Regular snoring is associated with uncontrolled hypertension: A longitudinal objective assessment of nightly snoring and blood pressure

Abstract

Background Snoring may be a risk factor for cardiovascular disease and stroke. However, most prior studies have relied on subjective snoring evaluation from self-reports, or relatively short time-scale objective measures in small samples. This study assessed the prevalence of objectively quantified snoring measured over multiple months, and its association with blood pressure and hypertension. Methods 12,287 participants were monitored nightly in-home for approximately six months using an under-the-mattress sleep sensor to estimate the average percentage of sleep time spent snoring per night and the apnea-hypopnea index (AHI). Blood pressure cuff measurements from multiple daytime assessments were averaged to define uncontrolled hypertension based on mean systolic blood pressure >=140 mmHg and/or a mean diastolic blood pressure >=90 mmHg. Associations between snoring and uncontrolled hypertension were examined using logistic regressions controlled for age, body mass index (BMI), sex, and AHI. Findings Participants were predominantly middle-aged (mean+-SD; 50+-12 y) and male (88%). There were 2,467 cases (20%) with uncontrolled hypertension. Approximately 29, 14 and 7% of the study population snored for an average of >10, 20, and 30% per night, respectively. A higher proportion of time spent snoring (75th vs. 5th; 12% vs. 0.04%) was associated with an ~1.9-fold increase (OR [95%CI]; 1.87 [1.63, 2.15]) in uncontrolled hypertension independent of sleep apnea. The effect size of the association between snoring and uncontrolled hypertension was higher in younger adults and those who were not obese (BMI <30 kg/m2). Interpretations Multi-night recordings in a large consumer sample indicate that snoring is common, and that snoring duration is positively associated with hypertension. These findings highlight the potential clinical utility of simple, objective, and non-invasive methods to detect snoring.

Competing Interest Statement

Outside the submitted work, DJE has had research grants from Bayer, Apnimed, Takeda, Invicta Medical and Eli Lilly and a Cooperative Research Centre Grant (a collaboration between the Australian Government, Academia and Industry- industry partner Oventus Medical). DJE currently serves as a scientific advisor/consultant for Apnimed, Invicta Medical, Bayer and Mosanna. PE serves as a consultant for Withings. Withings provided sleep analysers for a validation trial. None of the other authors have any potential conflicts to declare.

Funding Statement

This was an unfunded, investigator-initiated study led by the Adelaide Institute for Sleep Health sleep research team. DJE is supported by a National Health and Medical Research Council (NHMRC) of Australia Leadership Fellowship (1196261).

Author Declarations

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

Yes

The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

The current study was approved by the Flinders University Human Research Ethics Committee (Project number: 4291).

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Data Availability

Deidentified data that support the findings of this study, including individual data, are available from the corresponding author upon request subject to ethical and data custodian (Withings) approval.

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