Smokers reported greater perceived stress which was indirectly effected by subjective symptoms of obstructive sleep apnea (OSA), according to results of a study presented at the 2022 Annual Meeting of the American Academy of Sleep Medicine and the Sleep Research Society, held from June 4 to 8, 2022, in Charlotte, North Carolina.

Smoking cigarettes has been associated with detriments to sleep quality and is known to exacerbate sleep disorders. In OSA, smoking increases irritation and inflammation of the upper respiratory tract. Smoking has also been found to have a bidirectional positive relationship with perceived stress, study authors noted. In general, individuals with increased stress often report more sleep problems and experience an increased risk for OSA.

In order to evaluate the relationship between smoking, perceived stress, and OSA, this cross-sectional survey conducted at the University of Alabama at Birmingham recruited smokers and nonsmokers. Study participants (N=459) were evaluated for OSA subjective symptoms using the STOP-BANG questionnaire, average sleep propensity using the Epworth Sleepiness Scale, and subjective sleep quality using the Pittsburgh Sleep Quality Index. A parallel mediation analysis was performed to evaluate the relationship between the 3 variables using race, sex, employment, and income as covariates.

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The study population comprised 75.8% women; 60.3% of participants were White.

The analysis found that risk for OSA was indirectly affected by subjective symptoms (β, -0.55; 95% CI, -1.07 to -0.09) and the relationship between smoking status and perceived stress was indirectly affected by overall subjective sleep quality (β, -1.39; 95% CI, -2.16 to -0.74).

There was no direct effect of smoking on perceived stress (β, 0.06; P =.93). Average sleep propensity did not modify significant effects (β, -0.09; 95% CI, -0.45 to 0.21).

The major limitation of this study, as cited by the investigators, was that OSA was determined using subjective symptoms evaluated by a questionnaire and not by an objective OSA clinical assessment.

The study authors concluded, “Findings illustrate that smokers tend to be at greater risk for OSA and overall report worse sleep quality, which in turn increases their reported levels of perceived stress.”


Chana SM, Thomas S, Gamble K, Cropsey K. Smoking and perceived stress: examining associations with subjective symptoms of obstructive sleep apnea through parallel mediation analyses. Presented at SLEEP 2022; June 4-8; Charlotte, North Carolina. Abstract 683.