Relationship Between Obstructive Sleep Apnea And Smoking And Their Effects On Glucose And Lipid Metabolism

Part ?Relationship between smoking and the severity of obstructive sleep apnea-hypopnea syndrome:evidence from a large-scale observational studyObjective:To explore the relationship between smoking and the severity of obstructive sleep apnea-hypopnea syndrome(OSAHS).Method:A total of 719 Chinese male adults were included in those referred to the sleep center of the Sixth People's Hospital Affiliated to Shanghai Jiao Tong University and the Second Hospital Affiliated to Suzhou University from January 2016 to December 2016.Laboratory-based polysomnographic variables[including apnea hypopnea index(AHI),oxygen desaturation index and microarousal index,etc.],and anthropometric measurements[including weight,neck circumference,waist circumference,hip circumference,systolic and diastolic blood pressure etc.]were collected for all participants.The severity of OSAHS was determined by AHI.No OSAHS was defmed as an AHI<5 events/h,mild OSAHS as an AHI of 5 to 14.9,moderate OSAHS as an AHI of 15 to 29.9,and severe OSAHS as an AHI of>30.Smoking was assessed by a questionnaire including an item on smoking pack-year exposure.And,smoking severity was determined by the smoking index[SI,calculated as(daily smoking count)×(years of smoking)].Light smoke was defined as an SI?200,moderate smoke was as an SI>200 to?400,and severe smoke as an SI?400.Results:The mean age of all participants included in this study was 40.7±11·1 years.There were 381 non-smokers,279 smokers and 59 quit smokers.There were 138 cases of non-OSAHS and 581 cases of OSAHS.The smoking rate of OSAHS group was significantly higher than that of non-OSAHS group(41.5%vs.27.5%,p<0.01).After excluding 59 quit smokers,the remaining 660 subjects were divided into four groups according to the severity of smoking,then each group was further divided into four groups according to OSAHS severity.Unadjusted analysis showed that OSAHS severity positively correlated with smoking severity(p<0.01,r=0.203).The positive correlation remained significant after further adjustment for age,BMI and waist-hip ratio.In addition,logistic regression analysis showed that compared to non-smokers,the odd ratios for OSAHS in moderate smokers were 1,72(95%CI:1.08-2.75)and in severe smokers were 2.68(95%CI:1.61-4.46),after adjustment for age,BMI and waist-hip ratio.Conclusions:The severity of smoking significantly correlated with the severity of OSAHS,independent of some confounders including obesity.Patients with severe OSAHS are more likely to be smokers.Part ?Smoking,obstructive sleep apnea-hypopnea syndrome and their combined effects on metabolic parameters:evidence from a large cross-sectional studyObjective:To explore the effects of interaction between obstructive sleep apnea-hypopnea syndrome(OSAHS)and smoking on glucose and lipid metabolic.Methods:A total of 719 Chinese male adults were included in those referred to the sleep center of the Sixth People's Hospital Affiliated to Shanghai Jiao Tong University and the Second Hospital Affiliated to Suzhou University from January 2016 to December 2016.All participants were accompanied by snoring and daytime sleepiness.Laboratory-based polysomnographic variables[including apnea hypopnea index(AHI),oxygen desaturation index and microarousal index,etc.],anthropometric measurements[including weight,neck circumference,waist circumference,hip circumference,systolic and diastolic blood pressure etc.],biochemical indicators[including total cholesterol(TC),triglycerides(TG),high-density lipoprotein cholesterol(HDL-C),low-density lipoprotein cholesterol(LDL-C)],and medical history(smoking,drinking,etc.)were collected.All participants were grouped according to OSAHS severity(AHI<5,AHI 5-14.9,AHI15?29.9,and AHI?30)and smoking status(non-smokers,smokers,quit smokers)for analysis.Results:The mean age of all participants included in this study was 40.7±11.1 years.In both smokers and non-smokers,the levels of FBG,insulin and TG were significantly higher in participants with OSAHS compared with non-OSAHS,while the level of HDL-C was significantly lower(p<0.05).And,as OSAHS severity increases,a significant increasing trend of insulin resistance was found.After adjustment,a significant effect of interaction between OSAHS and smoking on insulin level was observed(p=0.025).As to lipid metabolism,cigarette smoking cessation was associated with decreased LDL-C levels(2.91±0.65 mmol/1 vs.3.21±0.81 mmol/1 vs.3.13±0.83 mmol/1 for quit smoking group,smoking group,non-smoking group,respectively;p=0.031).Conclusions:There is a significant effect of interaction between smoking and OSAHS on glucose and lipid metabolism-related traits.Cessation of cigarette smoking may help ameliorate lipid metabolism in patients with OSAHS.Part ?Effect of smoking on glucose,lipid metabolism and sleep structure in postoperative patients with obstructive sleep apnea-hypopnea syndromeObjective:To investigate the effect of smoking on glucose,lipid metabolism and sleep structure in patients with moderate and severe obstructive sleep apnea-hypopnea syndrome(OSAHS)after operation.Method:We included 103 patients with moderate to severe OSAHS that underwent modified palatopharyngoplasty(H-UPPP)and/or tongue base surgery treatment.Before surgery,all participants were with evidence of upper airway obstruction and were unable to tolerate continuous positive airway pressure(CPAP)treatment.Laboratory-based polysomnographic variables[including apnea hypopnea index(AHI),oxygen desaturation index and microarousal index,sleep stages(REM/N1/N2/N3),etc.],anthropometric measurements[including weight,neck circumference,waist circumference,hip circumference,systolic and diastolic blood pressure etc.],biochemical indicators[including total cholesterol(TC),triglycerides(TG),high-density lipoprotein cholesterol(HDL-C),low-density lipoprotein cholesterol(LDL-C)],and medical history(smoking,drinking,etc.)were collected preoperatively and postoperatively.All participants were grouped according to smoking status(non-smokers,smokers)for analysis.And the difference of each variable preoperatively and postoperatively was demonstrated as delta(?,calculated as postoperative value minus preoperative value).Results:A total of 103 patients were enrolled with mean preoperative age of 41.3 ±8.6 years,and the mean follow-up time was 9.7±2.4 months.There were 62 smokers and 41 non-smokers,15 patients with preoperative moderate OSAHS and 88 patients with severe OSAHS.The overall successful rate of surgery was 55.3%(18.4%cured,23.3%markedly effective and 13.6%effective),and there was no statistical difference between the non-smokers and the smokers(59.7%vs 48.9%,p=0.276).After surgery,AHI,mean oxygen saturation,ODI,MAI,TC,FBG,fasting insulin,BMI,ESS,N1 and N3 were significantly improved(P<0.05).The amelioration of glucose or lipid metabolism related traits(including ? TC,? FBG,? fasting insulin)were not significantly different between smokers and non-smokers.However,as to sleep structure,?N3 was significantly higher in non-smoker as compared to smokers(5.7%(0.1%-11.8%)vs 3.3%(-7.5%-7.0%),p=0.039).Conclusions:Upper airway surgery helps to improve the patients' glycolipid metabolism and sleep structure.Postoperative smoking was associated with worse sleep structure,but not glycolipid metabolism.The postoperative improvement of sleep structure in non-smoking OSAHS patients was better than smokers.