Heart disease, stroke, lung diseases like chronic bronchitis and emphysema, osteoporosis, cataracts, and now you can add Obstructive Sleep Apnea to that list. Smoking is the leading cause of many medical conditions that can easily be prevented. There have been various studies now linking smoking to Obstructive Sleep Apnea. Those who smoke are three times more likely of developing OSA.
About 35% of smokers have OSA. The common risk factors and consequences of OSA and smoking include stroke, heart disease, cancer, decreased cognitive functioning, oxidative stress, and activation of the inflammatory system.
Obstructive Sleep Apnea occurs when the muscles of the throat or relax and cause an obstruction of the airway. This can be the result of excessive fatty tissue, an oversized tongue or uvula, a soft palate or a narrow airway. It can also is caused by anatomical swelling in the airway that happens when you smoke. OSA stops your breathing for periods of time and lowers your blood oxygen saturation because of the lack of oxygen.
These disruptions in breathing and lack of oxygen cause sleep fragmentation. Sleep fragmentation during OSA "breaks up your sleep", as you are temporarily woken up to resume breathing in a Flight or Fight response. The person’s mind and body have not restored during the night making them fatigued during the day, creating morning headaches or problems concentrating. Not to mention there are many serious medical consequences that result from a lack of sleep and a lack of oxygen in the body.
A study at Johns Hopkins University found 22.5 percent of smokers said they experienced restless sleep, in comparison to 5% of nonsmokers. Another study proves that smokers spend more time during the night in the lighter sleep stages, never reaching REM stage while non-smokers experienced more restorative, deep sleep. Heavy smokers with OSA had a higher percentage of light sleep in NREM stages N1 and N2 and a lower percentage of deep sleep found in NREM stage N3, because of sleep fragmentation caused by OSA.
Smoking causes induced upper airway inflammation caused by nicotine irritation of the upper airway muscles, and a response to nicotine withdrawal during sleep. During the first hour of sleep, nicotine acts as a stimulant, reducing the number of apneas and hypopneas during sleep. According to the National Sleep Foundation, the stimulating effects of nicotine can cause smokers to develop insomnia if they smoke frequently and close to bedtime. (As we have mentioned in the past OSA is commonly misdiagnosed as insomnia and its primary symptoms.) As nicotine withdrawal continues throughout the night, your sleep apnea increases due to a rebound effect produced by the withdrawal.
Smoking causes inflammation of the nose, uvula, and throat, which obstructs and reduces the space in the airway. Long-term smokers with moderate and severe OSA, have increased uvular mucosa and uvular collapse. An inflamed uvula is also known as “battered uvula.” This can be attributed to the thickened mucosa caused from smoking.
Smoking is a known risk for snoring, and snoring is a symptom of OSA. A study found a higher association between heavy smokers and a higher AHI of greater than 50 events per hour (severe apnea is 30 events per hour). Smokers were also found to have longer durations of hypoxia with significantly lower oxygen levels.
If you have sleep apnea and you smoke, please talk to one of our physicians. Help is available to you at Raphaelson Dental Associates. Our professionals are here to help to improve your health and quality of life.