By, Lisa Plant
Obstructive sleep apnea has a long list of risk factors, including physical factors such as carrying excess weight, having a large neck circumference, and having a narrow throat or enlarged tonsils. Certain habits and lifestyle factors can increase the risk too. These include the use of alcohol, and certain medications, such as tranquilizers and sedatives. In addition, smoking significantly increases your risk of sleep apnea. In fact, according to The Mayo Clinic, smoking triples the risk of developing obstructive sleep apnea.
Why does Smoking have this Effect?
In general, anything that narrows the airway can increase the risk of obstructive sleep apnea—this is why seemingly unrelated physical features such as enlarged tonsils or adenoids are a risk factor. Cigarette smoking is a risk factor because over time, smoking can cause the airway to become narrower, leading to an increased risk of airway obstruction while sleeping. This airway narrowing occurs because cigarette smoke is an irritant, and smoking can cause the upper airway to become inflamed. In addition, the irritation tends to increase fluid retention in the area. Inflammation and retained fluid combine to narrow the airway, increasing the likelihood of snoring and other sleeping problems. More importantly, smokers are three times more likely than non-smokers to develop obstructive sleep apnea.
Sleep Apnea and Smoking, Statistically Speaking
The American National Sleep Foundation typically carries out a large-scale poll each year, to uncover information about American sleeping habits and health. According to the results of the Sleep in America poll conducted in 2005, 5% of American adults have sleep apnea, and 8% experience at least three episodes of disrupted breathing each week. As part of the Sleep in America poll, participants were asked to complete the Berlin Assessment Questionnaire, a survey which is used to determine whether someone has sleep apnea. The results of this questionnaire, together with the poll results, indicated that 26% of American adults are at risk of developing obstructive sleep apnea. For smokers, therefore, the risk is high. Giving up smoking is difficult for most people—there’s no doubt about that. However, even if smoking itself doesn’t cause any significant health problems such as cancer or emphysema, the effects of sleep apnea, which include an increased risk of stroke and heart attack, are just as serious.
The Effects of Smoking and Sleep Apnea
Many research teams have already shown that people with obstructive sleep apnea have increased levels of cellular oxidative stress and free radicals, and of inflammatory cells and molecules. In addition, endothelial cells—the cells that line blood vessels—die off faster, and are more “sticky” in people with sleep apnea. This “stickiness” is a physiological feature of atherosclerosis, the cardiovascular disease which causes arteries to become stiffened and eventually blocked by plaque buildup. Partial or complete blockage of arteries can then lead to heart attack or stroke. Smoking is also a known cause of all of these signs and symptoms.
In 2007, researchers from the Technion-Israel Institute of Technology published a paper in the journal Sleep Medicine, demonstrating increased levels of these risk markers in smokers with sleep apnea. In this study, 35 smoking and 35 non-smoking participants were separated into categories according to gender, age, body mass index, severity of sleep apnea, and cardiovascular symptoms. Blood samples from each participant were analyzed for several markers of cardiovascular disease, including HDL and LDL cholesterol, inflammatory molecules, and molecules that cause endothelial “stickiness”.
The researchers found that smokers with sleep apnea have a much greater risk of cardiovascular disease and life-threatening cardiovascular events than smokers with mild sleep disorders, and non-smokers with severe sleep apnea. Essentially, smoking and sleep apnea appear to have a synergistic effect, making the combination of the two highly dangerous. The risk is especially great for people who smoke more than 20 cigarettes a day.
Reducing Your Risk Levels
The risks for smokers with sleep apnea are high—and sleep apnea is a disease that can remain undiagnosed for long periods of time. If you’re a smoker, therefore, finding out whether you have sleep apnea, or determining your level of risk, is extremely important. Giving up smoking isn’t easy, but reducing the amount you smoke can have positive health results even if you’re unable to quit completely. Just as important, if you are diagnosed with sleep apnea, getting effective treatment can reduce your risk of cardiovascular disease, at the same time as helping you obtain the many other benefits of restful sleep.