title: An epidemiologic study of snoring and all-cause mortality.
abstract: OBJECTIVE
  Snoring is a common problem that is often associated with obstructive sleep apnea syndrome (OSAS). However, it is suggested that snoring may itself be harmful. Patients with objectively measured snoring were matched against a mortality database and associations were explored.
  
  
  METHODS
  Database study.
  
  
  METHODS
  Community-based use of a portable sleep study device.
  
  
  METHODS
  More than 77,000 patients who underwent a portable sleep study (SNAP Test, SNAP Labs Inc, Wheeling, Illinois) with a detailed, acoustical snoring analysis were matched to the Social Security Death Master File to establish mortality (1653 deaths matched). Snoring indices to include amount (snoring events per hour), volume (dB), and palatal versus nonpalatal snoring were correlated to mortality using stepwise multivariate logistic regression and survival analysis.
  
  
  RESULTS
  As expected, increasing age (odds ratio [OR] = 1.84; 95% confidence interval [CI], 1.76-1.93; P < .001), body mass index (BMI) (OR = 1.23; 95% CI, 1.18-1.28; P < .001), and male sex (OR = 1.38; 95% CI, 1.2-1.56; P < .001) were associated with increased all-cause mortality. The presence of increasing OSAS confounded the relationship between snoring and mortality. For patients without OSAS (apnea–hypopnea index [AHI] < 5) and with a BMI < 30 (n = 5955), increasing snoring was associated with an age- and sex-adjusted increase in mortality (OR = 1.16; 95% CI, 1.01-1.32; P = .034). For all patients, increasing nonpalatal snoring was associated with an increase in mortality (OR = 1.21; 95% CI, 1.09-1.35; P < .001) after adjustment for age, sex, BMI, and AHI. Survival analysis produced identical results to logistic regression.
  
  
  CONCLUSIONS
  In patients without OSAS and with a BMI less than 30, increasing snoring was associated with a significant increase in all-cause mortality. Nonpalatal snoring is associated with an increase in observed all-cause mortality controlling for age, sex, BMI, and AHI.
authors.affiliation: Walter Reed Army Medical Center, Department of Otolaryngology, Washington, DC 20307, USA.
authors.forename: Jeremy
authors.initials: J
authors.lastname: Rich
authors.forename: Ayelette
authors.initials: A
authors.lastname: Raviv
authors.forename: Nataly
authors.initials: N
authors.lastname: Raviv
authors.forename: Scott E
authors.initials: SE
authors.lastname: Brietzke
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002423:Cause of Death / Q000639:trends; D002648:Child; D002675:Child, Preschool; D016001:Confidence Intervals; D018450:Disease Progression; D005260:Female; D006801:Humans; D007223:Infant; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009017:Morbidity / Q000639:trends; D016017:Odds Ratio; D012307:Risk Factors; D012891:Sleep Apnea Syndromes / Q000150:complications / Q000453:epidemiology*; D012913:Snoring / Q000453:epidemiology* / Q000209:etiology; D016019:Survival Analysis; D014481:United States / Q000453:epidemiology; D055815:Young Adult