Snoring is related to daytime sleepiness and sleep disturbances independent of sleep apnea

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Introduction: In treatment decisions for sleep-disordered breathing both severity of sleep apnea, measured as apnea hypopnea index (AHI), and symptoms are considered. Excessive daytime sleepiness (EDS) is the main symptom of sleep apnea, but it is unknown whether it is independent of snoring. Aims and objectives: This study assessed the association between EDS and various sleep disturbances with snoring and sleep apnea, respectively. Methods: In the population-based Swedish CArdioPulmonary bioImage Study (SCAPIS) whole-night polygraphy was performed in 9,018 men and women aged 50-64 years and residing in Gothenburg, Uppsala or Umeå. Participants completed questionnaires on snoring and sleep disturbances. Sleep apnea was defined as an AHI >15/h and EDS as score >10 on the Epworth Sleepiness Scale. Snoring and other symptoms were defined as present if reported to occur >3 nights/week. Participants treated with CPAP were excluded. Logistic regressions were performed with adjustments for BMI, age, sex and site. Results: Snoring was reported by 2,281 participants (26.8%) and 1,121 (12.5%) had sleep apnea. Snoring was associated with EDS (adjusted Odds Ratio; 95% confidence interval: 1.6; 1.4-1.8), impaired sleep quality (1.5; 1.3-1.7), difficulty maintaining sleep (1.4; 1.3-1.6) and difficulty initiating sleep (1.4; 1.2-1.6). All associations remained unchanged also after adjusting for sleep apnea. In contrast, no significant associations were identified between sleep apnea and any of these symptoms. There was no interaction with sex for any of the results. Conclusions: Snoring is associated with both EDS and self-reported sleep disturbances. These associations are independent of sleep apnea.

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