Sleep and Breathing

, Volume 16, Issue 4, pp 977–986 | Cite as

Gender difference in snoring and how it changes with age: systematic review and meta-regression

  • Chung-hong Chan
  • Billy M. Wong
  • Jin-ling Tang
  • Daniel K. Ng



The aim of this study was to study the interactions among age, gender, and snoring across all age groups


All cross-sectional study reporting gender-specific prevalence of snoring in general population published from 1966 through July 2008 were included and were meta-analyzed. The sources of heterogeneity among primary studies were studied by meta-regression.


From a total of 1,593 citations reviewed, 63 were included in the analysis of snoring. These 63 studies were comprised 104,337 and 110,474, respectively. A combined odds ratio of 1.89 with a 95% confidence interval of 1.75–2.03 for male versus female was found. The heterogeneity was significant with an estimated between-study variance, τ 2 being 0.065 and 95% confidence interval of 0.0397–0.0941. Multiple meta-regression showed that age were the significant effect modifier of the relationship between snoring and gender.


This study found a consistent male predominance in snoring among the general population, and the heterogeneity in the risk of snoring between two genders can be partly explained by age.


Snoring Meta-analysis Sleep disorders 


Disclosure statement

This was not an industry supported study. The authors have indicated no financial conflicts of interest.

Supplementary material

11325_2011_596_MOESM1_ESM.doc (3.3 mb)
ESM 1 (DOC 3,383 kb)


  1. 1.
    Block AJ, Boysen PG, Wynne JW, Hunt LA (1979) Sleep apnea, hypopnea and oxygen desaturation in normal subjects. A strong male predominance. N Engl J Med 300:513–517PubMedCrossRefGoogle Scholar
  2. 2.
    Lumeng JC, Chervin RD (2008) Epidemiology of pediatric obstructive sleep apnea. Proc Am Thorac Soc 5:242–252PubMedCrossRefGoogle Scholar
  3. 3.
    Young T, Peppard PE, Gottlieb DJ (2002) Epidemiology of obstructive sleep apnea: a population health perspective. Am J Respir Crit Care Med 165:1217–1239PubMedCrossRefGoogle Scholar
  4. 4.
    Higgins JP, Green S (2008) Cochrane Handbook for Systematic Reviews of Interventions Version 5.0.1. Accessed 19 Jul 2011
  5. 5.
    Egger M, Schneider M, Davey SG (1998) Spurious precision? Meta-analysis of observational studies. BMJ 316:140–144PubMedCrossRefGoogle Scholar
  6. 6.
    Dickersin K (2002) Systematic reviews in epidemiology: why are we so far behind? Int J Epidemiol 31:6–12PubMedCrossRefGoogle Scholar
  7. 7.
    Gülmezoglu AM, Say L, Betrán AP, Villar J, Piaggio G (2004) WHO systematic review of maternal mortality and morbidity: methodological issues and challenges. BMC Med Res Methodol 4:16PubMedCrossRefGoogle Scholar
  8. 8.
    Lindberg E, Janson C, Gislason T, Björnsson E, Hetta J, Boman G (1997) Sleep disturbances in a young adult population: can gender differences be explained by differences in psychological status? Sleep 20:381–387PubMedGoogle Scholar
  9. 9.
    Punjabi NM (2008) The epidemiology of adult obstructive sleep apnea. Proc Am Thorac Soc 5:136–143PubMedCrossRefGoogle Scholar
  10. 10.
    Cook DJ, Mulrow CD, Haynes RB (1997) Systematic reviews: synthesis of best evidence for clinical decisions. Ann Intern Med 126:376–380PubMedGoogle Scholar
  11. 11.
    Stroup DF, Berlin JA, Morton SC, Olkin I, Williamson GD, Rennie D, Moher D, Becker BJ, Sipe TA, Thacker SB (2000) Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis Of Observational Studies in Epidemiology (MOOSE) group. JAMA 283:2008–2012PubMedCrossRefGoogle Scholar
  12. 12.
    Berman NG, Parker RA (2002) Meta-analysis: neither quick nor easy. BMC Med Res Methodol 2:10PubMedCrossRefGoogle Scholar
  13. 13.
    Davies HT, Crombie IK, Tavakoli M (1998) When can odds ratios mislead? BMJ 316:989–991PubMedCrossRefGoogle Scholar
  14. 14.
    DerSimonian R, Laird N (1986) Meta-analysis in clinical trials. Control Clin Trials 7:177–188PubMedCrossRefGoogle Scholar
  15. 15.
    Takkouche B, Cadarso-Suárez C, Spiegelman D (1999) Evaluation of old and new tests of heterogeneity in epidemiologic meta-analysis. Am J Epidemiol 150:206–215PubMedCrossRefGoogle Scholar
  16. 16.
    Rücker G, Schwarzer G, Carpenter JR, Schumacher M (2008) Undue reliance on I(2) in assessing heterogeneity may mislead. BMC Med Res Methodol 8:79PubMedCrossRefGoogle Scholar
  17. 17.
    Rücker G, Schwarzer G, Carpenter J (2008) Arcsine test for publication bias in meta-analyses with binary outcomes. Stat Med 27:746–763PubMedCrossRefGoogle Scholar
  18. 18.
    Thompson SG, Sharp SJ (1999) Explaining heterogeneity in meta-analysis: a comparison of methods. Stat Med 18:2693–2708PubMedCrossRefGoogle Scholar
  19. 19.
    Tang JL, Liu JL (2000) Misleading funnel plot for detection of bias in meta-analysis. J Clin Epidemiol 53:477–484PubMedCrossRefGoogle Scholar
  20. 20.
    Sterne JA, Egger M (2001) Funnel plots for detecting bias in meta-analysis: guidelines on choice of axis. J Clin Epidemiol 54:1046–1055PubMedCrossRefGoogle Scholar
  21. 21.
    Song F (1999) Exploring heterogeneity in meta-analysis: is the L’Abbé plot useful? J Clin Epidemiol 52:725–730PubMedCrossRefGoogle Scholar
  22. 22.
    van Houwelingen HC, Arends LR, Stijnen T (2002) Advanced methods in meta-analysis: multivariate approach and meta-regression. Stat Med 21:589–624PubMedCrossRefGoogle Scholar
  23. 23.
    Maldonado G, Greenland S (1993) Simulation study of confounder-selection strategies. Am J Epidemiol 138:923–936PubMedGoogle Scholar
  24. 24.
    Viechtbauer W (2010) Conducting meta-analyses in R with the metafor package. J Stat Software 36:1–48Google Scholar
  25. 25.
    Lugaresi E, Cirignotta F, Coccagna G, Piana C (1980) Some epidemiological data on snoring and cardiocirculatory disturbances. Sleep 3:221–224PubMedGoogle Scholar
  26. 26.
    Jordan AS, McEvoy RD (2003) Gender differences in sleep apnea: epidemiology, clinical presentation and pathogenic mechanisms. Sleep Med Rev 7:377–389PubMedCrossRefGoogle Scholar
  27. 27.
    Bixler EO, Vgontzas AN, Lin HM, Ten Have T, Rein J, Vela-Bueno A, Kales A (2001) Prevalence of sleep-disordered breathing in women: effects of gender. Am J Respir Crit Care Med 163:608–613PubMedGoogle Scholar
  28. 28.
    Dexter DD, Dovre EJ (1998) Obstructive sleep apnea due to endogenous testosterone production in a woman. Mayo Clin Proc 73:246–248PubMedCrossRefGoogle Scholar
  29. 29.
    Fogel RB, Malhotra A, Pillar G, Pittman SD, Dunaif A, White DP (2001) Increased prevalence of obstructive sleep apnea syndrome in obese women with polycystic ovary syndrome. J Clin Endocrinol Metab 86:1175–1180PubMedCrossRefGoogle Scholar
  30. 30.
    Vgontzas AN, Legro RS, Bixler EO, Grayev A, Kales A, Chrousos GP (2001) Polycystic ovary syndrome is associated with obstructive sleep apnea and daytime sleepiness: role of insulin resistance. J Clin Endocrinol Metab 86:517–520PubMedCrossRefGoogle Scholar
  31. 31.
    Stewart DA, Grunstein RR, Berthon-Jones M, Handelsman DJ, Sullivan CE (1992) Androgen blockade does not affect sleep-disordered breathing or chemosensitivity in men with obstructive sleep apnea. Am Rev Respir Dis 146:1389–1393PubMedGoogle Scholar
  32. 32.
    Williams SJ, Seale C, Boden S, Lowe P, Steinberg DL (2008) Medicalization and beyond: the social construction of insomnia and snoring in the news. Health (London) 12:251–268CrossRefGoogle Scholar
  33. 33.
    Redline S, Kump K, Tishler PV, Browner I, Ferrette V (1994) Gender differences in sleep disordered breathing in a community-based sample. Am J Respir Crit Care Med 149:722–726PubMedGoogle Scholar
  34. 34.
    Venn S (2007) “It’s Okay for a Man to Snore”: the influence of gender on sleep disruption in couples. Socio Res Online 12:1Google Scholar
  35. 35.
    Ambrogetti A, Olson LG, Saunders NA (1991) Differences in the symptoms of men and women with obstructive sleep apnoea. Aust N Z J Med 21:863–866PubMedCrossRefGoogle Scholar
  36. 36.
    Lavie P, Pillar G (2001) Gender and age differences in symptoms’ profile in sleep apnea syndrome: a possible cause of gender bias in diagnosis. Somnologie 5:93–96CrossRefGoogle Scholar
  37. 37.
    Young T, Hutton R, Finn L, Badr S, Palta M (1996) The gender bias in sleep apnea diagnosis. Are women missed because they have different symptoms? Arch Intern Med 156:2445–2451PubMedCrossRefGoogle Scholar
  38. 38.
    Thompson SG, Higgins JPT (2002) How should meta-regression analyses be undertaken and interpreted? Stat Med 21:1559–1573PubMedCrossRefGoogle Scholar
  39. 39.
    Schmid CH, Stark PC, Berlin JA, Landais P, Lau J (2004) Meta-regression detected associations between heterogeneous treatment effects and study-level, but not patient-level, factors. J Clin Epidemiol 57:683–697PubMedCrossRefGoogle Scholar
  40. 40.
    Kelley K, Clark B, Brown V, Sitzia J (2003) Good practice in the conduct and reporting of survey research. Int J Qual Health Care 15:261–266PubMedCrossRefGoogle Scholar
  41. 41.
    Copas J, Eguchi S (2005) Local model uncertainty and incomplete-data bias. J Roy Stat Soc B 67:459–513CrossRefGoogle Scholar
  42. 42.
    Cooper H (1994) The Handbook of Research Synthesis. 1st ed. Russell Sage Foundation; 1994Google Scholar
  43. 43.
    Gamble C, Hollis S (2005) Uncertainty method improved on best-worst case analysis in a binary meta-analysis. J Clin Epidemiol 58:579–588PubMedCrossRefGoogle Scholar
  44. 44.
    Kelley GA, Kelley KS, Tran ZV (2004) Retrieval of missing data for meta-analysis: a practical example. Int J Technol Assess Health Care 20:296–299PubMedCrossRefGoogle Scholar
  45. 45.
    Gibson CA, Bailey BW, Carper MJ, Lecheminant JD, Kirk EP, Huang G, Dubose KD, Donnelly JE (2006) Author contacts for retrieval of data for a meta-analysis on exercise and diet restriction. Int J Technol Assess Health Care 22:267–270PubMedCrossRefGoogle Scholar
  46. 46.
    Oxman AD, Clarke MJ, Stewart LA (1995) From science to practice. Meta-analyses using individual patient data are needed. JAMA 274:845–846PubMedCrossRefGoogle Scholar
  47. 47.
    Egger M, Zellweger-Zähner T, Schneider M, Junker C, Lengeler C, Antes G (1997) Language bias in randomised controlled trials published in English and German. Lancet 350:326–329PubMedCrossRefGoogle Scholar
  48. 48.
    Jüni P, Holenstein F, Sterne J, Bartlett C, Egger M (2002) Direction and impact of language bias in meta-analyses of controlled trials: empirical study. Int J Epidemiol 31:115–123PubMedCrossRefGoogle Scholar
  49. 49.
    Moher D, Pham B, Klassen TP, Schulz KF, Berlin JA, Jadad AR, Liberati (2000) What contributions do languages other than English make on the results of meta-analyses? J Clin Epidemiol 53:964–972PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • Chung-hong Chan
    • 1
  • Billy M. Wong
    • 2
  • Jin-ling Tang
    • 3
  • Daniel K. Ng
    • 1
  1. 1.Department of PaediatricsKwong Wah HospitalKowloonChina
  2. 2.Continuing Rehabilitation CenterSAHKNorth PointChina
  3. 3.School of Public Health and Primary CareThe Chinese University of Hong KongSha TinChina

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