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. Study Design. Database study. Setting. Community-based use of a portable sleep study device. Subjects and 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. Conclusion. 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.