title: Self-reported snoring and risk of cardiovascular disease among postmenopausal women (from the Women's Health Initiative).
abstract: Habitual snoring may be associated with cardiovascular disease (CVD); however, limited evidence exists among women. We investigated whether frequent snoring is a predictor of coronary heart disease (CHD) and stroke among 42,244 postmenopausal women participating in the Women's Health Initiative Observational Study. Participants provided self-reported information regarding snoring habits at baseline (1993 to 1998) and were followed up for outcomes through August 2009. Physician adjudicators confirmed CHD (defined as myocardial infarction, CHD death, revascularization procedures, or hospitalized angina) and ischemic stroke. Cox proportional hazards models were used to evaluate whether snoring frequency is a significant predictor of the adjudicated outcomes. We observed 2,401 incident cases of CHD during 437,899 person-years of follow-up. After adjusting for age and race, frequent snoring was associated with incident CHD (hazard ratio [HR] 1.54, 95% confidence interval [CI] 1.39 to 1.70) and stroke (HR 1.41, 95% CI 1.19 to 1.66), and all CVD (HR 1.46, 95% CI 1.34 to 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 to 1.28), stroke (HR 1.19, 95% CI 1.02 to 1.40), and CVD (HR 1.12, 95% CI 1.01 to 1.24). In conclusion, snoring is associated with a modest increased risk of incident CHD, stroke, and CVD after adjustment for CVD risk factors. Additional studies are needed to elucidate the mechanisms by which snoring might be associated with CVD risk factors and outcomes.
authors.affiliation: Center for Sleep and Circadian Neurobiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA. megsands@mail.med.upenn.edu
authors.forename: Megan
authors.initials: M
authors.lastname: Sands
authors.forename: Eric B
authors.initials: EB
authors.lastname: Loucks
authors.forename: Bing
authors.initials: B
authors.lastname: Lu
authors.forename: Mary A
authors.initials: MA
authors.lastname: Carskadon
authors.forename: Katherine
authors.initials: K
authors.lastname: Sharkey
authors.forename: Marcia
authors.initials: M
authors.lastname: Stefanick
authors.forename: Judith
authors.initials: J
authors.lastname: Ockene
authors.forename: Neomi
authors.initials: N
authors.lastname: Shah
authors.forename: Kristen G
authors.initials: KG
authors.lastname: Hairston
authors.forename: Jennifer
authors.initials: J
authors.lastname: Robinson
authors.forename: Marian
authors.initials: M
authors.lastname: Limacher
authors.forename: Lauren
authors.initials: L
authors.lastname: Hale
authors.forename: Charles B
authors.initials: CB
authors.lastname: Eaton
mesh_terms: D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D006801:Humans; D015994:Incidence; D008875:Middle Aged; D017698:Postmenopause; D016016:Proportional Hazards Models; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D057566:Self Report; D012913:Snoring / Q000150:complications* / Q000453:epidemiology; D014481:United States / Q000453:epidemiology; D016387:Women's Health