Cigarette Smoking Behavior and Respiratory Alterations During Sleep in a Healthy Population

Gonzalo G. Casasola; José L. Álvarez-Sala; José A. Marques; José M. F. Sánchez-Alarcos; Donald P. Tashkin; Domingo Espinós

doi:10.1055/s-2002-23152

Sleep Breath 2002; 06(1): 019-024
DOI: 10.1055/s-2002-23152

ORIGINAL ARTICLE

Cigarette Smoking Behavior and Respiratory Alterations During Sleep in a Healthy Population

Gonzalo G. Casasola¹ , José L. Álvarez-Sala² , José A. Marques³ , José M.F. Sánchez-Alarcos² , Donald P. Tashkin³ , Domingo Espinós¹

¹Department of Internal Medicine, , San Carlos University Hospital, Complutense School of Medicine, Madrid, Spain
²Department of Pulmonary Medicine, San Carlos University Hospital, Complutense School of Medicine, Madrid, Spain
³Division of Pulmonary and Critical Care Medicine, UCLA School of Medicine, Los Angeles, California

Abstract

ABSTRACT

Background and study objective: The importance of tobacco smoking in the origin of sleep ventilatory abnormalities is disputed. The purpose of our study was to evaluate the influence of cigarette smoking behavior on the sleep respiratory alterations in a healthy population. Design and methods: We studied 38 healthy volunteers (21 M, 17 F; age 42 ± 12 years; BMI 23.7 ± 3.6 kg/m

@affil2:²) who were divided into two matched groups: current tobacco smokers (n = 18; over 10 pack-years) and nonsmokers (n = 20). All individuals underwent a single nocturnal domiciliary polygraphic study (Polygraphics CNS, Minneapolis, Minnesota). Apnea (AI), apnea-hypopnea (AHI), and desaturation (DI) indexes were defined according to conventional criteria. A nocturnal hypoxia index (NHI) was calculated as an index of the magnitude and duration of oxyhemoglobin desaturation during sleep. The mean transcutaneous oxygen saturation (SpO₂) of the first 60 seconds of oxymetric registration (subject supine and awake) was considered basal SpO₂. Venous carboxyhemoglobin (COHb) levels were measured (CO-Oximeter AVL-912, Basel, Switzerland) in all individuals before (22:00 h) and after (10:00 h) sleep. A correction factor of 0.9 x COHb was applied to the basal SpO₂ values to calculate the corrected basal SpO₂ (SpO_{2 corr}). Results: AI, AHI, and DI were not significantly different between smokers and nonsmokers. The smokers have significantly higher NHI than nonsmokers [median (25th percentile-75th percentile): 5.3 (0-39.7) vs. 0.5 (0-1.7); p = 0.017]. There were significant correlations (P < 0.05) in smokers between NHI and pack-years index, between NHI and COHb levels, and between current smoking intensity and COHb levels. As expected, smokers had higher COHb levels at 10:00 as well as at 22:00 hours. The Sp0_{2 corr} was significantly lower (p < 0.001) among smokers than nonsmokers (88.9 ± 3.3% vs. 94.7 ± 1.3%). In multiple regression analyses, AHI and DI showed a significant correlation (p = 0.02 and p = 0.05, respectively) with habitual snoring, and NHI with pack-years and BMI (p = 0.02 and p = 0.04, respectively). Conclusions: Cigarette smoking does not seem to be associated with increased apneic activity during sleep. However, it is associated with a decrease in nocturnal oxygen saturation.

KEYWORD

Apnea-hypopnea index - carboxyhemoglobin - cigarette smoking - healthy subjects - nocturnal oxygen saturation

Full Text

References

REFERENCES

1 Krieger J. Breathing during sleep in normal subjects. In: Kryger MH, Roth T, Dement VC, eds. Principles and Practice of Sleep Medicine 2nd ed. Philadelphia, PA: WB Saunders Co 1994: 212-223
2 Partinen M. Epidemiology of sleep disorders. In: Kryger MH, Roth T, Dement VC, eds. Principles and Practice of Sleep Medicine 2nd ed. Philadelphia, PA: WB Saunders Co 1994: 437-452
3 Bloom J W, Kaltenborn W T, Quan S F. Risk factors in a general population for snoring. Importance of cigarette smoking and obesity. Chest . 1988; 93 678-683
4 Yamamoto H, Inaba S, Nishiura Y, Kishi F, Kawakami Y. Acute inhalation of cigarette smoke augments hypoxic chemosensitivity in humans. J Appl Physiol . 1985; 58 717-723
5 Nishimura M, Yamamoto M, Yoshioka A, Akiyama Y, Kishi F, Kawakami Y. Longitudinal analyses of respiratory chemosensitivity in normal subjects. Am Rev Respir Dis . 1991; 143 1278-1281
6 Hasday J D, Grum C M. Nocturnal increase of uric acid/creatinine ratio. A biochemical correlate of sleep-associated hypoxemia. Am Rev Respir Dis . 1987; 135 534-538
7 Tawaklna M T, Greville H W. The effect of carboxyhemoglobin (COHb) on the accuracy of pulse oximetry in ambulatory care patients. Am Rev Respir Dis . 1991; 143(suppl) A72
8 Stradling J R, Crosby J H. Predictors and prevalence of obstructive sleep apnea and snoring in 1001 middle aged men. Thorax . 1991; 46 85-90
9 Kauffmann F, Annesi I, Neukirch F, Oryszczyn M P, Alperovitch A. The relation between snoring and smoking, body mass index, age, alcohol consumption and respiratory symptoms. Eur Respir J . 1989; 2 599-603
10 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
11 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
12 Lugaresi E, Cirignotta F, Montagna P, Sforza E. Snoring: pathogenic, clinical and therapeutic aspects. In: Kryger MH, Roth T, Dement VC, eds. Principles and Practice of Sleep Medicine 2nd ed. Philadelphia, PA: WB Saunders Co 1994: 621-629
13 Casasola G G, Danta I, Bascuñana J. Tobacco smoking and nightly respiratory changes in a healthy population. Sleep Breathing . 1996; 1 15-23
14 Cirignotta F, D'Alesandro R, Partinen L. Prevalence of every night snoring and obstructive sleep apneas among 30 to 69-year-old men in Bologna, Italy. Acta Neurol Scand . 1989; 79 366-372
15 Guilleminault C, Stoohs R, Duncan S, Snoring I. <~>Daytime sleepiness in regular heavy snorers. Chest . 1991; 99 40-48
16 Issa F G, Sullivan C E. Upper airway closing pressure in snorers. J Appl Physiol . 1984; 57 528-535
17 Bradley T D, Brown I G, Grossman R. Pharyngeal size in snorers, non-snorers, and patients with obstructive sleep apnea. N Engl J Med . 1986; 315 1327-1331
18 Caballero P, Álvarez-Sala R, García Río F. CT in the evaluation of the upper airway in healthy subjects and in patients with obstructive sleep apnea syndrome. Chest . 1998; 113 111-116
19 Gothe B, Stohl K P, Levin S, Cherniack N S. Nicotine: a different approach to treatment of sleep apnea. Chest . 1985; 87 11-17
20 Chapman K R, Liu F LW, Watson R M, Rebuck A S. Range of accuracy of two wavelength oximetry. Chest . 1986; 89 540-542
21 Tremper K K. Pulse oximetry. Chest . 1989; 95 713-715
22 Barker S J, Tremper K K. The effect of carbon monoxide inhalation on pulse oximeter and transcutaneous PO₂ . Anesthesiology . 1987; 66 677-679
23 Wright J L, Cagle P, Churg A, Colby T V, Myers J. Diseases of the small airways. Am Rev Respir Dis . 1992; 146 240-262
24 Cosío M, Ghezzo H, Hogg J C. The relations between structural changes in small airways and pulmonary function test. N Engl J Med . 1978; 298 1277-1281