The association between traffic-related air pollution and obstructive sleep apnea: A systematic review

David P Q Clark; Dinh Bui Son; Gayan Bowatte; Chamara V Senaratna; Caroline Lodge; Jennifer L Perret; Garun S Hamilton; Shyamali Dharmage

doi:10.1016/j.smrv.2020.101360

The association between traffic-related air pollution and obstructive sleep apnea: A systematic review

Sleep Med Rev. 2020 Dec:54:101360. doi: 10.1016/j.smrv.2020.101360. Epub 2020 Jul 11.

Authors

David P Q Clark¹, Dinh Bui Son², Gayan Bowatte³, Chamara V Senaratna⁴, Caroline Lodge⁵, Jennifer L Perret⁶, Garun S Hamilton⁷, Shyamali Dharmage⁸

Affiliations

¹ The University of Melbourne, School of Population & Global Health, 207, Bouverie Street, Carlton, VIC 3052, Australia. Electronic address: clarkd1@student.unimelb.edu.au.
² The University of Melbourne, School of Population & Global Health, Centre for Epidemiology and Biostatistics, Allergy and Lung Health, 207, Bouverie Street, Carlton, VIC 3052, Australia. Electronic address: dinh.bui@unimelb.edu.au.
³ The University of Melbourne, School of Population & Global Health, Centre for Epidemiology and Biostatistics, Allergy and Lung Health, 207, Bouverie Street, Carlton, VIC 3052, Australia; Department of Basic Sciences, Faculty of Allied Health Sciences, University of Peradeniya, National Institute of Fundamental Studies, Sri Lanka. Electronic address: gayan.bowatte@unimelb.edu.au.
⁴ The University of Melbourne, School of Population & Global Health, Centre for Epidemiology and Biostatistics, Allergy and Lung Health, 207, Bouverie Street, Carlton, VIC 3052, Australia; Faculty of Medical Sciences, Non-Communicable Diseases Research Centre, University of Sri Jayewardenepura, Sri Lanka. Electronic address: chamaravs@sjp.ac.lk.
⁵ The University of Melbourne, School of Population & Global Health, Centre for Epidemiology and Biostatistics, Allergy and Lung Health, 207, Bouverie Street, Carlton, VIC 3052, Australia. Electronic address: clodge@unimelb.edu.au.
⁶ The University of Melbourne, School of Population & Global Health, Centre for Epidemiology and Biostatistics, Allergy and Lung Health, 207, Bouverie Street, Carlton, VIC 3052, Australia; The Institute for Breathing and Sleep (IBAS), Heidelberg, Melbourne, VIC, Australia. Electronic address: jennifer.perret@unimelb.edu.au.
⁷ Dept of Lung and Sleep Medicine, Monash Health, Victoria, Australia; School of Clinical Sciences, Monash University, Victoria, Australia. Electronic address: Garun.Hamilton@monash.edu.
⁸ The University of Melbourne, School of Population & Global Health, Centre for Epidemiology and Biostatistics, Allergy and Lung Health, 207, Bouverie Street, Carlton, VIC 3052, Australia. Electronic address: s.dharmage@unimelb.edu.au.

PMID: 32755810
DOI: 10.1016/j.smrv.2020.101360

Abstract

Recent evidence suggests that air pollution exposure may be a contributing risk factor for obstructive sleep apnea (OSA), however, current evidence is conflicting. This systematic review aims to determine the association between air pollution and OSA in the general population, and examine for potential effect modification by seasonality, temperature and humidity. Five full-text articles were included in the review out of 905 articles found by systematically searching PubMed, Embase and Scopus databases. The included studies were limited to OSA in adults that were conducted in middle to high-income countries. The results highlight heterogeneity in the diagnostic criteria for OSA and method used to assess air pollution exposure. There is some evidence to support a relationship between air pollution exposure and OSA. However, the duration of exposure to different air pollutants including particulate matter (PM_2.5 and PM₁₀) and nitric oxides (NO₂) in relation to OSA varied across different seasons, temperatures, and countries. This variability of the pollutants across studies warrants a more robust study design using time-series analysis with multiple follow-ups to strengthen the evidence for this relationship before considering its implications.

Keywords: Obstructive sleep apnea; Systematic review; Traffic-related air pollution.

Publication types

Systematic Review

MeSH terms

Air Pollutants / analysis*
Air Pollution / adverse effects*
Developed Countries
Humans
Internationality
Nitric Oxide / analysis
Particulate Matter / analysis
Seasons*
Sleep Apnea, Obstructive / epidemiology*
Temperature*
Time Factors

Substances

Air Pollutants
Particulate Matter
Nitric Oxide