Link between Secondhand Smoke Exposure and Obstructive Sleep Apnea among Nonsmoking U.S General Adults: Finding from the National Health and Nutrition Examination Survey 2015-2020

The association between secondhand smoke exposure (SHSE) and obstructive sleep apnea (OSA) in general adults remains to be explored and therefore is investigated based on the representative National Health and Nutrition Examination Survey (NHANES) in this study. SHSE was assessed by self-reporting of passive exposure to burning cigarette in an indoor area (home, restaurant or bar, etc.), and OSA was defined by self-reporting OSA-related symptoms and frequency. A survey-weighted regression model and stratified analyses were used to estimate the association between SHSE and odds of OSA. The study involved 9,991 participants who had never smoked, representing a weighted number of 449.9 million adults ranging from 20 to 80 years old in the noninstitutionalized U. S population. There was a strong association between several kinds of SHSEs and OSA that compared with participants staying indoors without exposure to secondhand smoke (SHS), the odds of OSA was 1.2 times higher for those with SHSE at home (adjusted odds ratio AOR=1.225, 95% CI: 1.009, 1.484), 1.4 times higher for those with SHSE in car (AOR=1.404, 95% CI: 1.219, 1.616), and 1.3 times higher for those with e-cigarette SHSE (AOR=1.302, 95% CI: 1.087, 1.557). Participants with simultaneous exposure to more different SHSs were 36% (one to three kinds of SHSEs (AOR=1.368, 95% CI: 1.219, 1.534)) and 44% (above four kinds of SHSEs (AOR=1.444, 95% CI: 1.034, 2.004)) more likely to have OSA, respectively. In general, general adults with SHSE in separate indoor areas, especially those with simultaneous exposure to different SHSs, had higher OSA risk. Identifying causality and health consequences of the association requires future longitudinal studies.