Witnessed breathing pauses during sleep: a study in middle-aged French males

The aim of the study was to evaluate the prevalence, the covariates and determinants of respiratory pauses during sleep in a sample of French middle-aged males. Study subjects were 850 active males, aged 22-66 years; 88.4% of them answered the question on breathing pauses during sleep from a structured, validated sleep questionnaire. Forty-one (=5.4%) subjects reported breathing pauses at least once a week; these "positive responders" were older, heavier and had larger neck- and waist girths as compared to subjects with negative answers. Loud habitual snoring, various sleep disturbances, excessive daytime sleepiness, a doctor diagnosis of sleep apnoea, history of stroke and hypertension were significantly more frequent among subjects with breathing pauses during sleep. The prevalence found in this survey was close to that reported from the UK (5.2%). However, by logistic regression, we identified novel determinants of breathing pauses i.e. habitual snoring, loud snoring, and excessive sleepiness, factors well known in clinical setting, but never previously reported in epidemiologic studies.     

Prevalence of snoring and symptoms of sleep-disordered breathing in primary school children in istanbul

STUDY OBJECTIVES: Snoring during sleep is an important manifestation of obstructive sleep apnea syndrome (OSAS). Although clinical history is not sufficiently sensitive and specific to distinguish primary snoring from OSAS, snoring is indicative of upper airway obstruction and may be associated with the presence of diurnal symptoms. Our study aims were to determine the prevalence of snoring in primary school children in Istanbul, and to evaluate the diurnal symptoms and conditions that may be associated with sleep problems. DESIGN, SETTING, AND SUBJECTS: A parental questionnaire was used to assess the sleep and wake behavioral patterns in children. Eight representative schools in each of 9 school districts randomly selected from the 32 school districts in Istanbul were visited. RESULTS: The response rate was 78.1%; 2,147 of 2,746 questionnaires were fully completed, returned, and analyzed. The prevalence of habitual snoring was 7.0%. Habitual snorers had significantly more nighttime symptoms, such as observed apneas (odds ratio [OR], 16.9; 95% confidence interval [CI], 10.0 to 28.8; p < 0.0001), difficulty breathing (OR, 17.8; CI, 10.9 to 29.2; p < 0.0001), restless sleep, parasomnias, and nocturnal enuresis, compared to occasional and nonsnorers. There were also increased prevalence of daytime symptoms, such as falling asleep while watching television (OR, 1.8; CI, 0.9 to 3.7; p = 0.01) and in public places (OR, 2.1; CI, 1.2 to 3.8; p = 0.03), and hyperactivity (OR, 2.7; CI, 1.8 to 3.9; p < 0.0001). Exposure to cigarette smoke and the presence of asthma and hay fever increased the likelihood of habitual snoring. Children with a higher risk for OSAS (habitual snoring, apnea, and difficulty breathing during sleep) were also compared to nonsnorers. Although nighttime symptoms were more likely in the high-risk group, the risk of daytime symptoms increased as well. CONCLUSIONS: Habitual snoring is a significant problem for children and may be associated with diurnal symptoms. Exposure to cigarette smoke at home and the presence of asthma and hay fever increase the likelihood of habitual snoring.     

Prevalence of habitual snoring in a sample of French males. Role of "minor" nose-throat abnormalities.

BACKGROUND: No data on snoring prevalence obtained with a standard questionnaire exist for France. Major nose-throat abnormalities have been demonstrated in cases with obstructive sleep apnea; evidence of "minor" abnormalities in community studies is scarce. OBJECTIVES: The first objective of our study was to estimate the prevalence of habitual snoring in a sample of middle-aged active males in France. The second objective was to test the hypothesis that "minor" nose-throat abnormalities could be associated with habitual snoring in a field survey. METHODS: Three hundred thirty-four male employees of a local university volunteered for the study (93.6% of those contacted by mail); 300 returned a sleep questionnaire. The protocol also included anthropometry and a noninvasive nose-throat examination. RESULTS: Complete data were obtained in 299 subjects aged 23-63 years. When "habitual snorers" (= 32%) were compared with never-snorers, significant differences were found for all anthropometric variables, except height. In univariate analysis, habitual snoring was associated with a large number of variables, including a large soft palate, a large uvula, and altered nose patency. A logistic regression model retained 8 factors independently associated with snoring: age, neck circumference, tobacco consumption, breathing pauses during sleep, not feeling rested during the day, need for coffee to stay awake, blocked or running nose at night and a large soft palate. CONCLUSIONS: The prevalence of habitual snoring in this sample of middle-aged French males was 32%. We confirmed the significant association of habitual snoring with age, weight excess, and tobacco smoking, and identified two further factors: blocked nose at night and a large soft palate.     

Severe obstructive sleep apnea--I: Onset, clinical course, and characteristics

The clinical course and characteristics of severe obstructive sleep apnea are described for 50 adults whose condition warranted recommendation for tracheostomy. All patients had a history of snoring, excessive daytime sleepiness and sleep attacks, nocturnal snorting and gasping sounds and observer-noted nocturnal breath cessations. Generally, these symptoms became manifest before age 40, their appearance tended to cluster together within only a few years and, invariably, they were chronic. Aside from snoring, excessive daytime sleepiness was on average often the first symptom and began at a mean age of 36 years. However, in half of the patients either hypertension or overweight preceded excessive daytime sleepiness by at least 1 year. Physicians in the office setting should suspect severe obstructive sleep apnea in patients who have loud snoring and either excessive daytime sleepiness, hypertension, or obesity. Further evidence of apnea can be obtained by determining the presence of the additional signs of loud nocturnal snorting and gasping sounds and nocturnal breath cessations.     

Snoring and breathing pauses during sleep in the Malaysian population

Objective: The aim of this study was to determine the prevalence of snoring and breathing pauses during sleep, and to assess associated factors, including morbidity and the impact on daytime functioning, in an adult Malaysian population. Methods: A cross-sectional survey of community-dwelling adults aged 30-70 years was conducted. Daytime sleepiness was assessed using the Epworth Sleepiness Scale. Physical examinations were limited to measurements of body habitus and blood pressure. Results: The sample consisted of 1611 adults (52.9% male). The prevalence of habitual snoring, breathing pauses and excessive daytime sleepiness were 47.3%, 15.2% and 14.8%, respectively. Seven per cent of respondents (8.8% male, 5.1% female) were clinically suspected to have obstructive sleep apnoea syndrome (OSAS). The independent predictors of habitual snoring were older age, Chinese or Indian ethnicity (compared with Malays), smoking, obesity and use of sedatives. Clinically suspected OSAS and habitual snoring were significantly associated with difficulty in getting up in the morning, morning headache, driving and workplace accidents, hypertension, and ischaemic heart disease. Conclusions: The prevalence of habitual snoring is high in the Malaysian population. Sleep-related breathing disorders in Malaysian adults are associated with significant morbidity.     

Bipolar radiofrequency thermal ablation of the soft palate in habitual snorers without significant desaturations assessed by magnetic resonance imaging

Sleep-disordered breathing, including habitual snoring, is a major health problem. Treatment of primary habitual snoring should be individualized using both conservative and active treatment methods. Active surgical interventions are, however, associated with significant morbidity. Therefore, procedures causing far less morbidity should be preferred. Our aim was to assess the efficacy and acceptability of bipolar radiofrequency thermal ablation of the soft palate in habitual snorers without significant desaturations associated with excessive daytime sleepiness. We treated 20 nonobese habitual snorers (median age, 43 years, range 35-63). All the patients had the major site of obstruction at the level of the soft palate, and they were treated on an outpatient basis in two treatment sessions separated by 1 week. The pretreatment and post-treatment symptoms and findings as well as the overall efficacy of the procedure were evaluated by questionnaires, visual analogue scales, and magnetic resonance imaging. All the questionnaires showed a statistically significant change, indicating decreased snoring and daytime sleepiness. The magnetic resonance studies showed that the procedure induced notable T1-signal alterations in the treated tissue, and when compared with the pretreatment images, certain dimensions of the soft palate were significantly changed. Bipolar radiofrequency thermal ablation of the soft palate seems to be well tolerated and effective regarding primary habitual snorers without significant desaturations associated with excessive daytime sleepiness.     

Obstructive sleep apnea in older adults

The "typical" presentation of obstructive sleep apnea (OSA) is chronic loud snoring and excessive daytime sleepiness in middle-aged obese men. OSA can result in increased risk for cardiovascular morbidity and mortality. The diagnostic features of OSA in older adults are similar to those in younger adults; however, the older adult may be less likely to seek medical attention or have the sleep disorder recognized because symptoms of snoring, sleepiness, fatigue, nocturia, unintentional napping, and cognitive dysfunction may be ascribed to the aging process itself or to other disorders. This article reviews the basic terminology and pathophysiology of sleep-disordered breathing, discusses why OSA may be even more prevalent in older adults than in the middle-aged group, and reviews similarities and differences between the two groups in the manifestations, consequences, and treatments of OSA.     

The role of habitual snoring and obesity in the development of diabetes: a 10-year follow-up study in a male population

OBJECTIVES: There are many similarities between diabetes (mainly type 2) and sleep breathing disturbances regarding risk factors, anthropometric criteria and consequences of morbidity and mortality. The aim of this study was to investigate whether the association between habitual snoring and diabetes is entirely dependent on obesity. DESIGN: A population-based prospective study. SETTING: The municipality of Uppsala, Sweden. SUBJECTS AND METHODS: In 1984 and in 1994, 2668 men aged 30-69 years at baseline answered questionnaires concerning sleep breathing disturbances and somatic diseases. RESULTS: Of those with habitual snoring in 1984, 5.4% reported that they had developed diabetes during the 10-year period compared with 2.4% of those without habitual snoring (P < 0.001). Amongst obese snorers, 13.5% developed diabetes compared with 8.6% of obese non-snorers (P = 0.17). In a multiple logistic regression model, the odds ratio (95% confidence interval) for development of diabetes was higher in obese snorers [7.0 (2.9-16.9)] than in obese non-snorers [5.1 (2.7-9.5)] after adjustment for age, weight gain, smoking, alcohol dependence and physical inactivity. CONCLUSIONS: We conclude that, in males aged 30-69 years, habitual snoring is associated with an increased incidence of diabetes within 10 years. Although obesity is the main risk factor for developing diabetes, coexistent habitual snoring may add to this hazard.     

A community study of sleep-disordered breathing in middle-aged Chinese men in Hong Kong

BACKGROUND: Sleep-disordered breathing (SDB) in Asian populations is being increasingly recognized. This study investigated the prevalence of SDB in Chinese middle-aged office-based male workers in Hong Kong. METHODS: Sleep questionnaires were distributed to 1,542 men (age range, 30 to 60 years), and 784 questionnaires were returned. Subsequently, full polysomnographic (PSG) examinations were conducted in 153 questionnaire respondents. Subjects with an apnea-hypopnea index (AHI) > or =5 were recalled for clinical assessment. RESULTS: Questionnaire respondents were similar in age and body mass index (BMI) to the general community in the target age range and gender. Habitual snoring was reported by 23% of this cohort and was associated with excessive daytime sleepiness (EDS), hypertension, witnessed abnormal breathing pattern, BMI, and leg movements during sleep. Allowing for subject bias in undergoing PSG, the estimated prevalence of SDB and obstructive sleep apnea syndrome (OSAS) (defined as SDB in the presence of EDS) at various AHI cutoff threshold values was 8.8% and 4.1% (AHI > or =5), 6.3% and 3.2% (AHI > or =10), and 5.3% and 3.1% (AHI > or =15). Multiple stepwise logistic regression analysis identified BMI, habitual snoring, time taken to fall asleep, and age as predictors of SDB at AHI > or =5. Analysis of anthropometric parameters indicated that the relative risk of OSAS attributable to obesity was less than in white subjects. CONCLUSION: This community-based study of sleep apnea among middle-aged men in Hong Kong using full PSG demonstrated an estimated prevalence of OSAS (AHI > or =5 and EDS) at 4.1%. Increasing BMI and age were associated with SDB, although factors other than adiposity may also have an important pathogenic role in OSA in Chinese subjects.     

Snoring and sleep architecture

The purpose of this study was to examine whether snoring adversely affects sleep architecture and sleep efficiency, and thus may account for the frequent complaints of daytime tiredness and fatigue expressed by heavy snorers. We recruited eight self-confessed heavy snorers and six self-confessed nonsnorers. All subjects had full nocturnal polysomnography, including continuous monitoring of snoring, which was quantified by counting the number of snores per hour of sleep (snoring index), the number of snores per minute of snoring time (snoring frequency), maximal and mean nocturnal sound intensity (dBmax and dBmean, respectively). We found that even the self-confessed nonsnorers snored lightly, with significantly smaller frequency and index than the heavy snorers. Sleep architecture was similar in both groups. Distribution of snoring among the sleep stages differed for light and heavy snorers: light snorers snored uniformly throughout all sleep stages, whereas heavy snorers tended to snore more during slow-wave and REM sleep. Snoring frequency and snoring index were similar during all sleep stages in light snorers, but they were higher during slow-wave sleep in heavy snorers. Wakefulness time after sleep onset and sleep efficiency correlated significantly with the snoring index. We conclude that although snoring does not affect sleep architecture in general, it influences sleep efficiency and wakefulness time after sleep onset; this may have an adverse effect on daytime function of heavy snorers.     

Are sleep-related breathing disorders important contributing factors to the production of essential hypertension?

About 50% of all patients with essential hypertension have obstructive sleep apnea (OSA), and another 40% of essential hypertension patients are habitual snorers, but without OSA. There is now convincing evidence that both OSA and habitual snoring are independent risk factors for essential hypertension, and that treatment of OSA will reduce the blood pressure. There is also some evidence that treatment of habitual snoring will also reduce the blood pressure. If this is the case, then we postulate a unifying hypothesis: that these two sleep-related breathing disorders (SRBD) (OSA and habitual snoring) are very common contributing factors to what is called "essential hypertension." The many epidemiologic, clinical, hematologic, biochemical, and physiologic findings seen in essential hypertension could also be due to the associated SRBD. A routine search for SRBD by asking a few simple questions of all patients (especially those with hypertension) and their bed partners could increase the number of patients detected and treated significantly. Successful treatment of SRBD would improve sleep quality and the associated excessive daytime sleepiness, and thus improve the quality of life. In addition, there is a good chance that the hypertension will improve as well.     

Associations of symptoms of sleep apnea with cardiovascular disease, cognitive impairment, and mortality among older Japanese-American men.

OBJECTIVES: To examine the association between symptoms of sleep apnea and prevalent cardiovascular disease, cognitive impairment, and subsequent 3-year mortality. DESIGN: A longitudinal study. SETTING: Participants lived in the community on Oahu, Hawaii. PARTICIPANTS: A total of 2905 older Japanese-American men participating in the fourth examination of the Honolulu Heart Program cohort study from 1991-1993, which is the baseline for the Honolulu-Asia Aging Study of dementia. MEASUREMENTS: Self-reported snoring, daytime sleepiness, and breathing pauses; diagnosed cardiovascular disease and dementia; cognitive functioning and vital status approximately 3 years later. RESULTS: More than 12% of the participants reported that they often or always snored loudly, and 8% reported being sleepy most of the day. Fewer than 2% reported that they stop breathing when sleeping, and this was found more frequently among habitual snorers (7%, P < .001) and those sleepy during the day (5%, P < .001). The prevalence of habitual snoring declined in the older age groups, was higher among those with greater Body Mass Index scores, and was not associated with the reporting of daytime sleepiness, diagnosis of heart disease, stroke, dementia, or cognitive impairment. Daytime sleepiness was more prevalent at older ages and was associated with a higher prevalence of heart disease and with cognitive impairment and dementia, chronic obstructive pulmonary disease, and diabetes. Self-reported apnea was associated only with a history of pneumonia. Three-year mortality was not associated with these symptoms after adjusting for prevalent heart disease and cognitive impairment. CONCLUSION: Symptoms of sleep apnea are reported less frequently in older Japanese-American men. Excessive daytime sleepiness is associated with poor cognition and dementia, but whether it also is an indicator for sleep apnea in this age group remains unclear. Epidemiologic studies of sleep apnea in older adults will require polysomnography to determine accurately the correlates and consequences of this condition.     

Patient- and bed partner-reported symptoms, smoking, and nasal resistance in sleep-disordered breathing

OBJECTIVES: Nocturnal and daytime symptoms are important determinants in clinical decision making in patients suspected of having sleep-disordered breathing (SDB). We compared patients' and bed partners' reporting of symptoms associated with SDB in a clinical sample of snoring men. The bed partners' view on snoring disturbance was assessed. The relationship between sleep parameters, anthropometric data, and selected subjective symptoms was assessed. Additionally, we evaluated the relationship between smoking, nasal resistance, and habitual snoring. DESIGN: A cross-sectional, prospective study. SETTING: University teaching hospital. PATIENTS: Thirty-seven consecutive snoring men referred to ENT Hospital because of a snoring problem or suspicion of sleep apnea, and scheduled for surgical treatment of nasal obstruction. INTERVENTIONS: The patients completed a sleep questionnaire, a questionnaire on nasal history, and the Epworth sleepiness scale. The bed partners were asked to complete a separate sleep questionnaire of the patient's daytime and nocturnal symptoms. Both patients and bed partners evaluated the intensity of snoring on a visual analog scale. The patients underwent polysomnography and anterior rhinomanometry. RESULTS: Agreement of patients' and bed partners' reports on symptoms related to SDB was good in this material. One half of the bed partners were disturbed by snoring every night or almost every night, and one third of the bed partners reported disharmony in the relationship from time to time or repeatedly due to snoring. The combination of current smoking and total nasal resistance in a supine position higher than the median value in this patient sample was associated with history of habitual snoring. CONCLUSIONS: Male patients and their bed partners seem to give congruent reports of snoring and symptoms related to SDB in a clinical population with mild SDB. One half of the bed partners found their sleep constantly disturbed. The combination of current smoking and high nasal resistance was related with habitual snoring.     

Symptoms of obstructive sleep apnea in a Caribbean sample

Obstructive sleep apnea (OSA) is a prevalent sleep disorder that disproportionately affects blacks. While clinical and epidemiologic data indicate intraethnic differences in several medical diseases, little is known about whether OSA symptoms differ within the black ethnic group. We estimated the rate of OSA symptoms in a community-based sample of Caribbean-born black men and women. We also ascertained which sociodemographic and/or medical factors were associated with OSA risk. A total of 554 patients (mean age = 48.17 ± 16.75 years) participated in the study; 55% were women. Data were collected in four primary-care clinics in Brooklyn, NY. A health educator explained the purpose of the study to interested patients and assisted consenting participants in completing questionnaires, which required 15 min to complete. Participants reporting habitual snoring, excessive daytime sleepiness, and sleep fragmentation were considered at high OSA risk. The rate of OSA symptoms was: snoring (45%), excessive daytime sleepiness (33%), and difficulty maintaining sleep (34%). Many reported falling asleep while watching television (47%) or while driving (14%). Based on logistic regression analysis, a history of heart disease was the most important predictor of the likelihood of expressing OSA symptoms, with a corresponding multivariate-adjusted odds ratio of 11 (95% confidence interval = 3.03–40.63). Findings suggest the need to investigate whether Caribbean-born blacks are at greater risk for developing OSA than African Americans and whites. Caribbean-born blacks with a history of heart disease should be a prime target for interventions that promote adequate screening and timely OSA diagnosis.     

Prevalence of habitual snoring and sleep-disordered breathing in primary school children in Afyonkarahisar

Obstructive sleep apnea syndrome affects 0.7-3% of children and snoring is an important symptom. We aimed to evaluate the prevalence of habitual snoring and sleep-disordered breathing in primary school students in Afyonkarahisar city. There are 41 primary schools in ü? education regions in Afyonkarahisar city. One school from each region was randomly selected and all the students in that school were given a questionnaire. Of the 1100 given questionnaires 786 (71.5%) were filled in adequately and were accepted for evaluation. Of the students 407 (51.8%) were girls and 379 (48.2%) were boys. Mean age was 9.9 +/- 2.0 (7-15). The prevalence of habitual snoring was found as 4.8%. With regard to gender, occasional snoring and habitual snoring was significantly more prevalent than never snoring in boys. The prevalence of sleep disordered breathing symptoms was found to be significantly higher in habitual snorers. Maternal and paternal smoking frequency and passive smoke exposure was more common in habitual snorers but there were no significant differences among the groups. Hyperactivity symptoms were significantly higher in habitual snorers. In our study, school performance was found to be 10.9 folds lower in habitual snorers than non-snorers. We think that questioning the obstructive sleep apnea syndrome symptoms in children and performing diagnostic procedures and treatment when suspected will decrease the morbidity.     

Prevalence of sleep problems in Hong Kong primary school children: a community-based telephone survey

STUDY OBJECTIVES: To estimate the prevalence of snoring, witnessed sleep apnea, teeth grinding, primary and secondary nocturnal enuresis, and sleep duration in Hong Kong primary school children. DESIGN: Cross-sectional telephone questionnaire survey in a community. PARTICIPANTS: A total of 3,047 6- to 12-year-old apparently healthy children. INTERVENTION: Those who agreed to the study were contacted by telephone. Survey questions were asked about the symptoms of the different sleep disorders, and the frequency of each positive symptom was noted for the preceding 1 week. OUTCOME MEASURES: Prevalence and risk factors of sleep disorders in Hong Kong primary school children. RESULTS: The prevalence of the following sleep symptoms was listed as follows: habitual snoring (10.9%), witnessed sleep apnea (1.5%), nocturnal enuresis (5.1%), and sleep teeth grinding (20.5%). Significant risk factors for habitual snoring included witnessed sleep apnea, mouth breathing during sleep, snoring in first-degree relatives, headache on rising, male gender, allergic rhinitis, and sleep teeth grinding. Significant risk factors for witnessed sleep apnea included habitual snoring, allergic rhinitis, tiredness on rising, and excessive daytime sleepiness. Poor academic results were associated with present of witnessed sleep apnea and absence of sleep teeth grinding. None of the sleep problem was associated with poor conduct results. The mean sleep duration was 8.79 h (SD 0.96). CONCLUSIONS: This study provides epidemiologic data of sleep-disordered breathing, enuresis, sleep teeth grinding, and duration of sleep in Chinese primary school children in Hong Kong.     

Snoring in a Hispanic-American population. Risk factors and association with hypertension and other morbidity

Snoring was investigated in a survey of respiratory disease in Hispanic-Americans of a New Mexico community. A population-based sample of 1222 adults was studied with questionnaires and measurements of height, weight, and blood pressure. The age-adjusted prevalence of regular loud snoring was 27.8% in men and 15.3% in women. Snoring prevalence increased with age and obesity in both men and women. Cigarette smoking was also associated with snoring, but chronic obstructive lung disease and alcohol consumption were not. Snorers more frequently had hypertension, ischemic heart disease, and excessive daytime sleepiness. In contrast to other studies, after adjustment for confounding factors, there was no effect of snoring on hypertension (odds ratio, 1.0; 95% confidence interval, 0.7 to 1.5), but an effect on myocardial infarction was still demonstrable (odds ratio, 1.8; 95% confidence interval, 0.9 to 3.6). The association of snoring with sleepiness suggests that respiratory disturbance of sleep related to upper airway obstruction, such as sleep apnea, occurs more frequently in snorers in this population.     

The Importance of Suspecting Sleep Apnoea as a Common Cause of Excessive Daytime Sleepiness: Further Experience from the Diagnosis and Management of 19 Patients

Summary: Over an 18 month period, 19 patients were referred for assessment of excessive daytime sleepiness and/or loud snoring. Respiratory studies during sleep were performed in 14 of these patients with additional features such as disturbed sleep, observed apnoea during sleep, morning headache, mental and personality changes, hypertension and cardiac failure.
Nocturnal respiratory studies undertaken for periods of 4–8 hours confirmed a diagnosis of the Sleep Apnoea Syndrome in eight patients. In these patients apnoeas, lasting from 30–144 seconds, occurred frequently during sleep (from 35–291 episodes per patient).
In one severely affected patient, tracheostomy abolished all symptoms. The use of conservative therapy such as weight loss, protriptyline or a neck collar, highlighted the inadequacies of current medical treatment. Awareness of the symptom complex and potential complications of the Sleep Apnoea Syndrome is important because the diagnosis may easily be missed if the patient presents with one or two isolated complaints.     

Daytime sleepiness predicts mortality and cardiovascular disease in older adults. The Cardiovascular Health Study Research Group

INTRODUCTION: As part of the baseline examination in the Cardiovascular Health Study, sleep disturbance symptoms including snoring and daytime sleepiness, were assessed as potential risk factors or precipitants of cardiovascular disease (CVD). Because of the association of sleep disturbance with poorer health and the possible associations of sleep apnea with CVD, we hypothesized that those with poorer sleep or daytime sleepiness may be at increased risk of mortality or incident CVD. SETTING: Participants (n = 5888) were recruited in 1989, with an additional minority cohort recruited in 1993, in four US communities for a cohort study designed to evaluate risk factors for cardiovascular disease. METHODS: An interview-administered questionnaire regarding health and sleep habits with ongoing ascertainment of total mortality and cardiovascular disease morbidity and mortality, including total CVD morbidity and mortality, incident myocardial infarction, and congestive heart failure. RESULTS: Daytime sleepiness was the only sleep symptom that was significantly associated with mortality in both men and women. The unadjusted hazard ratio was 2.12 (1.66, 2.72) in women and 1.40 (1.12, 1.73) in men. Men who reported difficulty falling asleep also had an increased mortality rate (HR = 1.43 (1.14, 1.80)) which was not seen in women. The risks were attenuated with adjustment for age but remained significant for daytime sleepiness in women (HR = 1.82 (1.42, 2.34)) and for difficulty falling asleep in men. (HR = 1.29 (1.03, 1.63)). Frequent awakenings, early morning awakening, and snoring were not associated with a significantly increased risk of mortality in these older men and women. Crude event rates were evaluated for total incident cardiovascular morbidity and mortality, incident myocardial infarction, and incident congestive heart failure (CHF). Incident CVD rates were higher in both men and women with daytime sleepiness. The aged adjusted HR was 1.35 (95% CI = 1.03, 1.76) in men and was 1.66 (95% CI = 1.28, 2.16) in women. Incident CVD was not higher in those with any other sleep disturbance including snoring. The risk of CVD events associated with daytime sleepiness was attenuated but remained significant in women after adjustment for age. Incident myocardial infarction (MI) rates were also higher in women with daytime sleepiness but were not significantly higher in men. Incident CHF rates were increased in both men and women with daytime sleepiness. In men, the age adjusted HR was 1.49 (95% CI, 1.12- 1.98) and in women, was 2.21 (95% CI, 1.64-2.98). Women reporting both daytime sleepiness and frequent awakening had a hazard ratio of 2.34 (95% CI, 1.66-3.29) for incident CHF compared with those with daytime sleepiness but without frequent awakening. This interaction was not found in men. CONCLUSIONS: In this study, daytime sleepiness was the only sleep disturbance symptom that was associated with mortality, incident CVD morbidity and mortality, MI, and CHF. These findings were stronger in women than men, i.e., the associations persisted for mortality, CVD, and CHF in women after adjustment for age and other factors. Thus, a report of daytime sleepiness identifies older adults at increased risk for total and cardiovascular mortality, and is an independent risk factor in women.     

Sleep-disordered breathing and daytime napping are associated with maternal hyperglycemia

Objectives

Sleep disturbances in pregnancy may impair glucose mechanism. This study aimed to examine associations of sleep-disordered breathing, sleep, and nap duration with 1-h glucose challenge test (GCT) levels in pregnant women after controlling for known risk factors for gestational diabetes.

Methods

This is a case–control study of 104 pregnant women. All women underwent full polysomnography and a GCT and completed the multivariable apnea prediction and Pittsburgh Sleep Quality indexes. The primary outcome was maternal hyperglycemia measured by GCT. Bivariate and multivariable logistic regression analyses were performed.

Results

Over 13 % subjects reported habitual snoring in the first trimester. Only 9.3 % women with normoglycemia (GCT?<?135) were habitual snorers, whereas 45.5 % women with hyperglycemia (GCT?≥?135) had habitual snoring (p?<?0.001). Sleep-disordered breathing symptoms (loud snoring, snorting/gasping, and apneas) (odds ratio (OR) 2.85; 95 % confidence interval (CI) 1.50–5.41; p?=?0.001) and total nap duration (OR 1.48; 95 % CI 0.96–2.28; p?=?0.08) were associated with hyperglycemia. After adjusting for confounders, sleep-disordered breathing symptoms (OR 3.37; 95 % CI 1.44–8.32; p?=?0.005) and nap duration (OR 1.64; 95 % CI 1.00–2.681.02; p?=?0.05) continued to be associated with hyperglycemia. However, the primary exposure measure, the apnea/hypopnea index in the first trimester was not significantly associated with hyperglycemia (OR 1.03; 95 % CI 0.83–1.28; p?=?0.77).

Conclusions

Sleep-disordered breathing symptoms and nap duration are associated with hyperglycemia. Sleep duration was not associated with hyperglycemia. Research is needed concerning whether women with sleep-disordered breathing and/or daytime napping are at risk for gestational diabetes.