Sex Differences in the Association Between Smoking and Sleep-Disordered Breathing in the Hispanic Community Health Study/Study of Latinos

      Background

      Results of previous studies examining associations between cigarette smoking and sleep-disordered breathing (SDB) are inconsistent. We therefore investigated this association in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL).

      Methods

      A total of 13,863 US Hispanic/Latino subjects, 18 to 76 years old, provided smoking histories and underwent home SDB testing. Logistic regression analyses were conducted to assess the independent association of smoking and SDB with covariate adjustment. Sex- and age-stratified analyses were performed.

      Results

      The weighted prevalence of moderate to severe SDB was 9.7% (95% CI, 9.0-10.5). No independent and statistically significant association was observed between ever smoking (defined as minimum lifetime cigarette use of 100) and moderate to severe SDB (defined as an apnea-hypopnea index ≥ 15 events per hour) (OR, 1.02; 95% CI, 0.85-1.22; P = .85). Sex and age were effect modifiers of the aforementioned association. Stratification according to age and sex revealed that younger (aged 35-54 years) female smokers had 83% higher odds of SDB compared with younger female never smokers (OR, 1.83; 95% CI, 1.19-2.81; P = .01). A significant dose-response relation was noted between smoking intensity and SDB in younger female smokers ( P < .01). Lastly, use of ≥ 10 cigarettes per day was associated with a nearly threefold increase in SDB odds in younger female ever smokers. These associations were not observed in younger male subjects.

      Conclusions

      In the HCHS/SOL, no independent and statistically significant association was found between smoking and SDB. Sex and age stratification revealed a novel statistically significant association between smoking and SDB in younger (35-54 years old) female smokers. Our findings highlight the importance of investigating sex- and age-specific associations of SDB risk factors.

      Key Words

      Abbreviations:

      AHI ( apnea-hypopnea index), OLD ( obstructive lung disease), SDB ( sleep-disordered breathing)
      To read this article in full you will need to make a payment
      Subscribe to CHEST
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Berry D.T.
        • Webb W.B.
        • Block A.J.
        • Switzer D.A.
        Sleep-disordered breathing and its concomitants in a subclinical population.
        Sleep. 1986; 9: 478-483
        • Young T.
        • Palta M.
        • Dempsey J.
        • Skatrud J.
        • Weber S.
        • Badr S.
        The occurrence of sleep-disordered breathing among middle-aged adults.
        N Engl J Med. 1993; 328: 1230-1235
        • Bixler E.O.
        • Vgontzas A.N.
        • Ten Have T.
        • Tyson K.
        • Kales A.
        Effects of age on sleep apnea in men: I. Prevalence and severity.
        Am J Respir Crit Care Med. 1998; 157: 144-148
        • Young T.
        • Peppard P.E.
        • Gottlieb D.J.
        Epidemiology of obstructive sleep apnea: a population health perspective.
        Am J Respir Crit Care Med. 2002; 165: 1217-1239
        • Hiestand D.M.
        • Britz P.
        • Goldman M.
        • Phillips B.
        Prevalence of symptoms and risk of sleep apnea in the US population: results from the National Sleep Foundation Sleep in America 2005 Poll.
        Chest. 2006; 130: 780-786
        • Peppard P.E.
        • Young T.
        • Barnet J.H.
        • Palta M.
        • Hagen E.W.
        • Hla K.M.
        Increased prevalence of sleep-disordered breathing in adults.
        Am J Epidemiol. 2013; 177: 1006-1014
        • Hudgel D.W.
        Mechanisms of obstructive sleep apnea.
        Chest. 1992; 101: 541-549
        • Peppard P.E.
        • Young T.
        • Palta M.
        • Dempsey J.
        • Skatrud J.
        Longitudinal study of moderate weight change and sleep-disordered breathing.
        JAMA. 2000; 284: 3015-3021
        • Newman A.B.
        • Foster G.
        • Givelber R.
        • Nieto F.J.
        • Redline S.
        • Young T.
        Progression and regression of sleep-disordered breathing with changes in weight.
        Arch Intern Med. 2005; 165: 2408
        • Redline S.
        • Tishler P.V.
        The genetics of sleep apnea.
        Sleep Med Rev. 2000; 4: 583-602
        • Schwab R.J.
        • Gupta K.B.
        • Gefter W.B.
        • Metzger L.J.
        • Hoffman E.A.
        • Pack A.I.
        Upper airway and soft tissue anatomy in normal subjects and patients with sleep-disordered breathing: significance of the lateral pharyngeal walls.
        Am J Respir Crit Care Med. 1995; 152: 1673-1689
        • Dempsey J.A.
        • Skatrud J.B.
        • Jacques A.J.
        • et al.
        Anatomic determinants of sleep-disordered breathing across the spectrum of clinical and nonclinical male subjects.
        Chest. 2002; 122: 840-851
        • Strohl K.P.
        • Redline S.
        Recognition of obstructive sleep apnea.
        Am J Respir Crit Care Med. 1996; 154: 279-289
        • Mirer A.G.
        • Young T.
        • Palta M.
        • Benca R.M.
        • Rasmuson A.
        • Peppard P.E.
        Sleep-disordered breathing and the menopausal transition among participants in the Sleep in Midlife Women Study.
        Menopause. 2017; 24: 157-162
        • Wetter D.W.
        • Young T.B.
        • Bidwell T.R.
        • Badr M.S.
        • Palta M.
        Smoking as a risk factor for sleep-disordered breathing.
        Arch Intern Med. 1994; 154: 2219-2224
        • Kashyap R.
        • Hock L.M.
        • Bowman T.J.
        Higher prevalence of smoking in patients diagnosed as having obstructive sleep apnea.
        Sleep Breath. 2001; 5: 167-172
        • Newman A.
        • Nieto F.
        • Guidry U.
        • et al.
        Relation of sleep-disordered breathing to cardiovascular disease risk factors: the Sleep Heart Health Study.
        Am J Epidemiol. 2001; 154: 50-59
        • Kim K.S.
        • Kim J.H.
        • Park S.Y.
        • et al.
        Smoking induces oropharyngeal narrowing and increases the severity of obstructive sleep apnea syndrome.
        J Clin Sleep Med. 2012; 8: 367-374
        • Haxhiu M.A.
        • Deal E.C.
        • Norcia M.P.
        • Van Lunteren E.
        • Mitra J.
        • Cherniack N.S.
        Medullary effects of nicotine and GABA on tracheal smooth muscle tone.
        Respir Physiol. 1986; 64: 351-363
        • Zhao Y.Y.
        • Blackwell T.
        • Ensrud K.E.
        • Stone K.L.
        • Omachi T.A.
        • Redline S.
        Sleep apnea and obstructive airway disease in older men: outcomes of Sleep Disorders in Older Men Study.
        Sleep. 2016; 39: 1343-1351
        • Redline S.
        • Kump K.
        • Tishler P.V.
        • Browner I.
        • Ferrette V.
        Gender differences in sleep disordered breathing in a community-based sample.
        Am J Respir Crit Care Med. 1994; 149: 722-726
        • Bixler E.O.
        • Vgontzas A.N.
        • Lin H.M.
        • et al.
        Prevalence of sleep-disordered breathing in women: effects of gender.
        Am J Respir Crit Care Med. 2001; 163: 608-613
        • Quintana-Gallego E.
        • Carmona-Bernal C.
        • Capote F.
        • et al.
        Gender differences in obstructive sleep apnea syndrome: a clinical study of 1166 patients.
        Respir Med. 2004; 98: 984-989
        • Kaplan R.C.
        • Bangdiwala S.I.
        • Barnhart J.M.
        • et al.
        Smoking among US Hispanic/Latino adults.
        Am J Prev Med. 2014; 46: 496-506
        • Redline S.
        • Sotres-Alvarez D.
        • Loredo J.
        • et al.
        Sleep-disordered breathing in Hispanic/Latino individuals of diverse backgrounds. The Hispanic Community Health Study/Study of Latinos.
        Am J Respir Crit Care Med. 2014; 189: 335-344
        • Sorlie P.D.
        • Avilé S-Santa L.M.
        • Wassertheil-Smoller S.
        • et al.
        Design and implementation of the Hispanic Community Health Study/Study of Latinos.
        Ann Epidemiol. 2010; 20: 629-641
        • Lavange L.M.
        • Kalsbeek W.D.
        • Sorlie P.D.
        • et al.
        Sample design and cohort selection in the Hispanic Community Health Study/Study of Latinos.
        Ann Epidemiol. 2010; 20: 642-649
        • Ayappa I.
        • Norman R.G.
        • Seelall V.
        • Rapoport D.M.
        Validation of a self-applied unattended monitor for sleep disordered breathing.
        J Clin Sleep Med. 2008; 4: 26-37
        • Zhao Y.Y.
        • Weng J.
        • Mobley D.R.
        • et al.
        Effect of manual editing of total recording time: implications for home sleep apnea testing.
        J Clin Sleep Med. 2017; 13: 121-126
        • Johns M.W.
        A new method for measuring daytime sleepiness: the Epworth Sleepiness Scale.
        Sleep. 1991; 14: 540-545
        • Barr R.G.
        • Avilés-Santa L.
        • Davis S.M.
        • et al.
        Pulmonary disease and age at immigration among Hispanics. Results from the Hispanic Community Health Study/Study of Latinos.
        Am J Respir Crit Care Med. 2016; 193: 386-395
        • Ronen O.
        • Malhotra A.
        • Pillar G.
        Influence of gender and age on upper-airway length during development.
        Pediatrics. 2007; 120: e1028-e1034
        • Pickett C.K.
        • Regensteiner J.G.
        • Woodard W.D.
        • Hagerman D.D.
        • Weil J.V.
        • Moore L.G.
        Progestin and estrogen reduce sleep-disordered breathing in postmenopausal women.
        J Appl Physiol. 1989; 66: 1656-1661
        • Popovic R.M.
        • White D.P.
        Upper airway muscle activity in normal women: influence of hormonal status.
        J Appl Physiol. 1998; 84: 1055-1062
        • Wetter D.W.
        • Young T.B.
        The relation between cigarette smoking and sleep disturbance.
        Prev Med (Baltim). 1994; 23: 328-334
        • Zhang L.
        • Samet J.
        • Caffo B.
        • Punjabi N.M.
        Cigarette smoking and nocturnal sleep architecture.
        Am J Epidemiol. 2006; 164: 529-537
        • Conway S.G.
        • Roizenblatt S.S.
        • Palombini L.
        • et al.
        Effect of smoking habits on sleep.
        Brazilian J Med Biol Res. 2008; 41: 722-727
        • Schmidt-Nowara W.W.
        • Coultas D.B.
        • Wiggins C.
        • Skipper B.E.
        • Samet J.M.
        Snoring in a Hispanic-American population. Risk factors and association with hypertension and other morbidity.
        Arch Intern Med. 1990; 150: 597-601