Snoring Tied To Vascular Remodeling In Overweight, Obese Adults Without Apnea

Young to middle-aged adults who are overweight or obese, and heavy snorers have an increased risk for vascular remodeling even when they don't have obstructive sleep apnea, according to a small study that suggests snoring might contribute to cardiovascular risk in these individuals.

Researchers examined data on 122 adults with overweight or obesity who were assessed using the snoring index (SI), which measures snoring vibration, and the oxygen desaturation index (ODI), which determines the presence and severity of obstructive sleep apnea. The analysis included 41 people with obstructive sleep apnea (ODI score of 5 or more); the remaining participants didn't have apnea and were consider either "low snoring" (below median SI score, n=41) or "heavy snoring" (above median SI score, n=40).

Among participants without obstructive sleep apnea, common carotid intima-media thickness (IMT) and carotid interadventitial diameter (IAD) were higher in heavy snorers than low snorers (unstandardized beta estimates 0.03 and 0.21 for IMT and IAD, respectively).

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There are several possible explanations for why snoring was associated with vascular remodeling in people without obstructive sleep apnea, said senior study author Emma Barinas-Mitchell, an associate professor of epidemiology and director of the Ultrasound Research Laboratory at the University of Pittsburgh in Pennsylvania.

"One hypothesis is that vibrations from snoring may induce damage to the walls of the carotid artery, a nearby blood vessel," Barinas-Mitchell said by email. "Snoring may also be associated with risk factors or conditions that are associated with vascular remodeling; these include being male and overweight or obese, alcohol use, and having a family history of snoring or obstructive sleep apnea."

Compared with the low snoring group, people in the study who did have obstructive sleep apnea also had more vascular remodeling but these results were no longer statistically significant after adjusting for age, sex, race, BMI, mean arterial pressure, non-HDL cholesterol, and HOMA-IR.

There isn't a standard way to assess snoring severity, the study team notes in Sleep Health, and the current analysis didn't utilize recordings of snoring as part of its assessment of snoring severity.

Another limitation of the study is that researchers lacked data on respiratory rate, which is often related to snoring severity, the authors point out.

"The link between snoring and the carotid artery could be due to the physical effects of snoring, such as the vibration of the blood vessels, which ultimately causes damage, and it could be due to sleep disruption, which has also been linked to vascular changes," said Kristen Knutson, an associate professor at the Center for Circadian & Sleep Medicine at Northwestern University in Chicago.

"The underlying mechanisms still need to be identified," Knutson, who wasn't involved in the study, said by email.

Even so, the results suggest that heavy snoring, even without sleep apnea, has cardiovascular consequences, Knutson said.

"Clinicians should consider treating those who report snoring even if they don't have sleep apnea," Knutson advised.

—Lisa Rapaport

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