Wednesday, December 11, 2013

Snoring, sleepiness, and cardiovascular disease

Snoring is common. Habitual snoring is defined as occurring at least 3 days per week. Studies show that 10 - 20% of women and 29 - 39% of men snore habitually. Almost all of my patients with obstructive sleep apnea (OSA) snore, but not all snorers have OSA - studies show that over a third of snorers do not have OSA. Studies have not convincingly linked snoring without OSA to cardiovascular disease (CVD).

Studies have shown that OSA without subjective sleepiness does not increase CVD risk as much as those with OSA that do report sleepiness. This study sought to determine if people who snore and are sleepy, but do not have a history of OSA are at increased risk of developing CVD. Researchers studied >2000 healthy men and women with an average age of 73.5 years. Snoring and sleepiness were assessed with self-report questionnaire. Participants were followed for 10 years on average.

Results showed that 36% of those that reported habitual snoring and sleepiness developed CVD. In contrast, only 22% of those with no snoring or sleepiness, 23% of those with sleepiness but no snoring, and 26% of those with snoring but no sleepiness developed CVD. The researchers concluded that sleepy snorers had a significantly greater risk of developing CVD than the other groups.

However, these results must be interpreted cautiously. First, OSA was not ruled out in all participants with a sleep study. Second, self-reported snoring is not reliable - especially if there is no bedpartner to report it. Also, the authors admitted that the association between sleepy snorers and CVD disappeared when the way they asked about sleepiness was more stringent.

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