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Volume 15 No. 06
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Accepted Papers

Scientific Investigations

Air Pollutants Are Associated With Obstructive Sleep Apnea Severity in Non-Rapid Eye Movement Sleep

Wan-Ju Cheng, MD, PhD1,2; Shinn-Jye Liang, MD3,4; Chun-Sen Huang, MSc4; Cheng-Li Lin, MSc5,6; Li-Chung Pien, PhD7; Liang-Wen Hang, MD, PhD3,4
1Department of Psychiatry, China Medical University Hospital, Taichung, Taiwan; 2Department of Public Health, China Medical University, Taichung, Taiwan; 3Department of Respiratory Therapy, College of Health Care, China Medical University, Taichung, Taiwan; 4Sleep Medicine Center, Department of Pulmonary and Critical Care Medicine, China Medical University Hospital, Taichung, Taiwan; 5Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan; 6College of Medicine, China Medical University, Taichung, Taiwan; 7Department of Nursing, Cardinal Tien Junior College of Healthcare and Management, New Taipei City, Taiwan

Study Objectives:

The relationship between seasonal variation of obstructive sleep apnea and ambient temperature and pollutants has been inconsistent in previous studies. It is also unknown whether the seasonal variation in apnea-hypopnea index influences continuous positive airway pressure treatment dose. This study aims to examine the seasonality of obstructive sleep apnea and continuous positive airway pressure treatment, and the association between air pollutants and apnea-hypopnea index in adults with different sleep apnea severity during different sleep stages.


Polysomnography of 5,413 patients referred to one sleep center during 2008–2015 were examined retrospectively. Ambient conditions and air pollutants levels were collected from the official air condition surveillance database. Cosinor analysis was used to examine seasonal variances. The general linear model was used to examine associations between air conditions and apnea-hypopnea index adjusted for seasonality. Models for apnea-hypopnea index in different sleep stages, sex groups, and obstructive sleep apnea severity groups were analyzed separately.


Seasonal variations for continuous positive airway pressure treatment were not significant. Particulate matter less than or equal to 10 μm, ozone, sulfur dioxide, and relative humidity were associated with apnea-hypopnea index only in patients with severe obstructive sleep apnea. The association was significant only in non-rapid eye movement sleep.


An adjustment for continuous positive airway treatment dose by season is not warranted. Protection for air pollutant-vulnerable groups should be provided. The exact mechanism of the associations between apnea-hypopnea index and air conditions only in non-rapid eye movement sleep must be clarified.


Cheng WJ, Liang SJ, Huang CS, Lin CL, Pien LC, Hang LW. Air pollutants are associated with obstructive sleep apnea severity in non-rapid eye movement sleep. J Clin Sleep Med. 2019;15(6):831–837.

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