Self-Reported Snoring and Risk of Cardiovascular Disease Among Postmenopausal Women (From the Women’s Health Initiative)

Study Questions:

Is snoring associated with an increased risk for cardiovascular disease (CVD) among postmenopausal women?

Methods:

Data from the Women’s Health Initiative observational study cohort, a multiethnic population of 93,676 postmenopausal women ages 50-79 years at baseline, were used for the present analysis. Only those who provided self-reported information regarding snoring habits at baseline (1993-1998), were free of CVD at baseline, and who were followed up for outcomes through August 2009, were included. The subjects were classified as nonsnorers, occasional snorers (<1 to 4 times/week), and frequent snorers (≥5 times/week). The primary outcomes of interest included confirmed coronary heart disease (CHD) (defined as myocardial infarction, CHD death, revascularization procedures, or hospitalized angina) and ischemic stroke.

Results:

A total of 2,401 incident cases of CHD over 437,890 person-years of follow-up were confirmed. At baseline, 47% of women reported no snoring, 33% reported occasional snoring, and 20% reported frequent snoring. Compared to the overall cohort, women who reported frequent snoring had a greater body mass index (BMI), were more likely to be current smokers, had a greater blood pressure, and had a greater prevalence of diabetes and depression. After adjusting for age and race, frequent snoring was associated with incident CHD (hazard ratio [HR], 1.54; 95% confidence interval [CI], 1.39-1.70), stroke (HR, 1.41; 95% CI, 1.19-1.66), and all CVD (HR, 1.46; 95% CI, 1.34-1.60). In fully adjusted models that included CVD risk factors such as obesity, hypertension, and diabetes, frequent snoring was associated with a more modest increase in incident CHD (HR, 1.14; 95% CI, 1.01-1.28), stroke (HR, 1.19; 95% CI, 1.02-1.40), and CVD (HR, 1.12; 95% CI, 1.01-1.24). After stratifying by BMI, frequent snoring was a significant predictor of CHD among overweight and obese women in the age- and race-adjusted models (HR, 1.29; 95% CI, 1.07-1.54 for overweight; HR, 1.33; 95% CI, 1.10-1.61 for obese), but not normal-weight women (HR, 1.19; 95% CI, 0.93-1.52). These associations were attenuated and no longer statistically significant in the fully adjusted models.

Conclusions:

The investigators concluded that snoring is associated with a modest increase in risk for heart disease and stroke after adjustment for CVD risk factors.

Perspective:

This analysis observed an association between snoring and CVD risk, which was no longer significant after stratification for BMI and adjustment for additional CVD risk factors. However, information on obstructive sleep apnea was not collected. Further details regarding sleep characteristics and pathology are warranted when examining the association of snoring with CVD risk.

Clinical Topics: Prevention, Hypertension, Sleep Apnea

Keywords: Depression, Myocardial Infarction, Stroke, Follow-Up Studies, Overweight, Women's Health, Coronary Disease, Blood Pressure, Risk Factors, Estrogen Replacement Therapy, Heart Diseases, Body Mass Index, Cardiovascular Diseases, Obesity, Hypertension, Sleep Apnea, Obstructive, Diabetes Mellitus


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