Association of traffic air pollution with severity of obstructive sleep apnea in urban areas of Northern Taiwan: A cross-sectional study

Yansu He; Wente Liu; Shangyang Lin; Zhiyuan Li; Hong Qiu; Steve Hung Lam Yim; Hsiaochi Chuang; Kinfai Ho

doi:10.1016/j.scitotenv.2022.154347

Association of traffic air pollution with severity of obstructive sleep apnea in urban areas of Northern Taiwan: A cross-sectional study

Sci Total Environ. 2022 Jun 25:827:154347. doi: 10.1016/j.scitotenv.2022.154347. Epub 2022 Mar 4.

Authors

Yansu He¹, Wente Liu², Shangyang Lin³, Zhiyuan Li⁴, Hong Qiu⁴, Steve Hung Lam Yim⁵, Hsiaochi Chuang⁶, Kinfai Ho⁷

Affiliations

¹ JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China.
² Research Center of Sleep Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; School of Respiratory Therapy, College of Medicine, Taipei Medical University, Taipei, Taiwan; Division of Pulmonary Medicine, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan.
³ Research Center of Sleep Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
⁴ Institute of Environment, Energy and Sustainability, The Chinese University of Hong Kong, Hong Kong, China.
⁵ The Asian School of the Environment, Nanyang Technological University, Singapore.
⁶ School of Respiratory Therapy, College of Medicine, Taipei Medical University, Taipei, Taiwan; Division of Pulmonary Medicine, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan; Cell Physiology and Molecular Image Research Center, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.
⁷ JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China; Institute of Environment, Energy and Sustainability, The Chinese University of Hong Kong, Hong Kong, China. Electronic address: kfho@cuhk.edu.hk.

PMID: 35257757
DOI: 10.1016/j.scitotenv.2022.154347

Abstract

Background: Although recent studies have indicated an association between obstructive sleep apnea (OSA) and air pollution, they have reported inconsistent results. Moreover, few studies investigated the effects of short-term air pollution exposure.

Objective: To estimate the health effects of short- and long-term exposure to traffic air pollution on mild OSA in Taipei.

Methods: We collected participants' data from Taipei Sleep Center and air pollution data from Taiwan Environmental Protection Administration. A spatiotemporal model was used to estimate the individual exposure level. Generalized linear models were used to assess the percent change of overall apnea-hypopnea index (AHI), AHI in rapid eye movement period (AHI-REM), AHI in non-REM (AHI-NREM), and oxygen desaturation index (ODI) associated with an interquartile (IQR) increase in personal pollution exposure. A generalized logistic model was used to estimate the ORs of different severities of OSA compared with the reference group.

Results: In the patients with AHI of <15, both short- and long-term exposure to NO₂ were significantly associated with AHI and ODI increases: an IQR increase in 2-year mean NO₂ increased 7.3% of AHI and 8.4% of ODI; these values were the highest among all exposure windows. The effects of NO₂ on AHI increase were stronger in the men and younger patients. Moreover, the association between AHI and NO₂ in the patients with AHI of <15 was mediated by the REM stage. NO₂ exposure was associated with an increased risk of mild OSA that reached up to 24.8% per IQR increase in NO₂ averaged over 2 years. PM_2.5 exerted no effects on AHI, but an IQR increase in 1-year and 2-year mean PM_2.5 was associated with 6.8% and 8.8% increases in ODI, respectively.

Conclusions: Both short- and long-term exposure to traffic air pollution were associated with the risk of mild OSA, which was modified by REM stage.

Keywords: Air pollution; Non-rapid eye movement sleep; Obstructive sleep apnea; Oxygen adesaturation index; Rapid eye movement sleep; Spatio-temporal exposure assessment.

MeSH terms

Air Pollution* / analysis
Cross-Sectional Studies
Humans
Male
Nitrogen Dioxide / analysis
Oxygen
Particulate Matter / analysis
Sleep Apnea, Obstructive* / epidemiology
Taiwan / epidemiology

Substances

Particulate Matter
Nitrogen Dioxide
Oxygen