Can exposure to Aqueous Film Forming Foam (AFFF)/Per- and Polyfluoroalkyl Substances (PFAS) from use of firefighting foam cause Obstructive Sleep Apnea (OSA)?

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Last updated: May 22, 2025 • View editorial policy

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From the Guidelines

There is currently no established direct causal link between exposure to AFFF (Aqueous Film-Forming Foam) containing PFAS (Per- and Polyfluoroalkyl Substances) and obstructive sleep apnea. While PFAS are concerning environmental contaminants with various potential health effects, including possible endocrine disruption, immune system effects, and associations with certain cancers, the scientific evidence has not specifically connected these chemicals to sleep apnea development 1. Obstructive sleep apnea is primarily caused by physical factors such as obesity, anatomical features of the airway, aging, family history, smoking, alcohol use, and certain medical conditions.

The diagnosis of obstructive sleep apnea involves measuring breathing during sleep, and the third edition of the International Classification of Sleep Disorders (ICSD-3) defines OSA as a PSG-determined obstructive respiratory disturbance index (RDI) ≥ 5 events/h associated with the typical symptoms of OSA, or an obstructive RDI ≥ 15 events/h (even in the absence of symptoms) 1. If you're concerned about sleep apnea symptoms (such as loud snoring, observed breathing pauses during sleep, excessive daytime sleepiness, morning headaches, or difficulty concentrating), you should consult a healthcare provider for proper evaluation regardless of your PFAS exposure history.

Some key points to consider:

  • A sleep study would be the appropriate diagnostic tool to determine if you have sleep apnea, and treatment options like CPAP therapy, lifestyle modifications, or other interventions would be based on the severity of your condition rather than potential chemical exposures.
  • The American Academy of Sleep Medicine clinical practice guideline for diagnostic testing for adult obstructive sleep apnea provides guidance on the diagnosis and management of OSA 1.
  • The American College of Physicians also provides a clinical practice guideline for the diagnosis of obstructive sleep apnea in adults 1.

In terms of morbidity, mortality, and quality of life, it is essential to prioritize the diagnosis and treatment of obstructive sleep apnea, regardless of potential exposure to PFAS. Untreated OSA can lead to significant health consequences, including cardiovascular disease, metabolic dysregulation, and decreased quality of life 1. Therefore, if you are concerned about sleep apnea, you should consult a healthcare provider for a comprehensive sleep evaluation.

From the Research

Exposure to AFFF/PFAS and Obstructive Sleep Apnea

  • There is no direct evidence to suggest that exposure to AFFF/PFAS from the use of firefighting foam causes obstructive sleep apnea 2, 3, 4, 5, 6.
  • Studies have shown that firefighters are at risk of occupational exposure to long-chain per- and poly-fluoroalkyl substances (PFASs) from PFASs present in Class B aqueous film-forming foam (AFFF) 2, 5.
  • Exposure to PFAS-containing AFFF may contribute to firefighter cancer risk, but there is no mention of its relation to obstructive sleep apnea 2, 5.
  • Obstructive sleep apnea (OSA) is a common problem that can be treated with continuous positive airway pressure (CPAP) therapy, but the provided studies do not link AFFF/PFAS exposure to OSA 3, 4, 6.

Firefighter Exposure to PFAS

  • Firefighters have been found to have elevated serum levels of long-chain PFASs due to their occupational exposure to AFFF 2, 5.
  • Possible sources of occupational exposure to PFAS include turnout gear, aqueous film-forming foam, and air and dust at both the fire scene and fire station 5.
  • Elevated levels of PFAS in firefighters' blood serum may associate with an increased risk of cancer, but there is no direct link to obstructive sleep apnea 2, 5.

Obstructive Sleep Apnea Treatment and Adherence

  • Continuous positive airway pressure (CPAP) is the first-line treatment for patients with moderate to severe OSA, but adherence to CPAP therapy can be sub-optimal 3, 4, 6.
  • Factors such as socio-demographic/economic characteristics, disease severity, psychological factors, and side-effects can affect CPAP adherence in OSA patients 6.
  • Intervention studies have suggested that augmented support/education, behavioral therapy, telemedicine, and technological interventions may improve CPAP adherence 6.

References

1
Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

3
Research

Management of obstructive sleep apnea by continuous positive airway pressure.

Oral and maxillofacial surgery clinics of North America, 2009

4
Research

Continuous versus bilevel positive airway pressure for obstructive sleep apnea.

American journal of respiratory and critical care medicine, 1995

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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