Self-reported snoring and incident cardiovascular disease events: results from the Jackson Heart Study

  • David M. Rosen
  • Vaishnavi Kundel
  • Michael Rueschman
  • Robert Kaplan
  • Na Guo
  • James G. Wilson
  • Yuan-I Min
  • Susan Redline
  • Neomi ShahEmail author
Sleep Breathing Physiology and Disorders • Original Article



Evidence suggests that snoring is associated with increased risk for cardiovascular disease (CVD) events such as myocardial infarction and stroke. Limited data exists pertaining to this association among African Americans. We therefore examined the association between self-reported habitual snoring and incident CVD in the Jackson Heart Study (JHS), a population-based cohort study of African Americans.


Self-reported data on snoring and risk factors for CVD were collected at baseline (2000–2004). Participants were followed prospectively for the development of incident CVD. Habitual snoring was defined as present if the participants reported it as “often” or “almost always” or absent if reported as “sometimes,” “never,” or “seldom.” A CVD event included stroke, myocardial infarction, coronary revascularization procedure, or fatal CHD event. Cox proportional hazards models assessed the independent association between self-reported habitual snoring and incident CVD event adjusting for multiple covariates, including age, sex, hypertension, body mass index, diabetes, hypercholesterolemia, and smoking status.


The snorer group consisted of 787 participants (mean age 52.1 years) and the nonsnorer group consisted of 3708 participants (mean age 54.9 years). Frequency of incident CVD events in the snorer group was not significantly different from the nonsnorer group. The fully adjusted hazard ratio for a CVD event in the snorer group was 1.01 (95% confidence interval [0.69, 1.47], p value of 0.96).


In conclusion, self-reported habitual snoring was not associated with incident CVD among this large African American cohort. Future studies providing objective data on snoring and sleep apnea may provide more information on the snoring-CVD association among African Americans.

Trial registration

Identification Number: NCT00005485


Snoring Cardiovascular disease Stroke Coronary artery disease Sleep apnea 



Drs. Rosen, Shah, and Kaplan contributed to the study design. Na Guo and Michael Rueschman did the statistical analysis. Drs. Rosen, Shah, Redline, Min, and Michael Rueschman interpreted the data. Drs. Redline, Shah, Kundel, Min, and Rosen contributed to the review of the data analysis. Dr. Rosen was the primary author who was responsible for the writing of this manuscript. Many sections of the manuscript were further edited by Dr. Shah and Dr. Kundel after Dr. Rosen was unable to work on revisions of this manuscript due to graduation from fellowship. The authors thank the participants and data collection staff of the Jackson Heart Study.


The Jackson Heart Study (JHS) is supported and conducted in collaboration with Jackson State University (HHSN268201800013I), Tougaloo College (HHSN268201800014I), the Mississippi State Department of Health (HHSN268201800015I/HHSN26800001), and the University of Mississippi Medical Center (HHSN268201800010I, HHSN268201800011I and HHSN268201800012I) contracts from the National Heart, Lung, and Blood Institute (NHLBI) and the National Institute for Minority Health and Health Disparities (NIMHD). The study analysis was also supported by funding from Dr. Shah’s National Institute of Health/National Heart, Lung, and Blood Institute Research Career Development Award (5K23HL125923-03).

Compliance with ethical standards

Declaration of interests

The views expressed in this manuscript are those of the authors and do not necessarily represent the views of the National Heart, Lung, and Blood Institute; the National Institutes of Health; or the U.S. Department of Health and Human Services.

Conflict of interest

The authors declare that they have no conflict of interest.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.


  1. 1.
    National Sleep Foundation (2015) 2002 Sleep in America Poll – adult sleep habits. Sleep Heal J Natl Sleep Found 1:e1. Google Scholar
  2. 2.
    Young PP, Palta M et al (1997) Population-based study of sleep-disordered breathing as a risk factor for hypertension. Arch Intern Med 157:1746–1752CrossRefGoogle Scholar
  3. 3.
    Peppard PE, Young T, Palta M, Skatrud J (2000) Prospective study of the association between sleep-disordered breathing and hypertension. N Engl J Med 342:1378–1384CrossRefGoogle Scholar
  4. 4.
    Yaggi H, Mohsenin V (2003) Sleep-disordered breathing and stroke. Clin Chest Med 24:223–237CrossRefGoogle Scholar
  5. 5.
    Yaggi H, Mohsenin V (2004) Obstructive sleep apnoea and stroke. Lancet Neurol 3:333–342CrossRefGoogle Scholar
  6. 6.
    Shahar E, Whitney CW, Redline S et al (2001) Sleep-disordered breathing and cardiovascular disease: cross-sectional results of the Sleep Heart Health Study. Am J Respir Crit Care Med 163:19–25CrossRefGoogle Scholar
  7. 7.
    Redline S, Yenokyan G, Gottlieb DJ et al (2010) Obstructive sleep apnea-hypopnea and incident stroke: the sleep heart health study. Am J Respir Crit Care Med 182:269–277. CrossRefGoogle Scholar
  8. 8.
    Peker Y, Carlson J, Hedner J (2006) Increased incidence of coronary artery disease in sleep apnoea: a long-term follow-up. Eur Respir J Off J Eur Soc Clin Respir Physiol 28:596–602. Google Scholar
  9. 9.
    Shah NA, Yaggi HK, Concato J, Mohsenin V (2010) Obstructive sleep apnea as a risk factor for coronary events or cardiovascular death. Sleep Breath 14:131–136. CrossRefGoogle Scholar
  10. 10.
    Punjabi NM, Caffo BS, Goodwin JL et al (2009) Sleep-disordered breathing and mortality: a prospective cohort study. PLoS Med 6:e1000132. CrossRefGoogle Scholar
  11. 11.
    Marshall NS, Wong KK, Liu PY et al (2008) Sleep apnea as an independent risk factor for all-cause mortality: the Busselton Health Study. Sleep 31:1079–1085CrossRefGoogle Scholar
  12. 12.
    Yeboah J, Redline S, Johnson C et al (2011) Association between sleep apnea, snoring, incident cardiovascular events and all-cause mortality in an adult population: MESA. Atherosclerosis 219:963–968. CrossRefGoogle Scholar
  13. 13.
    Hu FB, Willett WC, Manson JE et al (2000) Snoring and risk of cardiovascular disease in women. J Am Coll Cardiol 35:308–313CrossRefGoogle Scholar
  14. 14.
    Drager LF, Lorenzi-Filho G (2008) Heavy snoring and carotid atherosclerosis: is there more than an association? Sleep 31:1335 discussion 1337Google Scholar
  15. 15.
    Lee SA, Amis TC, Byth K et al (2008) Heavy snoring as a cause of carotid artery atherosclerosis. Sleep 31:1207–1213Google Scholar
  16. 16.
    Sands M, Loucks EB, Lu B et al (2012) Self-reported snoring and risk of cardiovascular disease among postmenopausal women (from the Women’s Health Initiative). Am J Cardiol.
  17. 17.
    Roger VL, Go AS, Lloyd-Jones DM et al (2011) Heart disease and stroke statistics-2011 update: a report from the American Heart Association. Circulation 123:e18–e209. CrossRefGoogle Scholar
  18. 18.
    Mozaffarian D, Benjamin EJ, Go AS et al (2015) Heart disease and stroke statistics-2015 update: a report from the American Heart Association. Circulation 131:e29–e322. Google Scholar
  19. 19.
    Taylor HA Jr (2005) Ethn Dis 15:S6-1–S6-3Google Scholar
  20. 20.
    Fuqua SR, Wyatt SB, Andrew ME et al (2005) Recruiting African-American research participation in the Jackson Heart Study: methods, response rates, and sample description. Ethn Dis 15:S6-18–S6-29Google Scholar
  21. 21.
    Payne TJ, Wyatt SB, Mosley TH et al (2005) Sociocultural methods in the Jackson Heart Study: conceptual and descriptive overview. Ethn Dis 15:S6-38–S6-48Google Scholar
  22. 22.
    Carpenter MA, Crow R, Steffes M et al (2004) Laboratory, reading center, and coordinating center data management methods in the Jackson Heart Study. Am J Med Sci 328:131–144 S0002-9629(15)33984-7CrossRefGoogle Scholar
  23. 23.
    Keku E, Rosamond W, Taylor HA Jr et al (2005) Cardiovascular disease event classification in the Jackson Heart Study: methods and procedures. Ethn Dis 15:S6-62–S6-70Google Scholar
  24. 24.
    Johnson DA, Lisabeth L, Hickson D et al (2016) The social patterning of sleep in African Americans: associations of socioeconomic position and neighborhood characteristics with sleep in the Jackson heart study. Sleep 39:1749–1759. CrossRefGoogle Scholar
  25. 25.
    Nieto FJ, Young TB, Lind BK et al (2000) Association of sleep-disordered breathing, sleep apnea, and hypertension in a large community-based study. Sleep Heart Health Study. JAMA 283:1829–1836CrossRefGoogle Scholar
  26. 26.
    Hiestand DM, Britz P, Goldman M, Phillips B (2006) Prevalence of symptoms and risk of sleep apnea in the US population: results from the national sleep foundation sleep in America 2005 poll. Chest 130:780–786CrossRefGoogle Scholar
  27. 27.
    Kump K, Whalen C, Tishler PV et al (1994) Assessment of the validity and utility of a sleep-symptom questionnaire. Am J Respir Crit Care Med 150:735–741CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • David M. Rosen
    • 1
  • Vaishnavi Kundel
    • 2
  • Michael Rueschman
    • 3
  • Robert Kaplan
    • 4
    • 5
  • Na Guo
    • 3
  • James G. Wilson
    • 6
  • Yuan-I Min
    • 7
  • Susan Redline
    • 3
  • Neomi Shah
    • 2
    • 4
    Email author
  1. 1.Division of Pulmonary and Critical Care MedicineThe Valley HospitalRidgewoodUSA
  2. 2.Division of Pulmonary, Critical Care and Sleep MedicineIcahn School of Medicine at Mount SinaiNew YorkUSA
  3. 3.Brigham and Women’s Hospital, Division of Sleep and Circadian DisordersHarvard Medical SchoolBostonUSA
  4. 4.Department of Epidemiology and Population HealthAlbert Einstein College of MedicineNew YorkUSA
  5. 5.Public Health Science DivisionFred Hutchinson Cancer Research CenterSeattleUSA
  6. 6.Department of PhysiologyThe University of Mississippi Medical CenterJacksonUSA
  7. 7.School of MedicineThe University of Mississippi Medical CenterJacksonUSA

Personalised recommendations