title: Snoring and insomnia are not associated with subclinical atherosclerosis in the Northern Manhattan Study.
abstract: BACKGROUND
  Sleep-disordered breathing is a risk factor for stroke, but its association with subclinical atherosclerosis remains controversial. Snoring and insomnia are frequently comorbid with sleep-disordered breathing and may contribute to stroke. Data on the relationship between snoring and insomnia with atherosclerotic disease are sparse. We investigated the relationship between markers of subclinical atherosclerosis, insomnia, snoring, and carotid intima-media thickness, in the Northern Manhattan Study.
  
  
  METHODS
  A group of 1605 participants (mean age 65 +/- 8 years; 40% men; 61% Hispanic, 19% black, 20% white) who had carotid intima-media thickness measurements performed was assessed for self-reported sleep habits. Habitual snoring was defined as self-reported snoring greater than four times per week. Presence of insomnia was based on three items extracted from the Hamilton Rating Scale for Depression. Carotid intima-media thickness was expressed as a mean composite measure of intima-media thickness in the carotid bifurcation, common, and internal carotid artery. Multivariate linear regression models were used to identify associations between snoring, insomnia, and carotid intima-media thickness.
  
  
  RESULTS
  Habitual snoring was present in 29% of the subjects and insomnia in 26%. There was a higher prevalence of self-reported snoring (84%) and insomnia (66%) among Hispanics than non-Hispanics. The mean total carotid intima-media thickness was 0.95 +/- 0.09 mm; among those with self-reported snoring was 0.94 +/- 0.09 mm; and among those with insomnia was 0.95 +/- 0.08 mm. After controlling for age, gender, race-ethnicity, body mass index and cardiovascular risk factors, snoring (P=0.986) and insomnia (P=0.829) were not significantly associated with increased carotid intima-media thickness.
  
  
  CONCLUSIONS
  Snoring and insomnia were not significantly associated with subclinical atherosclerosis in this population-based community cohort.
authors.affiliation: Department of Neurology, Miller School of Medicine, University of Miami Miller School of Medicine, Miami, FL 33136, USA. aramos@med.miami.edu
authors.forename: Alberto
authors.initials: A
authors.lastname: Ramos-Sepulveda
authors.forename: William
authors.initials: W
authors.lastname: Wohlgemuth
authors.forename: Hannah
authors.initials: H
authors.lastname: Gardener
authors.forename: Dalia
authors.initials: D
authors.lastname: Lorenzo
authors.forename: Salim
authors.initials: S
authors.lastname: Dib
authors.forename: Douglas M
authors.initials: DM
authors.lastname: Wallace
authors.forename: Bruce
authors.initials: B
authors.lastname: Nolan
authors.forename: Bernadette
authors.initials: B
authors.lastname: Boden-Albala
authors.forename: Mitchell S V
authors.initials: MS
authors.lastname: Elkind
authors.forename: Ralph L
authors.initials: RL
authors.lastname: Sacco
authors.forename: Tatjana
authors.initials: T
authors.lastname: Rundek
mesh_terms: D001741:Black or African American; D000368:Aged; D050197:Atherosclerosis / Q000150:complications / Q000000981:diagnostic imaging / Q000453:epidemiology*; D002339:Carotid Arteries / Q000000981:diagnostic imaging; D003863:Depression / Q000523:psychology; D005006:Ethnicity; D005260:Female; D006630:Hispanic or Latino; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D009519:New York City / Q000453:epidemiology; D012307:Risk Factors; D007319:Sleep Initiation and Maintenance Disorders / Q000150:complications / Q000000981:diagnostic imaging / Q000453:epidemiology*; D012913:Snoring / Q000150:complications / Q000000981:diagnostic imaging / Q000453:epidemiology*; D012959:Socioeconomic Factors; D020521:Stroke / Q000453:epidemiology; D014463:Ultrasonography; D044465:White People