Alpha-1 antitrypsin deficiency and risk of sleep apnea: a nationwide cohort study

α₁-Antitrypsin deficiency is a disease characterized by increased neutrophil elastase activity leading to tissue getting less elastic and robust. It is known that if tissue in the pharynx becomes less elastic and robust, it could contribute to obstructive sleep apnea. This paper seeks to investigate whether patients with α₁-antitrypsin deficiency have an increased risk of sleep apnea.

We tested this hypothesis by doing a nationwide cohort study of 2702 individuals diagnosed with α₁-antitrypsin deficiency compared with 26,750 individuals without α₁-antitrypsin deficiency matched on sex, age, and municipality. All individuals were followed from birth and were censored at the time of outcome, emigration, death, or end of follow-up 31st of December 2018, whichever came first.

Individuals with α₁-antitrypsin deficiency had a higher risk of sleep apnea with an adjusted hazard ratio of 1.81 (95% CI 1.36-2.40) compared to controls without α₁-antitrypsin deficiency. Similarly, the risk of obstructive sleep apnea was nominally higher in individuals with α₁-antitrypsin deficiency compared to controls without the disease (1.47, 95% CI 0.95-2.28). In stratified analysis, the risk of sleep apnea was higher in individuals without chronic obstructive pulmonary disease (2.33, 95% CI 1.54-3.51) (P for interaction < 0.05). The increased risk of SA was unaffected when the analysis was stratified by ischemic heart disease, ischemic cerebrovascular disease, type 2 diabetes, hypertension, and liver cirrhosis.

Individuals with α₁-antitrypsin deficiency have a higher risk of sleep apnea in the Danish population.