Association of air pollution with risk and severity of obstructive sleep apnea: A systematic review and meta-analysis

Tahani Alrahbeni; Jeetendra Kumar Gupta; Anas Alkhouri; Ladi Alik Kumar; Ahmed Mahal; Khalid Al-Mugheed; Prakasini Satapathy; Neelima Kukreti; Mahalaqua Nazli Khatib; Shilpa Gaidhane; Abhay M Gaidhane; Sarvesh Rustagi; Dibyalochan Mohanty; Bijaya Kumar Padhi

doi:10.1016/j.neuro.2024.04.005

Association of air pollution with risk and severity of obstructive sleep apnea: A systematic review and meta-analysis

Neurotoxicology. 2024 Apr 17:102:106-113. doi: 10.1016/j.neuro.2024.04.005. Online ahead of print.

Authors

Affiliations

¹ Molecular Toxicology and Genetics, Riyadh Elm University, Saudi Arabia.
² Institute of Pharmaceutical Research, GLA University Mathura, Uttar Pradesh, India.
³ College of Pharmacy, Cihan University-Erbil, Erbil, Kurdistan Region, Iraq.
⁴ Centurion University of Technology and Management, Odisha, India.
⁵ Department of Medical Biochemical Analysis, College of Health Technology, Cihan University-Erbil, Erbil, Kurdistan Region, Iraq.
⁶ Adult Health Nursing and Critical Care, Riyadh Elm University, Saudi Arabia.
⁷ Center for Global Health Research, Saveetha Medical College and Hospital, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, India; Medical Laboratories Techniques Department, Al-Mustaqbal University, Hillah, Babil 51001, Iraq.
⁸ School of Pharmacy, Graphic Era Hill University, Dehradun, India.
⁹ Division of Evidence Synthesis, Global Consortium of Public Health and Research, Datta Meghe Institute of Higher Education, Wardha, India.
¹⁰ One Health Centre (COHERD), Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education, Wardha, India.
¹¹ Jawaharlal Nehru Medical College, and Global Health Academy, School of Epidemiology and Public Health, Datta Meghe Institute of Higher Education, Wardha, India.
¹² School of Applied and Life Sciences, Uttaranchal University, Dehradun, Uttarakhand, India.
¹³ Centre for Nano Medicine, Department of Pharmaceutics, School of Pharmacy, Anurag University, Hyderabad, India.
¹⁴ Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India. Electronic address: padhi.bijaya@pgimer.edu.in.

PMID: 38636605
DOI: 10.1016/j.neuro.2024.04.005

Abstract

Background: Obstructive Sleep Apnea (OSA) is a significant health concern characterized by recurrent upper airway blockages during sleep, causing various health issues. There's growing evidence of a link between air pollution and OSA, though research results have been inconsistent. This systematic review and meta-analysis aims to consolidate and examine data on the relationship between air pollution and OSA's risk and severity.

Methods: A literature search across PubMed, EMBASE, and Web of Science was conducted until January 10, 2024. The selection criteria targeted studies involving OSA participants or those at risk, with quantitative air pollution assessments. The Nested Knowledge software facilitated screening and data extraction, while the Newcastle-Ottawa Scale was used for quality assessment. Meta-analyses, utilizing random-effects models, computed pooled odds ratios (ORs) for the OSA risk associated with PM2.5 and NO2 exposure, analyzed using R software version 4.3.

Results: The systematic review included twelve studies, four of which were analyzed in the meta-analysis. The meta-analysis revealed diverse results on the association of PM2.5 and NO2 with OSA risk. PM2.5 exposure showed a pooled OR of 0.987 (95 % CI: 0.836-1.138), indicating no substantial overall impact on OSA risk. Conversely, NO2 exposure was linked to a pooled OR of 1.095 (95 % CI: 0.920-1.270), a non-significant increase in risk. Many studies found a relationship between air pollution exposure and elevated Apnea-Hypopnea Index (AHI) levels, indicating a relationship between air pollution and OSA severity.

Conclusion: The findings suggest air pollutants, especially NO2, might play a role in worsening OSA risk and severity, but the evidence isn't definitive. This highlights the variability of different pollutants' effects and the necessity for more research. Understanding these links is vital for shaping public health policies and clinical approaches to address OSA amidst high air pollution.

Keywords: Air pollution; Obstructive sleep apnea; Public health; Systematic review.

Publication types

Review