[Effect of smoking on glucose, lipid metabolism and sleep structure in postoperative patients with obstructive sleep...

Objective:The aim of this study is to investigate the effect of smoking on the glucose, lipid metabolism and sleep structure in patients with moderate and severe obstructive sleep apnea （OSA） after operation. Methods:A retrospective analysis of 103 adult male patients with moderate to severe OSA who were diagnosed and treated from January 2016 to December 2017. All of them could not tolerate continuous positive pressure ventilation. After evaluation by an otolaryngologist, they underwent modified uvulapalatopharyngoplasty surgery. All participants were grouped according to smoking status（non-smokers, smokers） for analysis. Laboratory-based polysomnographic variables, anthropometric measurements, biochemical indicators, and smoking history, Epworth sleepiness score（ESS） were collected preoperatively and postoperatively. And the difference of each variable preoperatively and postoperatively was demonstrated as delta（Δ, calculated as postoperative value minus preoperative value）. Results:Fifteen patients with preoperative moderate OSA and 88 patients with severe OSA. The overall successful rate of surgery was 55.3%（18.4% cured, 23.3% markedly effective and 13.6% effective）, and there was no statistical difference between the non-smokers and the smokers（59.7% vs 48.9%, P=0.276）. After surgery, AHI, mean oxygen saturation, ODI, MAI, TC, FBG, fasting insulin, BMI, ESS, N1 and N3 were significantly improved（P<0.05）. The amelioration of glucose or lipid metabolism related traits（including ΔTC, ΔFBG, Δfasting insulin） were not significantly different between smokers and non-smokers. However, as to sleep structure, ΔN3 was significantly higher in non-smoker as compared to smokers（P=0.039）. Conclusion:Upper airway surgery is helpful to improve the glucose and lipid metabolism disorder and sleep structure in OSA patients. Postoperative smoking was associated with worse sleep structure, but not glycolipid metabolism. The postoperative improvement of sleep structure in non-smoking OSA patients was better than smokers.