What is the association between secondhand smoke (SHS) and possible obstructive sleep apnea: a meta-analysis

• Published in: Environmental health 2022-06, Vol.21 (1), p.1-58, Article 58
• Main Authors: Chang, Chen-Wei, Chang, Ching-Hsiung, Chuang, Hung-Yi, Cheng, Han-Yun, Lin, Chia-I, Chen, Hsiang-Tai, Yang, Chen-Cheng
• Format: Article
• Language: English
• Subjects: Adults; Apnea; Cardiovascular disease; Children; Confidence intervals; Criteria; Environmental aspects; Environmental health; Exposure; Family medicine; Health aspects; Heterogeneity; Meta-analysis; Metabolism; Mortality; Obstructive sleep apnea; Occupational environmental medicine; Outdoor air quality; Passive smoking; Pollution; Questionnaires; Respiration; Risk analysis; Risk factors; Secondhand smoke; Sleep; Sleep apnea; Sleep apnea syndromes; Sleep disorders; Smoking; Statistical analysis; Subgroups; Tobacco smoke
• ISSN: 1476-069X; 1476-069X
• DOI: 10.1186/s12940-022-00868-6

Background Association between smoking and sleep apnea is well-known from previous studies. However, the influence of secondhand smoke (SHS), which is a potential risk factor of obstructive sleep apnea (OSA), remains unclear. Our aim was to investigate the relationship between SHS and OSA using a meta-analysis. Materials and methods For the meta-analysis, searches were performed in MEDLINE, EMBASE, and Web of Science databases on January 10, 2022, by combining various keywords including "SHS exposure" and "OSA". Data were extracted using defined inclusion and exclusion criteria. Fixed-effects model meta-analyses were used to pool risk ratio (RR) estimates with their 95% confidence intervals (CI). I.sup.2 was used to assess heterogeneity. Moreover, we performed subgroup meta-analyses of children-adults, and smoker fathers and mothers. Results In total, 267 articles were obtained through an electronic search. Twenty-six articles were included in our analysis according to the inclusion and exclusion criteria. We found evidence of an association between SHS exposure and possible OSA (RR 1.64, 95% CI 1.44-1.88). The results of the subgroup analyses showed that children passive smokers (RR 1.84, 95% CI 1.60-2.13) were at greater risks of possible OSA than adult passive smokers (RR 1.35, 95% CI 1.21-1.50). Also, significant differences were observed in mothers with smoking exposure (RR 2.61, 95% CI 1.62-4.21, p < 0.0001), as well as in fathers with smoking exposure (RR 2.15, 95% CI 0.98-4.72, p = 0.06). Short conclusion. Our meta-analysis confirmed that SHS exposure is significantly associated with OSA. In the subgroup analyses, the association of SHS and possible OSA was significant in both children and adults, as well as in smoker mothers and fathers. Keywords: Secondhand smoke, Obstructive sleep apnea, Meta-analysis, Occupational environmental medicine, Family medicine