …”

“…This result may be concerning because smoking and alcohol intake are common in patients with OSA and both have been related to a higher risk and worsening of this condition. [77][78][79] According to the meta-analyses performed on 12 RCTs and 23…”

Interdisciplinary Weight Loss and Lifestyle Intervention for Obstructive Sleep Apnoea in Adults: Rationale, Design and Methodology of the INTERAPNEA Study

“…Alcohol intake has also been related to the development and worsening of OSA not only for its direct and indirect effects on weight gain but also due to its negative impact on breathing parameters during sleep [20]. Recent meta-analyses on alcohol and risk of sleep apnoea emphasised that alcohol intake increases the risk of breathing cessation episodes by 25%, thus increasing AHI and reducing mean SaO 2 during sleep [93].…”

“…Yet, the number of reported randomised controlled trials addressing both diet and exercise components as a combination was significantly low and only included effects on specific OSA outcomes such as AHI, oxygen desaturation index, and excessive daytime sleepiness [1]. Furthermore, no original studies actively focusing on the cessation of tobacco and alcohol consumption were found [1], factors which have been shown to be common in patients with OSA and associated with the worsening of this condition [20,21]. Thus, the actual effectiveness of potential interdisciplinary interventions for the improvement of the main symptoms and consequences of OSA still remains unclear.…”

Obstructive sleep apnea in adults

“…Sleeping in the supine position also facilitates the occurrence of apneas due to the posterior repositioning of the tongue by gravitational effect. When alcohol 13 or other substances are ingested, such as sedatives and myorelaxants, this effect is made even worse by muscle relaxation at both the base of the tongue and the pharyngeal wall.…”