Poor air quality linked to worsening sleep apnea 

September 30, 2025

Poor air quality may exacerbate obstructive sleep apnea (OSA), according to a multi-national study linking environmental health with sleep medicine. The research, presented at the European Respiratory Society (ERS) Congress in Amsterdam, highlighted a measurable increase in the severity of OSA in areas with higher levels of air pollution.

OSA, a condition in which a person’s breathing repeatedly stops and starts during sleep, often goes undiagnosed. People with OSA typically experience loud snoring, interrupted sleep, and repeated awakenings throughout the night. The condition is more common among older adults and those who are overweight, but environmental factors appear to play a role as well.

The study examined 19,325 patients from 25 cities across 14 countries. Researchers assessed the relationship between the apnoea-hypopnea index (AHI)—the number of apneas and hypopneas per hour of sleep—and long-term exposure to PM10, airborne particles measuring 10 micrometers or less, primarily released by vehicles and industrial activity.

Findings showed that higher PM10 levels were associated with greater OSA severity. Patients with low AHI scores (under five events per hour) lived in areas with an average PM10 concentration of 16 micrograms per cubic meter. In contrast, patients with higher AHI scores (five or more) were exposed to higher average PM10 levels of around 19 micrograms per cubic meter.

Martino Pengo, Associate Professor at the University of Milano-Bicocca and clinician at Istituto Auxologico Italiano IRCCS, Milan, said the results confirmed a statistically significant association between air pollution and OSA severity. “Even after accounting for other known risk factors, we found an average increase of 0.41 respiratory events per hour of sleep for every one-unit increase in PM10,” he noted.

The study also revealed variation in the strength of this association across different cities, underscoring the impact of local environmental conditions on sleep health. Researchers emphasized the importance of considering air quality alongside established risk factors when diagnosing and managing OSA.

As awareness grows about the influence of pollution on respiratory health, these findings highlight the need for both public health interventions to reduce airborne particulate matter and clinical attention to environmental contributors in OSA management. The study reinforces the broader connection between environmental quality and chronic health conditions, suggesting that cleaner air could have benefits beyond lung health, extending into sleep and overall well-being.