Sleep and Breathing

, Volume 20, Issue 2, pp 589–596 | Cite as

Self-reported obstructive sleep apnea, simple snoring, and various markers of sleep-disordered breathing as predictors of cardiovascular risk

  • Teemu J. NiiranenEmail author
  • Erkki Kronholm
  • Harri Rissanen
  • Markku Partinen
  • Antti M. Jula
Sleep Breathing Physiology and Disorders • Original Article



Our objective was to investigate whether self-reported obstructive sleep apnea (OSA), simple snoring, and various markers of sleep-disordered breathing (SDB) are associated with cardiovascular risk.


We examined a representative nationwide cohort of 5177 Finnish adults aged ≥30 years. The participants underwent measurement of traditional cardiovascular risk factors and answered SDB-related questions derived from the Basic Nordic Sleep Questionnaire, which were used to operationalize self-reported OSA. The primary end point was incidence of a cardiovascular event (cardiovascular mortality, non-fatal myocardial infarction, non-fatal stroke, hospitalization for heart failure, or coronary interventions).


During a median follow-up of 11.2 years and 52,910 person-years of follow-up, 634 participants suffered a cardiovascular event. In multivariable-adjusted Cox models, self-reported OSA (hazard ratio [HR] 1.34; 95 % confidence interval [CI] 1.04–1.73; p = 0.03) was an independent predictor of cardiovascular events. Self-reported simple snoring by itself was not associated with future cardiovascular events (HR 0.88 versus non-snorers, 95 % CI 0.75–1.04, p = 0.15). However, among snorers (n = 3152), frequent breathing cessations (HR 2.19, 95 % CI 1.26–3.81, p = 0.006) and very loud and irregular snoring (HR 1.82, 95 % CI 1.31–2.54, p < 0.001) were associated with cardiovascular risk.


Self-reported OSA and SDB-related snoring variables are associated with cardiovascular risk, whereas simple snoring is not. In clinical practice and in surveys, questions concerning only habitual snoring should be amended with questions focusing on respiratory pauses and snoring stertorousness, which can be used to estimate the risk of OSA and cardiovascular events.


Sleep Epidemiology Sleep apnea Sleep disorders Snoring Questionnaires 



The project organization created for the study involved the Finnish Centre for Pensions, the Social Insurance Institution, the National Public Health Institute, the Local Government Pensions Institution, the National Research and Development Centre for Welfare and Health, the Finnish Dental Society and the Finnish Dental Association, Statistics Finland, the Finnish Work Environment Fund, the Finnish Institute for Occupational Health, the UKK Institute for Health Promotion, the State Pensions Office, and the State Work Environment Fund.

Compliance with ethical standards

Ethical standards

All participants of the study gave their informed consent prior to inclusion in the study.

Conflict of interest

The authors declare that they have no competing interests.

Supplementary material

11325_2015_1253_MOESM1_ESM.docx (23 kb)
ESM 1 (DOCX 22 kb)


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Copyright information

© Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  • Teemu J. Niiranen
    • 1
    Email author
  • Erkki Kronholm
    • 1
  • Harri Rissanen
    • 1
  • Markku Partinen
    • 2
    • 3
  • Antti M. Jula
    • 1
  1. 1.Department of HealthNational Institute for Health and WelfareTurkuFinland
  2. 2.Helsinki Sleep ClinicVitalmed Research CentreHelsinkiFinland
  3. 3.Department of Clinical NeurosciencesUniversity of HelsinkiHelsinkiFinland

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