The impact of alcohol on breathing parameters during sleep: A systematic review and meta-analysis.
Level 1 - systematic review of randomized trials
Systematic review and meta-analysis of randomized controlled trials
PubMed 30017492 · doi:10.1016/j.smrv.2018.05.007
What was done
A systematic review and meta-analysis of randomized controlled trials was conducted using Ovid Medline, Embase, and PsycINFO databases through November 1, 2017. Eligible studies reported objective measures of breathing during sleep before and after alcohol administration. Weighted mean differences (WMD) and 95% confidence intervals (CI) were calculated for apnea-hypopnea index (AHI), mean oxyhemoglobin saturation (SpO2), respiratory event duration, and nadir SpO2.
What was found
Fourteen eligible RCTs (n = 422; 71.9% male) were analyzed. Alcohol administration significantly increased overall AHI (WMD = 2.33; 95% CI = 1.41 to 3.25, I² = 62%) and significantly decreased mean SpO2 (WMD = -0.60; 95% CI = -0.72 to -0.49, I² = 0%). The increase in AHI was greater in snorers (WMD = 4.20; 95% CI = 1.19 to 6.50, I² = 0%) and individuals with diagnosed OSA (WMD = 7.10; 95% CI = 3.59 to 10.61, I² = 0%). Alcohol also increased respiratory event duration (WMD = 0.86; 95% CI = 0.18 to 1.55, I² = 19%) and decreased nadir SpO2 (WMD = -1.25; 95% CI = -2.00 to -0.50, I² = 25%).
Why it matters
This review establishes alcohol as an acute modifiable risk factor that worsens nocturnal oxygenation and significantly exacerbates sleep-disordered breathing, particularly among snorers and patients with diagnosed obstructive sleep apnea.
Limits
The total sample across 14 trials was relatively small (422 participants) and predominantly male (71.9%), limiting generalizability to women. Heterogeneity was moderate for the overall AHI analysis (I² = 62%), and the abstract does not report alcohol dosages, timing relative to sleep, or long-term clinical consequences.
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