Recent studies indicate that ambient temperature may modulate obstructive sleep apnoea (OSA) severity. However, study results are contradictory warranting more investigation in this field. We analysed 19,293 patients of the European Sleep Apnoea Database (ESADA) cohort with restriction to the three predominant climate zones according to the Köppen-Geiger climate classification: Cfb (warm temperature, fully humid, warm summer), Csa (warm temperature, summer dry, hot summer), and Dfb (snow, fully humid, warm summer). Average outside temperature values were obtained and several hierarchical regression analyses were performed to investigate the impact of temperature on the apnea-hypopnea index (AHI), oxygen desaturation index (ODI), time of oxygen saturation <90% (T90) and minimum oxygen saturation (MinSpO2 ) after controlling for confounders including age, body mass index, gender, and air conditioning (A/C) use. AHI and ODI increased with higher temperatures with a standardised coefficient beta (β) of 0.28 for AHI and 0.25 for ODI, while MinSpO2 decreased with a β of -0.13 (all results p < .001). When adjusting for climate zones, the temperature effect was only significant in Cfb (AHI: β = 0.11) and Dfb (AHI: β = 0.08) (Model 1: p < .001). The presence of A/C (3.9% and 69.3% in Cfab and Csa, respectively) demonstrated only a minor increase in the prediction of the variation (Cfb: AHI, R2 +0.003; and Csa: AHI, R2 +0.007; both p < .001). Our present study indicates a limited but consistent influence of environmental temperature on OSA severity and this effect is modulated by climate zones.

Center of Sleep and Wake Disorders Sahlgrenska Academy Gothenburg University Göteborg Sweden

Department of Cardiology University Hospital Brno Brno Czech Republic

Department of Cardiovascular Neural Metabolic Sciences Istituto Auxologico Italiano IRCCS St Luke Hospital Milan Italy

Department of Chest Diseases Ege University Izmir Turkey

Department of Medicine and Surgery University of Milano Bicocca Milan Italy

Department of Pneumology University Hospital de Santa Maria CHULN Lisbon Portugal

Department of Pulmonary Diseases and Clinical Allergology Sleep Research Centre University of Turku Turku Finland

Department of Sleep Medicine Royal Infirmary Edinburgh Edinburgh UK

Division of Medicine Department of Pulmonary Diseases Turku University Hospital Turku Finland

Faculdade de Medicina Instituto de Saúde Ambiental Universidade de Lisboa Lisbon Portugal

International Clinical Research Center St Ann's University Hospital Brno Czech Republic

IRIB CNR Palermo Italy

Multidisciplinary Sleep Disorders Centre Antwerp University Hospital Antwerp Belgium

PROMISE Dept University of Palermo Palermo Italy

Pulmonary and Sleep Disorders Unit School of Medicine St Vincent's University Hospital University College Dublin Dublin Ireland

Pulmonary Department Sleep Disorders Center Sahlgrenska University Hospital Gothenbrug Sweden

Respiratory Failure Unit G Papanikolaou Hospital Aristotle University of Thessaloniki Thessaloniki Greece

Sleep Disorders Unit Department of Respiratory Medicine Medical School University of Crete Heraklion Greece

Université Grenoble Alpes INSERM HP2 and Grenoble University Hospital Grenoble France

University of Antwerp Antwerp Belgium

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