Alcohol and the risk of sleep apnoea: a systematic review and meta-analysis

Evangelia Simou,John Britton,Jo Leonardi-Bee

doi:10.1016/j.sleep.2017.12.005

Evangelia Simou, John Britton + Show 1 more

Open Access

https://doi.org/10.1016/j.sleep.2017.12.005

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Abstract

ObjectiveA systematic review and meta-analysis of the association between alcohol consumption and risk of sleep apnoea in adults. MethodsWe searched Medline, EMBASE and Web of Science databases from 1985 to 2015 for comparative epidemiological studies assessing the relation between alcohol consumption and sleep apnoea. Two authors independently screened and extracted data. Random effects meta-analysis was used to estimate pooled effect sizes with 95% confidence intervals (CI). Heterogeneity was quantified using I2 and explored using subgroup analyses based on study exposure and outcome measures, quality, design, adjustment for confounders and geographical location. Publication bias was assessed using a funnel plot and Egger's test. ResultsWe identified 21 studies from which estimates of relative risk could be obtained. Meta-analysis of these estimates demonstrated that higher levels of alcohol consumption increased the risk of sleep apnoea by 25% (RR 1.25, 95%CI 1.13–1.38, I2 = 82%, p < 0.0001). This estimate's differences were robust in alcohol consumption and sleep apnoea definitions, study design, and quality but was greater in Low and Middle Income Country locations. We detected evidence of publication bias (p = 0.001). A further eight included studies reported average alcohol consumption in people with and without sleep apnoea. Meta-analysis revealed that mean alcohol intake was two units/week higher in those with sleep apnoea, but this difference was not statistically significant (p = 0.41). ConclusionThese findings suggest that alcohol consumption is associated with a higher risk of sleep apnoea, further supporting evidence that reducing alcohol intake is of potential therapeutic and preventive value in this condition.

Highlights

Obstructive sleep apnoea (OSA) is a disorder characterised by repeated episodes of partial or complete upper airway collapse or obstruction resulting in hypopnoea or apnoea during sleep [1,2]
Alcohol consumption is associated with a range of important health consequences, and a history of alcohol consumption is common among people with OSA
The extensive scientific literature of studies of the association between OSA and alcohol intake provides mixed evidence on the qualitative and quantitative nature of this association, making systematic review and meta-analysis likely to be helpful in this context

Summary

Introduction

Obstructive sleep apnoea (OSA) is a disorder characterised by repeated episodes of partial or complete upper airway collapse or obstruction resulting in hypopnoea or apnoea during sleep [1,2]. A diagnosis of OSA is confirmed by demonstration of apnoea's (10-s interruptions of breathing) on overnight polysomnography [3,4], or of apnoea or hypopnoea resulting in a 3% reduction in oxygen saturation on overnight oximetry [1], - occurring five or more times per hour [1,5]. OSA is thought to be more common among people who consume alcohol, possibly because alcohol increases upper airway collapsibility [4,8,9] and because alcohol intake can contribute to a higher body mass index. Evidence on the effect of alcohol consumption on the risk of OSA remains mixed, with some studies reporting an increased risk in those who consume alcohol [5,10,11], and others finding a decreased risk [12,13]

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