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Contemporary Reviews in Sleep Medicine |

Where There Is Smoke…There Is Sleep ApneaRelationship Between Smoking and Sleep Apnea: Exploring the Relationship Between Smoking and Sleep Apnea

Vidya Krishnan, MD, MHS; Sherrie Dixon-Williams, MD, MHS; J. Daryl Thornton, MD, MPH, FCCP
Author and Funding Information

From the Division of Pulmonary, Critical Care, and Sleep Medicine (Drs Krishnan, Dixon-Williams, and Thornton), and the Center for Reducing Health Disparities (Dr Thornton), MetroHealth Campus of Case Western Reserve University, Cleveland, OH.

CORRESPONDENCE TO: Vidya Krishnan, MD, MHS, Division of Pulmonary, Critical Care, and Sleep Medicine, MetroHealth Medical Center, 2500 MetroHealth Drive, Room BG3-38, Cleveland, OH 44109; e-mail: vkrishnan@metrohealth.org


FUNDING/SUPPORT: Dr Thornton is supported by the National Center on Minority Health and Health Disparities [Grant 1-P60MD002265-01] and by the US Department of Health and Human Services Health Resources and Services Administration [Grant R39OT22056].

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2014;146(6):1673-1680. doi:10.1378/chest.14-0772
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Smoking and OSA are widely prevalent and are associated with significant morbidity and mortality. It has been hypothesized that each of these conditions adversely affects the other, leading to increased comorbidity while altering the efficacy of existing therapies. However, while the association between smoking and OSA is plausible, the evidence is less than conclusive. Cigarette smoking may increase the severity of OSA through alterations in sleep architecture, upper airway neuromuscular function, arousal mechanisms, and upper airway inflammation. Conversely, some evidence links untreated OSA with smoking addiction. Smoking cessation should improve OSA, but the evidence to support this is also limited. This article reviews the current evidence linking both conditions and the efficacy of various treatments. Limitations of the current evidence and areas in need of future investigation are also addressed.

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