Evaluation of the Effects of Smoking Cessation on Depression Symptoms, Sleep Quality, Pulmonary Function Test and Body Composition Analysis

Aslıhan Titrek; Kamile Marakoğlu; Zeynep Ebru Şener; Muslu Kazım Körez

doi:10.18521/ktd.1792495

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Evaluation of the Effects of Smoking Cessation on Depression Symptoms, Sleep Quality, Pulmonary Function Test and Body Composition Analysis

Year 2026, Volume: 18 Issue: 1, 75 - 82, 24.03.2026

Aslıhan Titrek , Kamile Marakoğlu , Zeynep Ebru Şener , Muslu Kazım Körez

https://doi.org/10.18521/ktd.1792495

https://izlik.org/JA76ZY32HE

Abstract

Aim: This study aimed to evaluate the impact of smoking cessation on depressive symptoms, sleep quality, pulmonary function, and body composition in individuals attending a smoking cessation clinic and to assess the changes observed three months after quitting.
Methods: This prospective, single-center observational study was carried out in individuals aged 18–64 years who presented to a smoking cessation clinic. Data collection included a 67-item face-to-face questionnaire, expiratory carbon monoxide (CO) measurements, anthropometric assessments, and pulmonary function tests (PFTs). At the three-month follow-up, 236 participants who had successfully quit smoking underwent repeat evaluations using the same instruments.
Results: The mean age of the participants was 37.37 ± 12.12 years, and 75% were male. The median age at smoking initiation was 16 years (range, 9–42 years), and 59.7% (n=141) were classified as having high or very high nicotine dependence. The age at smoking initiation was progressively lower among younger cohorts (p<0.001). Three months after cessation, the mean Beck Depression Inventory (BDI) scores declined significantly (p<0.001). Pulmonary function tests demonstrated significant improvements in forced vital capacity (FVC), forced expiratory volume in one second (FEV1), and FEV1/FVC ratio, while lung age decreased toward the chronological age (all p<0.001). Pittsburgh Sleep Quality Index (PSQI) scores improved significantly at three months (p<0.001). Body composition analysis revealed statistically significant increases in the body mass index (BMI), body fat percentage (PBF), and basal metabolic rate (BMR) (all p<0.001).
Conclusion: Smoking cessation is associated with marked improvements in pulmonary function, mood, and sleep quality. Although modest weight gain may occur, its magnitude is negligible compared to the substantial health benefits of smoking cessation.

Keywords

Smoking , depression , lung age , sleep , body composition analysis

Ethical Statement

Before starting the study, the approval of the local non-invasive research ethics committee was obtained (approval date/number: 01.11.2019-E.104357), and an informed consent form in accordance with the Helsinki Declaration of the World Medical Association was obtained from individuals who accepted after being informed about the purpose of the study.

Supporting Institution

This research received no external funding.

Thanks

The authors do not wish to acknowledge any individual or institution.

References

1. Doll R, Peto R, Boreham J, Sutherland I. Mortality in relation to smoking: 50 years’ observations on male British doctors. BMJ. 2004;328:1519. doi:10.1136/bmj.38142.554479.AE.
2. Komiyama M, Wada H, Ura S, Yamakage H, Satoh-Asahara N, Shimatsu A, et al. Analysis of factors that determine weight gain during smoking cessation therapy. PLoS One. 2013;8:e72010. doi:10.1371/journal.pone.0072010.
3. Oh HY, Lee HS, Lee SW, Shim KW, Chun H, Kim JY. The association of lung age with smoking status in Korean men. Korean J Fam Med. 2014;35:35–41. doi:10.4082/kjfm.2014.35.1.35.
4. Grant BF, Hasin DS, Chou SP, Stinson FS, Dawson DA. Nicotine dependence and psychiatric disorders in the United States: results from the National Epidemiologic Survey on alcohol and related conditions. Arch Gen Psychiatry. 2004;61:1107–15. doi:10.1001/archpsyc.61.11.1107.
5. Kathuria H, Seibert RG, Cobb V, Weinstein ZM, Gowarty M, Helm ED, et al. Patient and physician perspectives on treating tobacco dependence in hospitalized smokers with substance use disorders: a mixed methods study. J Addict Med. 2019;13(5):338–45. doi:10.1097/ADM.0000000000000503.
6. Lowery CL 3rd, Elliott C, Cooper A, Hadden C, Sonon RN, Azzadi P, et al. Cigarette smoking associated alterations in serotonin/adrenalin signaling pathways of platelets. J Am Heart Assoc. 2017;6(5):e005465. doi:10.1161/JAHA.116.005465.
7. Smith PH, Mazure CM, McKee SA. Smoking and mental illness in the U.S. population. Tob Control. 2014;23(e2):e147–53. doi:10.1136/tobaccocontrol-2013-051466.
8. Weinberger AH, Kashan RS, Shpigel DM, Esan H, Taha F, Lee CJ, et al. Depression and cigarette smoking behavior: a critical review of population-based studies. Am J Drug Alcohol Abuse. 2017;43(4):416–31. doi:10.3109/00952990.2016.1171327.
9. Li H, Liu Y, Xing L, Yang X, Xu J, Ren Q, et al. Association of cigarette smoking with sleep disturbance and neurotransmitters in cerebrospinal fluid. Nat Sci Sleep. 2020;12:801–8. doi:10.2147/NSS.S272883.
10. Benowitz NL. Pharmacology of nicotine: addiction, smoking-induced disease, and therapeutics. Annu Rev Pharmacol Toxicol. 2009;49:57–71. doi:10.1146/annurev.pharmtox.48.113006.094742.
11. Liao Y, Xie L, Chen X, Kelly BC, Qi C, Pan C, et al. Sleep quality in cigarette smokers and nonsmokers: findings from the general population in central China. BMC Public Health. 2019;19(1):808. doi:10.1186/s12889-019-6929-4.
12. Ishii Y. [Smoking and respiratory diseases]. Nihon Rinsho. 2013;71:416–20. Japanese.
13. National Collaborating Centre for Chronic Conditions. Chronic obstructive pulmonary disease: national clinical guideline on management of chronic obstructive pulmonary disease in adults in primary and secondary care. Thorax. 2004;59(Suppl 1):1–232.
14. Soriano JB, Maier WC, Egger P, Visick G, Thakrar B, Sykes J, et al. Recent trends in physician diagnosed COPD in women and men in the UK. Thorax. 2000;55:789–94. doi:10.1136/thorax.55.9.789.
15. Morris JF, Temple W. Spirometric “lung age” estimation for motivating smoking cessation. Prev Med. 1985;14(5):655–62. doi:10.1016/0091-7435(85)90085-4.
16. Parkes G, Greenhalgh T, Griffin M, Dent R. Effect on smoking quit rate of telling patients their lung age: the Step2quit randomized controlled trial. BMJ. 2008;336(7644):598–600. doi:10.1136/bmj.39503.582396.25.
17. Mitsumune T, Senoh E, Nishikawa H, Adachi M, Kajii E. The effect of obesity and smoking status on lung age in Japanese men. Respirology. 2009;14(5):757–60. doi:10.1111/j.1440-1843.2009.01541.x.
18. Parker DR, Goldman RE, Eaton CB. A qualitative study of individuals at risk for or who have chronic obstructive pulmonary disease: what do they understand about their disease? Lung. 2008;18685):313–6. doi:10.1007/s00408-008-9091-9.
19. Killi AE, Baspinar MM, Basat O. Association between post-cessation weight gain and eating behavior changes. North Clin Istanb. 2020;7:153–60. doi:10.14744/nci.2019.58712.
20. Jain P, Danaei G, Manson JE, Robins JM, Hernán MA. Weight gain after smoking cessation and lifestyle strategies to reduce it. Epidemiology. 2020;31:7–14. doi:10.1097/EDE.0000000000001106.
21. Filozof C, Fernández Pinilla MC, Fernández-Cruz A. Smoking cessation and weight gain. Obes Rev. 2004;5:95–103. doi:10.1111/j.1467-789X.2004.00131.x.
22. Gennuso KP, Thraen-Borowski KM, Schlam TR, LaRowe TL, Fiore MC, Baker TB, et al. Smokers’ physical activity and weight gain one year after a successful versus unsuccessful quit attempt. Prev Med. 2014;67:189–92. doi:10.1016/j.ypmed.2014.07.040.
23. Locatelli I, Collet TH, Clair C, Rodondi N, Cornuz J. The joint influence of gender and amount of smoking on weight gain one year after smoking cessation. Int J Environ Res Public Health. 2014;11(8):8443–55. doi:10.3390/ijerph110808443.
24. Lycett D, Munafò M, Johnstone E, Murphy M, Aveyard P. Associations between weight change over 8 years and baseline body mass index in a cohort of continuing and quitting smokers. Addiction. 2011;106:188–96. doi:10.1111/j.1360-0443.2010.03136.x.
25. Veldheer S, Yingst J, Zhu J, Foulds J. Ten-year weight gain in smokers who quit, smokers who continued smoking and never smokers in the United States, NHANES 2003–2012. Int J Obes (Lond). 2015;39(12):1727–32. doi:10.1038/ijo.2015.127.
26. Fagerström KO. Measuring degree of physical dependence to tobacco smoking with reference to individualization of treatment. Addict Behav. 1978;3(3-4):235–41. doi:10.1016/0306-4603(78)90024-2.
27. Bedfont Scientific Ltd. piCO+ Smokerlyzer Operating Manual. [Internet] Issue 9. 2010 [cited 2026 Mar 12]. Available from: https://www.covita.net/wp-content/uploads/2019/09/pico-manual.pdf
28. Hisli N. Beck Depresyon Envanteri’nin geçerliği üzerine bir çalışma. Psikoloji Dergisi. 1988;6(22):118–22.
29. Agargun M, Kara H, Anlar Ö. Pittsburgh Uyku Kalitesi Indeksinin geçerligi ve güvenirliği. Türk Psikiyatri Dergisi. 1996;7(2):107–15.
30. Buysse DJ, Reynolds III CF, Monk TH, Berman SR, Kupfer DJ. The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res. 1989;28(2):193–213. doi:10.1016/0165-1781(89)90047-4.
31. Micro Medical Ltd. Spirometry PC Software (SPCS) [Internet]. [cited 2026 Mar 12]. Available from: https://www.wms.co.uk/MicroMedical/Software
32. InBody Co., Ltd. In-Body 770 User’s Manual [Internet]. 2015 [cited 2026 Mar 11]. Available from: https://nl.inbody.com/wp-content/uploads/2019/03/770_manual_ENG_C_150520.pdf
33. Hacettepe University Institute of Population Studies. Turkey Demographic and Health Survey 2008. T.R. Prime Ministry State Planning Organization, Ankara; 2008.
34. World Health Organization (WHO). Global adult tobacco survey, Turkey 2016 [Internet]. Geneva; 2016 [cited 2026 Mar 11]. Available from: https://extranet.who.int/ncdsmicrodata/index.php/catalog/872/download/6190
35. Solak I, Yıldırım Dİ, Gümüş F, Eren İ, Eryılmaz MA. Effects of depression and anxiety scores on smoking cessation treatment. Konuralp Med J. 2018;10(2):128–33. doi:10.18521/ktd.351519.
36. Marakoğlu K, Çetin Kargın N, Uçar RM, Kızmaz M. Evaluation of pharmacologic therapies accompanied by behavioural therapy on smoking cessation success: a prospective cohort study in Turkey. Psychiatry Clin Psychopharmacol. 2017;27:221–7. doi:10.1080/24750573.2017.1342751.
37. Velioğlu U, Sönmez CI. Sigara bırakma polikliniğine başvuran hastaların nikotin bağımlılığının sosyo demografik özellikler ve depresyon ile ilişkisi. Dicle Tıp Dergisi. 2018;45(1):35–41. doi:10.5798/dicletip.407242.
38. Pawlina MMC, Rondina Rde C, Espinosa MM, Botelho C. Depression, anxiety, stress, and motivation over the course of smoking cessation treatment. J Bras Pneumol. 2015;41(5):433–9. doi:10.1590/S1806-37132015000004527.
39. Taylor G, McNeill A, Girling A, Farley A, Lindson-Hawley N, Aveyard P. Change in mental health after smoking cessation: systematic review and meta-analysis. BMJ. 2014;348:g1151. doi:10.1136/bmj.g1151.
40. Wu AD, Gao M, Aveyard P, Taylor G. Smoking cessation and changes in anxiety and depression in adults with and without psychiatric disorders. JAMA Netw Open. 2023;6(5):e2316111. doi:10.1001/jamanetworkopen.2023.16111.
41. McClave AK, Dube SR, Strine TW, Kroenke K, Caraballo RS, Mokdad AH. Associations between smoking cessation and anxiety and depression among U.S. adults. Addict Behav. 2009;34(6-7):491–7. doi:10.1016/j.addbeh.2009.01.005.
42. Purani H, Friedrichsen S, Allen AM. Sleep quality in cigarette smokers: associations with smoking-related outcomes and exercise. Addict Behav. 2019;90:71–6. doi:10.1016/j.addbeh.2018.10.023.
43. Liu Y, Li H, Li G, Kang Y, Shi J, Kong T, et al. Active smoking, sleep quality and cerebrospinal fluid biomarkers of neuroinflammation. Brain Behav Immun. 2020;89:623–7. doi:10.1016/j.bbi.2020.07.021.
44. McNamara JPH, Wang J, Holiday DB, Warren JY, Paradoa M, Balkhi AM, et al. Sleep disturbances associated with cigarette smoking. Psychol Health Med. 2014;19(4):410–9. doi:10.1080/13548506.2013.832782.
45. Çetin Kargın N, Marakoğlu K. Sigarayı bırakmanın solunum işlevleri üzerine etkisi. Turk Aile Hek Derg. 2015;19(3):129–33. doi:10.15511/tahd.15.02129.
46. Iwaoka M, Tsuji T. Twelve weeks of successful smoking cessation therapy with varenicline reduces spirometric lung age. Intern Med. 2016;55(17):2387–92. doi:10.2169/internalmedicine.55.6844.
47. Pezzuto A, Stellato M, Catania G, Mazzara C, Tonini S, Caricato M, et al. Short-term benefit of smoking cessation along with glycopyrronium on lung function and respiratory symptoms in patients with mild COPD: a retrospective study. J Breath Res. 2018;12(4):046007. doi:10.1088/1752-7163/aad0a8.
48. Pekgor S, Duran C, Marakoğlu K, Solak I, Pekgor A, Eryilmaz M. The effects of smoking cessation on visceral adiposity index levels. Niger J Clin Pract. 2018;21(6):743–51. doi:10.4103/njcp.njcp_245_17.
49. Kleppinger A, Litt MD, Kenny AM, Oncken CA. Effects of smoking cessation on body composition in postmenopausal women. J Womens Health (Larchmt). 2010;19(9):1651–7. doi:10.1089/jwh.2009.1853.
50. Flegal KM, Troiano RP, Pamuk ER, Kuczmarski RJ, Campbell SM. The influence of smoking cessation on the prevalence of overweight in the United States. N Engl J Med. 1995;333:1165–70. doi:10.1056/NEJM199511023331801.
51. Verma M, Kapoor N, Jaiswal AK, Kumar P, Halder P, Esht V, et al. Relationship between tobacco use and body mass index- a propensity score matching analysis of an indian National Survey. PLoS One. 2025;20(5):e0323274. doi:10.1371/journal.pone.0323274.
52. Yaşar Z, Kar Kurt Ö, Talay F, Kargı A. One-year follow-up results of smoking cessation outpatient clinic: factors affecting the cessation of smoking. Eurasian J Pulmonol. 2014;16(2):99-104. doi:10.5152/ejp.2014.48295.