Heavy Snoring as a Cause of Carotid Artery Atherosclerosis

Lee, Sharon A.; Amis, Terence C.; Byth, Karen; Larcos, George; Kairaitis, Kristina; Robinson, Tracey D.; Wheatley, John R.

doi:10.5665/sleep/31.9.1207

Cited by 76 publications

(14 citation statements)

References 33 publications

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“…While uncontrolled factors may explain some of this effect (e.g., smoking or alcohol), snoring could also represent an independent mechanistic pathway via which chronically obstructed breathing during sleep contributes to elevated blood pressure. For example, via intrathoracic pressure effects on baroreceptor mediated control of systemic (and potentially pulmonary) blood pressure, or potentially via carotid baroreceptor effects from mechanical vibration emanating from the pharyngeal airway 6,7,[9][10][11] .…”

Section: Clinical Implications and Future Researchmentioning

confidence: 99%

“…Some of this effect could potentially be explained, at least in part, by largely arbitrary definitions around hypopnea events, which do not capture obstruction severity or duration and may exhibit relatively weak relationships with snoring measures. Nonetheless, it may also reflect a specific risk associated with snoring itself 6,7,[9][10][11] . Low level continuous positive airway pressure has been shown to significantly reduce snoring in participants without OSA 30 .…”

Section: Clinical Implications and Future Researchmentioning

confidence: 99%

“…Acknowledging the shortcomings of prior attempts to quantify snoring and the need for more systematic and objective assessments of snoring to evaluate potential ill-effects of snoring on cardiovascular health outcomes, snoring has been associated with multiple sub-clinical markers of cardiovascular pathology. This includes elevated blood pressure [6][7][8] , increased carotid-intimamedia thickness 9 , stenosis 10 , and atherosclerosis 11 . These effects could partly reflect mechanical stress imposed by snoring vibrations on the upper airway in combination with a range of shared risk factors for OSA and cardiovascular disease, such as obesity and a sedentary lifestyle.…”

Section: Introductionmentioning

confidence: 99%

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

Lechat

Naik

Appleton

et al. 2023

Preprint

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BackgroundSnoring 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.Methods12,287 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.FindingsParticipants 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).InterpretationsMulti-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.Funding SourceThis 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).Research in contextEvidence before this studyWe searched PubMed, Google, and Google Scholar for research articles published in English up to June 1, 2022, using common search terms including “wearable”, “nearable”, “sleep apnea”, and “snoring”. Articles were also retrieved through searching the citations of known literature.Snoring is a major feature of sleep disordered breathing, including hypopnea events which reflect partial airway obstruction typically with snoring. A meta-regression of 63 studies reported a highly variable snoring prevalence of between 2-83% in men and between 1-71% in women.These studies relied on self-reported snoring assessments, which may not be sufficiently reliable to evaluate prevalence and potential snoring impacts on cardiovascular health outcomes. A few small scale clinical and epidemiological studies with objective snoring assessments on a single night suggest associations between snoring and adverse cardiovascular health outcomes.However, a recent meta-analysis indicates that assessment of sleep apnea severity is highly variable night to night. Like sleep apnea severity, single time-point estimation of snoring parameters may not reliably reflect potentially problematic features of snoring and cumulative exposure risks over time.Added value of this studyWe investigated the prevalence of snoring and its association with uncontrolled hypertension on the largest dataset to date (>12,000 participants), including multi-night assessment of snoring over ∼6 months (∼2 million nights in total). Approximately 15% of the study population snored for an average of 20% per night, and a higher proportion of time spent snoring was associated with an 87% increase in uncontrolled hypertension independent of sleep apnea severity.Implications of all the available evidenceThese findings provide important insight into the consequences of snoring on hypertension risk and highlight the potential need to consider snoring as part of clinical care and management of sleep problems. These findings demonstrate the potential clinical utility of simple, objective, and non-invasive methods to detect and evaluate snoring.

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Section: Clinical Implications and Future Researchmentioning

confidence: 99%

Section: Clinical Implications and Future Researchmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

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

Lechat

Naik

Appleton

et al. 2023

Preprint

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“…Nearly one billion individuals have mild-to-severe OSA worldwide [4]. Left untreated, OSA is known to contribute to daytime somnolence, intermittent hypoxia, weakened cognitive function, increased risk of carotid atherosclerosis, and stroke [1,5,6]. Consequently, this disease may have a negative impact on patients' quality of life and safety [5].…”

Section: Introductionmentioning

confidence: 99%

Determining the Site of Upper Airway Narrowing in Snorers Using a Noninvasive Technique

Wali¹,

Alhejaili²,

Abosoudah³

et al. 2022

Cureus

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BackgroundIn this study, we aimed to determine the site of obstruction if surgical treatment is considered. Flexible nasopharyngoscopy is an invasive procedure currently used for the assessment of snoring and the level of obstruction. Here, we examine the role of Somnoscreen™ plus, a noninvasive cardiorespiratory polysomnographic device, in identifying the site of obstruction in patients presenting with snoring. MethodologyThis cross-sectional study was conducted in the Sleep Research Center at King Abdulaziz University Hospital. Polysomnography was conducted using Somnoscreen™ plus. All participants underwent flexible nasopharyngoscopy after polysomnography. ResultsNasopharyngoscopy revealed that the most common site of obstruction was the nose and the soft palate (35.4%), followed by the soft palate alone (25%). Somnoscreen revealed that the site of obstruction was the nose and the soft palate in 18 (37.5%) patients and the nose alone in 16 (33.3%) patients. However, distal obstructions were not detected using Somnoscreen. The concordance of nasopharyngoscopy and Somnoscreen was 52.9%. However, it showed a discrepancy in identifying distal obstructions, which Somnoscreen™ plus failed to detect. ConclusionsSomnoscreen appears to be sensitive for identifying proximal airway obstructions. The audio signal recordings can potentially be used as a tool to detect the site of airway obstruction in snoring; however, further studies are needed.

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“…The partial rupture and detachment of these plaques increase the risk of clogging the blood flow, which, ultimately, can lead to highly incapacitating or even mortal conditions such as myocardial infarction or cerebrovascular accidents [3]. The exact cause of atherosclerosis remains a subject of discussion and has been connected to several distinct mechanisms, hypotheses, and theories [4][5][6][7][8][9][10][11][12][13][14][15][16]. Nonetheless, despite its complexity, atherosclerosis is generally correlated to the levels of cholesterol in plasma [17][18][19][20][21][22].…”

Section: Introductionmentioning

confidence: 99%

[18F]Atorvastatin: synthesis of a potential molecular imaging tool for the assessment of statin-related mechanisms of action

et al. 2020

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Background: Statins are lipid-lowering agents that inhibit cholesterol synthesis and are clinically used in the primary and secondary prevention of cardiovascular diseases. However, a considerable group of patients does not respond to statin treatment, and the reason for this is still not completely understood. [ 18 F]Atorvastatin, the 18 Flabeled version of one of the most widely prescribed statins, may be a useful tool for statin-related research. Results: [ 18 F]Atorvastatin was synthesized via an optimized ruthenium-mediated late-stage 18 F-deoxyfluorination. The defluoro-hydroxy precursor was produced via Paal-Knorr pyrrole synthesis and was followed by coordination of the phenol to a ruthenium complex, affording the labeling precursor in approximately 10% overall yield. Optimization and automation of the labeling procedure reliably yielded an injectable solution of [ 18 F]atorvastatin in 19% ± 6% (d.c.) with a molar activity of 65 ± 32 GBq·μmol −1 . Incubation of [ 18 F]atorvastatin in human serum did not lead to decomposition. Furthermore, we have shown the ability of [ 18 F]atorvastatin to cross the hepatic cell membrane to the cytosolic and microsomal fractions where HMG-CoA reductase is known to be highly expressed. Blocking assays using rat liver sections confirmed the specific binding to HMG-CoA reductase. Autoradiography on rat aorta stimulated to develop atherosclerotic plaques revealed that [ 18 F]atorvastatin significantly accumulates in this tissue when compared to the healthy model. Conclusions: The improved ruthenium-mediated 18 F-deoxyfluorination procedure overcomes previous hurdles such as the addition of salt additives, the drying steps, or the use of different solvent mixtures at different phases of the process, which increases its practical use, and may allow faster translation to clinical settings. Based on tissue uptake evaluations, [ 18 F]atorvastatin showed the potential to be used as a tool for the understanding of the mechanism of action of statins. Further knowledge of the in vivo biodistribution of [ 18 F]atorvastatin may help to better understand the origin of off-target effects and potentially allow to distinguish between statin-resistant and non-resistant patients.

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Heavy Snoring as a Cause of Carotid Artery Atherosclerosis

Cited by 76 publications

References 33 publications

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

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

Determining the Site of Upper Airway Narrowing in Snorers Using a Noninvasive Technique

[18F]Atorvastatin: synthesis of a potential molecular imaging tool for the assessment of statin-related mechanisms of action

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