Sleep apnea and substance use: a meta-analysis.

INTRODUCTION: Sleep apnea and substance use disorders appear to interact bidirectionally, negatively influencing each other. Obstructive sleep apnea syndrome (OSA) seems particularly prevalent among substance users.

METHODS: This meta-analysis aims to evaluate the impact of the most commonly used substances (alcohol, tobacco, cannabis, opioids, and cocaine) on the apnea-hypopnea index (AHI) by comparing the mean AHI scores between users and non-users.

RESULTS: 3784 articles were identified from the PubMed search, and 28 studies were included in the meta-analysis. We found a higher AHI among alcohol users (SMD: 0.46, 95 % CI [0.21-0.71] (z = 3.62; p < 0.001)) and a higher prevalence of central sleep apnea among opioid users (SMD: 0.44 95 % CI 0.24-0.64] (z = 4.37; p < 0.001)). The AHI was also elevated among tobacco users, although this difference was not statistically significant. Regarding moderators effects, sex may influence alcohol's impact, while both age and sex could affect the relationship between opioids and AHI. No studies compared the AHI of cocaine users to non-users, and only one study comparing the AHI of cannabis users to non-users were found.

CONCLUSION: This study highlights the importance of diagnosing and managing sleep apnea in patients with substance use, in order to improve addiction prognosis through specific treatment approaches.