An investigation on the use of snus and its association with respiratory and sleep-related symptoms: a cross-sectional population study

Introduction Studies of the health effects of moist oral tobacco, snus, have produced inconsistent results. The main objective of this study is to examine the health effects of snus use on asthma, respiratory symptoms and sleep-related problems, a field that has not been investigated before. Methods and material This cross-sectional study was based on a postal questionnaire completed by 26 697 (59.3%) participants aged 16 to 75 years and living in Sweden. The questionnaire included questions on tobacco use, asthma, respiratory symptoms and sleeping problems. The association of snus use with asthma, respiratory symptoms and sleep-related symptoms was mainly tested in never-smokers (n=16 082). Results The current use of snus in never-smokers was associated with an increased risk of asthma (OR 1.51 (95% CI 1.28 to 1.77)), asthmatic symptoms, chronic bronchitis and chronic rhinosinusitis. This association was not present among ex-snus users. Snoring was independently related to both the former and current use of snus ((OR 1.37 (95% CI 1.12 to 1.68)) and (OR 1.59 (95% CI 1.34 to 1.89), respectively)). A higher risk of difficulty inducing sleep was seen among snus users. Conclusion Snus use was associated with a higher prevalence of asthma, respiratory symptoms and snoring. Healthcare professionals should be aware of these possible adverse effects of snus use.The GA2LEN survey was supported financially by the EU Sixth Framework Programme for Research, contract no FOOD-CT-2004-506378. The study was also supported financially by the Swedish Heart and Lung Foundation, the Swedish Asthma and Allergy Foundation and the Swedish Association against Heart and Lung Diseases, the Centre for Allergy Research at the Karolinska Institutet, the Karolinska Institutet and AstraZeneca Translational Science Centre Collaboration Research Program, and the Science for Life Laboratory Stockholm and AstraZeneca Collaboration Research Program. The Gothenburg part of the study was mainly funded by the VBG Group Centre for Asthma and Allergy Research.Peer Reviewe