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The impacts of ambient relative humidity and temperature on supine position-related obstructive sleep apnea in adults

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Abstract

Obstructive sleep apnea (OSA) is associated with seasonal variations. The objective of this study was to examine associations of ambient relative humidity (RH) and temperature on sleep parameters. We conducted a cross-sectional study by retrospectively recruiting 5204 adults from a sleep center in Taipei, Taiwan. Associations of 1-night polysomnography with ambient RH and temperature in 1-day, 7-day, 1-month, 6-month, and 1-year averages were examined using linear regression models and a mediation analysis. RH increase was associated with snoring index decrease and apnea/hypopnea index (AHI) increase. Temperature increase was associated with decreases in sleep efficiency and the AHI, and increases in the wake time after sleep onset and snoring index. RH increase was inversely associated with non-rapid eye movement (NREM) sleep stage I (N1), III (N3), and rapid eye movement (REM) sleep, but positively associated with the NREM sleep stage II (N2) stage. Temperature increase was associated with N1, N2, and N3 sleep. An increase in RH was associated with an increase in the arousal index and a decrease in the < 95% arterial oxygen saturation (SaO2) among total, REM, and NREM sleep, whereas a temperature increase was associated with a decrease in the arousal index and an increase in < 95% SaO2 among total, REM, and NREM sleep. An increase in RH was associated with increases in the time spent in a supine posture and the supine AHI. An increase in temperature was associated with decreases in the supine posture, supine AHI, and non-supine AHI. The N3 sleep stage was an important mediator in increasing the supine AHI with a long-term increase in RH. But the N1 and N2 sleep stages mediated a decrease in the supine AHI with an increase in RH. In conclusion, ambient RH and temperature were associated with alterations in sleep parameters in adults, which were mediated by the sleep cycle. An understanding of outdoor environments has important implications for diagnostic classifications in the supine dominance of OSA in adults.

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Data availability

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

The authors heartedly thank all of the staff in the Sleep Center of Shuang Ho Hospital for technical assistance during this project. KF Chung is a visiting professor at Taipei Medical University.

Funding

This study was supported by the Ministry of Science and Technology of Taiwan (MOST 109–2314-B-038–093-MY3).

Author information

Authors and Affiliations

  1. School of Respiratory Therapy, College of Medicine, Taipei Medical University, Taipei, Taiwan

    Wen-Te Liu, Chen-Chen Lo, Kang Lo & Hsiao-Chi Chuang

  2. Sleep Center, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan

    Wen-Te Liu, Dean Wu, Chen-Chen Lo & Kang Lo

  3. Division of Pulmonary Medicine, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan

    Wen-Te Liu & Hsiao-Chi Chuang

  4. Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan

    Yuan-Hung Wang

  5. Department of Medical Research, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan

    Yuan-Hung Wang

  6. Department of Environmental Engineering and Science, Feng Chia University, Taichung, Taiwan

    Li-Te Chang

  7. Department of Geomatics, National Cheng Kung University, Tainan, Taiwan

    Chih-Da Wu

  8. National Institute of Environmental Health Sciences, National Health Research Institutes, Miaoli, Taiwan

    Chih-Da Wu

  9. Department of Neurology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan

    Dean Wu

  10. Department of Neurology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan

    Dean Wu

  11. Department of Civil and Environmental Engineering, Imperial College London, London, UK

    Cheng-Yu Tsai

  12. National Heart and Lung Institute, Imperial College London, London, UK

    Kian Fan Chung

  13. Department of Occupational Safety and Health, College of Public Health, China Medical University, Taichung, Taiwan

    Ta-Yuan Chang

  14. School of Public Health, College of Public Health, Taipei Medical University, Taipei, Taiwan

    Kai-Jen Chuang

  15. Department of Public Health, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan

    Kai-Jen Chuang

  16. Department of Microbiology and Immunology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan

    Yueh-Lun Lee

  17. Cell Physiology and Molecular Image Research Center, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan

    Hsiao-Chi Chuang

Authors
  1. Wen-Te Liu
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  2. Yuan-Hung Wang
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  3. Li-Te Chang
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  4. Chih-Da Wu
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  5. Dean Wu
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  6. Cheng-Yu Tsai
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  7. Chen-Chen Lo
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  8. Kang Lo
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  9. Kian Fan Chung
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  10. Ta-Yuan Chang
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  11. Kai-Jen Chuang
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  12. Yueh-Lun Lee
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  13. Hsiao-Chi Chuang
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Li-Te Chang, Chih-Da Wu, Dean Wu, Cheng-Yu Tsai, Chen-Chen Lo, Kang Lo, Kian Fan Chung, Ta-Yuan Chang, Kai-Jen Chuang, Yueh-Lun Lee, and Hsiao-Chi Chuang. The first draft of the manuscript was written by Wen-Te Liu, Yuan-Hung Wang, and Hsiao-Chi Chuang, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Hsiao-Chi Chuang.

Ethics declarations

Ethics approval and consent to participate

This study was approved by the Ethics Committee of the Taipei Medical University-Joint Institutional Review Board (TMU-JIRB no. N201910048; Taipei, Taiwan). All patients received written information and provided informed consent.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.

Additional information

Responsible Editor: Lotfi Aleya

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Liu, WT., Wang, YH., Chang, LT. et al. The impacts of ambient relative humidity and temperature on supine position-related obstructive sleep apnea in adults. Environ Sci Pollut Res 29, 50755–50764 (2022). https://doi.org/10.1007/s11356-022-18922-8

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  • DOI: https://doi.org/10.1007/s11356-022-18922-8

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