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Does snoring predict sleepiness independently of apnea and hypopnea frequency?

TitleDoes snoring predict sleepiness independently of apnea and hypopnea frequency?
Publication TypeJournal Article
Year of Publication2000
AuthorsGottlieb, DJ, Yao, Q, Redline, S, Ali, T, Mahowald, MW
JournalAm J Respir Crit Care Med
Volume162
Issue4 Pt 1
Pagination1512-7
Date Published2000 Oct
ISSN1073-449X
KeywordsAdult, Aged, Arousal, Cohort Studies, Cross-Sectional Studies, Female, Humans, Male, Middle Aged, Polysomnography, Risk Factors, Sleep Apnea, Obstructive, Snoring, Wakefulness
Abstract<p>Obstructive apneas and hypopneas during sleep are a well recognized cause of excessive daytime sleepiness. Snoring is also associated with excess sleepiness, although it is not known whether this reflects an independent effect of snoring or whether snoring is simply a marker for obstructive sleep apnea. To further explore the relation of snoring to sleepiness, we conducted a cross-sectional cohort study of community-dwelling adults participating in the Sleep Heart Health Study. The study sample comprises 2,737 men and 3,040 women with a mean age of 64 (SD 11) yr. Sleepiness was quantified using the Epworth Sleepiness Scale (ESS). Snoring history was obtained via a self-completion questionnaire. The respiratory disturbance index (RDI), defined as the number of apneas plus hypopneas per hour of sleep, was measured during in-home polysomnography. The ESS score increased progressively with increasing RDI, from a mean of 7.1 (4.2) in subjects with RDI < 1.5 to 8.8 (4.8) in subjects with RDI >/= 15 (p < 0.001). A progressive increase in ESS score was also seen across five categories of snoring frequency, from 6.4 (4.2) in current nonsnorers to 9.3 (4.8) in subjects who snored six to seven nights per week (p < 0.001). The prevalence of excessive daytime sleepiness, defined as an ESS score >/= 11, increased from 15% in never-snorers to 39% in those who snored six to seven nights per week. The relation of snoring to sleepiness was seen at all levels of RDI, with no significant change in the relation of snoring to ESS score after adjustment for RDI in multivariate models. The effects of snoring and RDI on sleepiness were little affected by adjustment for age, sex, race, body mass index, or questionnaire evidence of insufficient sleep time or nocturnal leg jerks or cramps. We conclude that both snoring and RDI are independently associated with excess sleepiness in community-dwelling, middle-aged and older adults.</p>
DOI10.1164/ajrccm.162.4.9911073
Alternate JournalAm J Respir Crit Care Med
PubMed ID11029370
Grant ListU01HL53938 / HL / NHLBI NIH HHS / United States
U01HL53940 / HL / NHLBI NIH HHS / United States
U01HL53941 / HL / NHLBI NIH HHS / United States