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Clearing the air – The relationship between smoking and obstructive sleep apnea

Posted on August 15th, 2023

Obstructive sleep apnea (OSA) is a serious sleep disorder characterized by repeated episodes of breathing cessation during sleep. It occurs when the muscles in the back of the throat fail to keep the airway open, leading to breathing disruptions and frequent awakenings throughout the night. 

Several factors contribute to the development of OSA. But smoking is a significant risk factor that often goes unnoticed.

Several studies have highlighted smoking’s detrimental effects on respiratory health. Smoking tobacco damages the lungs and affects the upper airway, making it more susceptible to collapse during sleep.

Here are several ways in which smoking increases the risk of developing obstructive sleep apnea:

Smoking causes inflammation and airway narrowing 

Smoking causes inflammation and airway irritation. And this can lead to a condition known as chronic obstructive pulmonary disease (COPD). COPD is associated with persistent airway narrowing and reduced lung function. When the airway is already compromised due to smoking-related inflammation, it becomes more prone to collapse during sleep. 

Smoking increases upper airway resistance 

Smoking increases relaxation and reduces muscle tone in the upper airway. And these changes can lead to more upper airway resistance, making it more difficult for air to flow through the airway during sleep. This increased resistance can exacerbate the airway’s collapsibility. And it can contribute to the development or progression of OSA.

Smoking leads to fluid retention and swelling

Smoking has been linked to fluid retention and swelling in the upper airway. This includes the tissues surrounding the throat and the uvula (the tissue hanging at the back of the throat). This swelling can further narrow a person’s airway, making it more susceptible to collapse during sleep and increasing the likelihood of OSA.

Smoking negatively impacts sleep architecture 

Smoking can disrupt a person’s normal sleep architecture. Smokers often experience…

  • Reduced overall sleep time
  • Increased sleep fragmentation
  • Decreased deep sleep (also known as slow-wave sleep)

These disruptions in sleep patterns can affect the muscle tone and control of the upper airway, contributing to the development or worsening of OSA.

Smoking impairs oxygen levels 

Smoking damages the lungs and reduces lung function. In turn, this impairs oxygen levels in the blood. And this decreased oxygenation can affect the muscles involved in maintaining airway patency during sleep. Additionally, smokers with OSA may experience more severe drops in blood oxygen levels during apnea events, causing further health complications.

Smoking is not the only cause of OSA. And people who don’t smoke can still develop the condition. But smoking significantly increases the risk and severity of OSA. Moreover, the detrimental effects of smoking on a person’s overall health are well-documented. And quitting smoking has numerous benefits for both respiratory and cardiovascular health.

If you’re a smoker concerned about your risk of developing obstructive sleep apnea, the most effective course of action is to quit smoking. By quitting smoking, you can reduce inflammation, improve lung function, and minimize your risk of sleep apnea. Additionally, undergoing a sleep study can help diagnose and manage any existing sleep-disordered breathing.

Smoking is a major risk factor for obstructive sleep apnea. The detrimental effects of smoking on the respiratory system and upper airway contribute to the development, severity, and progression of OSA. If you smoke and experience sleep apnea symptoms, you should consult a healthcare professional for proper diagnosis and treatment.

Dr. Meghna Dassani has practiced dentistry for over two decades and is passionate about the role dentists play in whole-body health. You can learn more at her website:

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