Skip to main content
SpringerLink
Log in

Sex-specific association between serum uric acid and self-reported snoring in rural China: a cross-sectional study

  • Sleep Breathing Physiology and Disorders • Original Article
  • Published:
Sleep and Breathing Aims and scope Submit manuscript

Abstract

Purpose

Until now, information has been rare on the association of serum uric acid (SUA) with self-reported snoring. Therefore, the purpose of this study was to explore the sex-specific relationship between SUA and self-reported snoring in a general Chinese population.

Methods

A large cross-sectional study of 10,912 participants aged ≥35 years old were recruited from rural areas of Liaoning Province in China during 2012 to 2013. SUA were divided into quartiles separated for males and females. Anthropometric measurements and blood biochemical indexes were examined according to standard protocols. Sleep duration and self-reported snoring status were investigated by trained personnel using a structured questionnaire.

Results

The prevalence of self-reported snoring was 37.9% (n = 2197) among females and 47.4% (n = 2420) among males, respectively. The proportion of self-reported snoring presented a significant linear increase across the quartile of SUA level in both sexes. In multivariate logistic regression analysis adjusted for possible confounders, the odds ratio (OR) for SUA with regard to self-reported snoring was significantly higher in females. The OR of self-reported snoring associated with per 1 SD increase in SUA was 1.208 (95%CI 1.118–1.305, P<0.001). The highest quartile of SUA (>293 μmol/L) conferred an independently increased risk for self-reported snoring with OR of 1.643 (95%CI 1.384–1.950, p < 0.001) compared to the lowest quartile of SUA (<209 μmol/L). However, there were no significant relationships between SUA and self-reported snoring among males in all the models.

Conclusions

Our study showed that in rural China, SUA was positively correlated with an increased risk for self-reported snoring in females but not in males. The strong association of SUA levels with self-reported snoring in females emphasizes the necessity of stratifying the sex in investigations of self-reported snoring and encourages exploration of SUA as an effective clinical tool of self-reported snoring risk.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Bearpark H, Elliott L, Grunstein R, Cullen S, Schneider H, Althaus W, Sullivan C (1995) Snoring and sleep apnea. A population study in Australian men. Am J Respir Crit Care med 151(5):1459–1465. doi:10.1164/ajrccm.151.5.7735600

    Article  CAS  PubMed  Google Scholar 

  2. Marshall NS, Wong KK, Cullen SR, Knuiman MW, Grunstein RR (2012) Snoring is not associated with all-cause mortality, incident cardiovascular disease, or stroke in the Busselton health study. Sleep 35(9):1235–1240. doi:10.5665/sleep.2076

    Article  PubMed  PubMed Central  Google Scholar 

  3. Endeshaw Y, Rice TB, Schwartz AV, Stone KL, Manini TM, Satterfield S, Cummings S, Harris T, Pahor M (2013) Snoring, daytime sleepiness, and incident cardiovascular disease in the health, aging, and body composition study. Sleep 36(11):1737–1745. doi:10.5665/sleep.3140

    Article  PubMed  PubMed Central  Google Scholar 

  4. Young T, Shahar E, Nieto FJ, Redline S, Newman AB, Gottlieb DJ, Walsleben JA, Finn L, Enright P, Samet JM (2002) Predictors of sleep-disordered breathing in community-dwelling adults: the sleep heart health study. Arch Intern med 162(8):893–900

    Article  PubMed  Google Scholar 

  5. Wang T, Lu J, Wang W, Mu Y, Zhao J, Liu C, Chen L, Shi L, Li Q, Yang T, Yan L, Wan Q, Wu S, Liu Y, Wang G, Luo Z, Tang X, Chen G, Huo Y, Gao Z, Su Q, Ye Z, Wang Y, Qin G, Deng H, Yu X, Shen F, Chen L, Zhao L, Xu M, Sun J, Bi Y, Lai S, Bloomgarden ZT, Li D, Ning G (2015) Sleep duration and snoring associate with hypertension and glycaemic control in patients with diabetes. Diabetic Medicine: a Journal of the British Diabetic Association 32(8):1001–1007. doi:10.1111/dme.12809

    Article  CAS  Google Scholar 

  6. Valham F, Stegmayr B, Eriksson M, Hagg E, Lindberg E, Franklin KA (2009) Snoring and witnessed sleep apnea is related to diabetes mellitus in women. Sleep med 10(1):112–117. doi:10.1016/j.sleep.2007.11.005

    Article  PubMed  Google Scholar 

  7. Shin MH, Kweon SS, Choi BY, Kim MK, Chun BY, Shin DH, Lee YH (2014) Self-reported snoring and metabolic syndrome: the Korean Multi-Rural Communities Cohort Study. Sleep & Breathing = Schlaf & Atmung 18(2):423–430. doi:10.1007/s11325-013-0902-8

    Article  Google Scholar 

  8. Sun L, Pan A, Yu Z, Li H, Shi A, Yu D, Zhang G, Zong G, Liu Y, Lin X (2011) Snoring, inflammatory markers, adipokines and metabolic syndrome in apparently healthy Chinese. PLoS One 6(11):e27515. doi:10.1371/journal.pone.0027515

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Thomas GN, Jiang CQ, Lao XQ, McGhee SM, Zhang WS, Schooling CM, Adab P, Lam TH, Cheng KK (2006) Snoring and vascular risk factors and disease in a low-risk Chinese population: the Guangzhou Biobank Cohort Study. Sleep 29(7):896–900

    Article  PubMed  Google Scholar 

  10. Niiranen TJ, Kronholm E, Rissanen H, Partinen M, Jula AM (2016) Self-reported obstructive sleep apnea, simple snoring, and various markers of sleep-disordered breathing as predictors of cardiovascular risk. Sleep & Breathing = Schlaf & Atmung 20(2):589–596. doi:10.1007/s11325-015-1253-4

    Article  Google Scholar 

  11. Nagayoshi M, Tanigawa T, Yamagishi K, Sakurai S, Kitamura A, Kiyama M, Okada T, Maeda K, Ohira T, Imano H, Sato S, Iso H (2012) Self-reported snoring frequency and incidence of cardiovascular disease: the circulatory risk in communities study (CIRCS). Journal of Epidemiology 22(4):295–301

    Article  PubMed  PubMed Central  Google Scholar 

  12. Li D, Liu D, Wang X, He D (2014) Self-reported habitual snoring and risk of cardiovascular disease and all-cause mortality. Atherosclerosis 235(1):189–195. doi:10.1016/j.atherosclerosis.2014.04.031

    Article  CAS  PubMed  Google Scholar 

  13. Yeboah J, Redline S, Johnson C, Tracy R, Ouyang P, Blumenthal RS, Burke GL, Herrington DM (2011) Association between sleep apnea, snoring, incident cardiovascular events and all-cause mortality in an adult population: MESA. Atherosclerosis 219(2):963–968. doi:10.1016/j.atherosclerosis.2011.08.021

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Sands M, Loucks EB, Lu B, Carskadon MA, Sharkey K, Stefanick M, Ockene J, Shah N, Hairston KG, Robinson J, Limacher M, Hale L, Eaton CB (2013) Self-reported snoring and risk of cardiovascular disease among postmenopausal women (from the Women’s Health Initiative). Am J Cardiol 111(4):540–546. doi:10.1016/j.amjcard.2012.10.039

    Article  PubMed  Google Scholar 

  15. Li Y, Liu J, Wang W, Yong Q, Zhou G, Wang M, Sun J, Zhao D (2012) Association of self-reported snoring with carotid artery intima-media thickness and plaque. J Sleep res 21(1):87–93. doi:10.1111/j.1365-2869.2011.00936.x

    Article  PubMed  Google Scholar 

  16. Lee SA, Amis TC, Byth K, Larcos G, Kairaitis K, Robinson TD, Wheatley JR (2008) Heavy snoring as a cause of carotid artery atherosclerosis. Sleep 31(9):1207–1213

    PubMed  PubMed Central  Google Scholar 

  17. Bandaru P, Shankar A (2011) Association between serum uric acid levels and diabetes mellitus. Int J Endocrinol 2011:604715. doi:10.1155/2011/604715

    Article  PubMed  PubMed Central  Google Scholar 

  18. Huang H, Huang B, Li Y, Huang Y, Li J, Yao H, Jing X, Chen J, Wang J (2014) Uric acid and risk of heart failure: a systematic review and meta-analysis. Eur J Heart Fail 16(1):15–24. doi:10.1093/eurjhf/hft132

    Article  CAS  PubMed  Google Scholar 

  19. Abbasian M, Ebrahimi H, Delvarianzadeh M, Norouzi P, Fazli M (2016) Association between serum uric acid (SUA) levels and metabolic syndrome (MetS) components in personnel of Shahroud University of Medical Sciences. Diabetes & Metabolic Syndrome 10(3):132–136. doi:10.1016/j.dsx.2016.01.003

    Article  Google Scholar 

  20. Sun HL, Pei D, Lue KH, Chen YL (2015) Uric acid levels can predict metabolic syndrome and hypertension in adolescents: a 10-year longitudinal study. PLoS One 10(11):e0143786. doi:10.1371/journal.pone.0143786

    Article  PubMed  PubMed Central  Google Scholar 

  21. Storhaug HM, Norvik JV, Toft I, Eriksen BO, Lochen ML, Zykova S, Solbu M, White S, Chadban S, Jenssen T (2013) Uric acid is a risk factor for ischemic stroke and all-cause mortality in the general population: a gender specific analysis from The Tromso Study. BMC Cardiovasc Disord 13:115. doi:10.1186/1471-2261-13-115

    Article  PubMed  PubMed Central  Google Scholar 

  22. Feig DI, Kang DH, Johnson RJ (2008) Uric acid and cardiovascular risk. N Engl J med 359(17):1811–1821. doi:10.1056/NEJMra0800885

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. von Lueder TG, Girerd N, Atar D, Agewall S, Lamiral Z, Kanbay M, Pitt B, Dickstein K, Zannad F, Rossignol P (2015) Serum uric acid is associated with mortality and heart failure hospitalizations in patients with complicated myocardial infarction: findings from the High-Risk Myocardial Infarction Database Initiative. Eur J Heart Fail 17(11):1144–1151. doi:10.1002/ejhf.419

    Article  Google Scholar 

  24. Wu CY, Hu HY, Chou YJ, Huang N, Chou YC, Lee MS, Li CP (2015) High serum uric acid levels are associated with all-cause and cardiovascular, but not cancer, mortality in elderly adults. J am Geriatr Soc 63(9):1829–1836. doi:10.1111/jgs.13607

    Article  PubMed  Google Scholar 

  25. Hirotsu C, Tufik S, Guindalini C, Mazzotti DR, Bittencourt LR, Andersen ML (2013) Association between uric acid levels and obstructive sleep apnea syndrome in a large epidemiological sample. PLoS One 8(6):e66891. doi:10.1371/journal.pone.0066891

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Verhulst SL, Van Hoeck K, Schrauwen N, Haentjens D, Rooman R, Van Gaal L, De Backer WA, Desager KN (2007) Sleep-disordered breathing and uric acid in overweight and obese children and adolescents. Chest 132(1):76–80. doi:10.1378/chest.06-2930

    Article  PubMed  Google Scholar 

  27. Ruiz Garcia A, Sanchez Armengol A, Luque Crespo E, Garcia Aguilar D, Romero Falcon A, Carmona Bernal C, Capote F (2006) Blood uric acid levels in patients with sleep-disordered breathing. Archivos de Bronconeumologia 42(10):492–500

    Article  PubMed  Google Scholar 

  28. Hira HS, Shukla A, Kaur A, Kapoor S (2012) Serum uric acid and lactate levels among patients with obstructive sleep apnea syndrome: which is a better marker of hypoxemia? Annals of Saudi Medicine 32(1):37–42

    Article  PubMed  Google Scholar 

  29. Steiropoulos P, Kotsianidis I, Nena E, Tsara V, Gounari E, Hatzizisi O, Kyriazis G, Christaki P, Froudarakis M, Bouros D (2009) Long-term effect of continuous positive airway pressure therapy on inflammation markers of patients with obstructive sleep apnea syndrome. Sleep 32(4):537–543

    Article  PubMed  PubMed Central  Google Scholar 

  30. Wiener RC, Shankar A (2012) Association between serum uric acid levels and sleep variables: results from the National Health and Nutrition Survey 2005–2008. Int J Inflamm 2012:363054. doi:10.1155/2012/363054

    Article  Google Scholar 

  31. Zheng L, Li J, Sun Z, Zhang X, Hu D, Sun Y (2015) Relationship of blood pressure with mortality and cardiovascular events among hypertensive patients aged ≥ 60 years in rural areas of China: a strobe-compliant study. Medicine 94(39):e1551. doi:10.1097/md.0000000000001551

    Article  PubMed  PubMed Central  Google Scholar 

  32. Li Z, Bai Y, Guo X, Zheng L, Sun Y, Roselle AM (2016) Alcohol consumption and cardiovascular diseases in rural China. Int J Cardiol 215:257–262. doi:10.1016/j.ijcard.2016.04.095

    Article  PubMed  Google Scholar 

  33. Zhang N, Ye N, Chen Y, Guo X, Sun G, Sun Y (2016) The relationship between snoring and left ventricular hypertrophy of China: a cross-sectional study. BMC Cardiovasc Disord 16:15. doi:10.1186/s12872-016-0185-7

    Article  PubMed  PubMed Central  Google Scholar 

  34. O'Brien E, Petrie J, Littler W, de Swiet M, Padfield PL, O'Malley K, Jamieson M, Altman D, Bland M, Atkins N (1990) The British Hypertension Society protocol for the evaluation of automated and semi-automated blood pressure measuring devices with special reference to ambulatory systems. J Hypertens 8(7):607–619

    Article  PubMed  Google Scholar 

  35. Zhang N, Chen Y, Chen S, Jia P, Guo X, Sun G, Sun Y (2017) Self-reported snoring is associated with dyslipidemia, high total cholesterol, and high low-density lipoprotein cholesterol in obesity: a cross-sectional study from a rural area of China. Int J Environ res Public Health 14(1). doi:10.3390/ijerph14010086

  36. Janszky I, Ljung R, Rohani M, Hallqvist J (2008) Heavy snoring is a risk factor for case fatality and poor short-term prognosis after a first acute myocardial infarction. Sleep 31(6):801–807

    Article  PubMed  PubMed Central  Google Scholar 

  37. Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL Jr, Jones DW, Materson BJ, Oparil S, Wright JT Jr, Roccella EJ (2003) The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. Jama 289(19):2560–2572. doi:10.1001/jama.289.19.2560

    Article  CAS  PubMed  Google Scholar 

  38. Executive Summary of The Third Report of The National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, And Treatment of High Blood Cholesterol In Adults (Adult Treatment Panel III) (2001). Jama 285 (19):2486–2497

  39. Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies (2004). Lancet 363 (9403):157–163. doi:10.1016/s0140-6736(03)15268-3

  40. World Health Organization and International Diabetes Federation (2006) Definition and diagnosis of diabetes mellitus and intermediate hyperglycemia: report of a WHO/IDF consultation. Geneva: World Health Organization 

  41. Fleming WE, Ferouz-Colborn A, Samoszuk MK, Azad A, Lu J, Riley JS, Cruz AB, Podolak S, Clark DJ, Bray KR, Southwick PC (2016) Blood biomarkers of endocrine, immune, inflammatory, and metabolic systems in obstructive sleep apnea. Clin Biochem 49(12):854–861. doi:10.1016/j.clinbiochem.2016.05.005

    Article  CAS  PubMed  Google Scholar 

  42. Wingrove CS, Walton C, Stevenson JC (1998) The effect of menopause on serum uric acid levels in non-obese healthy women. Metab Clin Exp 47(4):435–438

    Article  CAS  PubMed  Google Scholar 

  43. Culleton BF, Larson MG, Kannel WB, Levy D (1999) Serum uric acid and risk for cardiovascular disease and death: the Framingham Heart Study. Ann Intern med 131(1):7–13

    Article  CAS  PubMed  Google Scholar 

  44. Lavie L (2012) Oxidative stress inflammation and endothelial dysfunction in obstructive sleep apnea. Frontiers in Bioscience (Elite Edition) 4:1391–1403

    Article  Google Scholar 

  45. Wysocka E, Cofta S, Piorunek T, Dziegielewska-Gesiak S, Bryl W, Torlinski L (2013) Blood antioxidant status, dysglycemia and obstructive sleep apnea. Adv Exp med Biol 756:121–129. doi:10.1007/978-94-007-4549-0_16

    Article  CAS  PubMed  Google Scholar 

  46. Schulz E, Gori T, Munzel T (2011) Oxidative stress and endothelial dysfunction in hypertension. Hypertension Research : Official Journal of the Japanese Society of Hypertension 34(6):665–673. doi:10.1038/hr.2011.39

    Article  CAS  Google Scholar 

  47. Dopp JM, Philippi NR, Marcus NJ, Olson EB, Bird CE, Moran JJ, Mueller SW, Morgan BJ (2011) Xanthine oxidase inhibition attenuates endothelial dysfunction caused by chronic intermittent hypoxia in rats. Respiration; International Review of Thoracic Diseases 82(5):458–467. doi:10.1159/000329341

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  48. Van Hoorenbeeck K, Franckx H, Debode P, Aerts P, Wouters K, Ramet J, Van Gaal LF, Desager KN, De Backer WA, Verhulst SL (2012) Weight loss and sleep-disordered breathing in childhood obesity: effects on inflammation and uric acid. Obesity (Silver Spring, md) 20(1):172–177. doi:10.1038/oby.2011.282

    Article  Google Scholar 

  49. Nieto FJ, Young TB, Lind BK, Shahar E, Samet JM, Redline S, D'Agostino RB, Newman AB, Lebowitz MD, Pickering TG (2000) Association of sleep-disordered breathing, sleep apnea, and hypertension in a large community-based study. Sleep Heart Health Study. Jama 283(14):1829–1836

    Article  CAS  PubMed  Google Scholar 

  50. Soletsky B, Feig DI (2012) Uric acid reduction rectifies prehypertension in obese adolescents. Hypertension (Dallas, Tex : 1979) 60(5):1148–1156. doi:10.1161/hypertensionaha.112.196980

    Article  CAS  Google Scholar 

  51. Kanbay M, Ozkara A, Selcoki Y, Isik B, Turgut F, Bavbek N, Uz E, Akcay A, Yigitoglu R, Covic A (2007) Effect of treatment of hyperuricemia with allopurinol on blood pressure, creatinine clearance, and proteinuria in patients with normal renal functions. Int Urol Nephrol 39(4):1227–1233. doi:10.1007/s11255-007-9253-3

    Article  CAS  PubMed  Google Scholar 

  52. Johnson RJ, Sanchez-Lozada LG, Mazzali M, Feig DI, Kanbay M, Sautin YY (2013) What are the key arguments against uric acid as a true risk factor for hypertension?, Hypertension Dallas: 1979) 61 (5):948–951. doi:10.1161/hypertensionaha.111.00650

Download references

Author information

Authors and Affiliations

  1. Department of Cardiology, The First Hospital of China Medical University, 155 Nanjing North Street, Heping District, Shenyang, 110001, Liaoning, People’s Republic of China

    Haoyu Wang, Zhao Li, Yintao Chen, Ning Ye, Pengbo Wang & Yingxian Sun

Authors
  1. Haoyu Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Zhao Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yintao Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ning Ye
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Pengbo Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Yingxian Sun
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Yingxian Sun.

Ethics declarations

Funding

This study was supported by grants from the “Twelfth Five-Year” project funds (National Science and Technology Support Program of China, Grant No. 2012BAJ18B02) and the Natural Science Foundation of Liaoning Province (2013021090).

Conflicts of interest

The authors declare that they have no conflicts of interest.

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.

Informed consent

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

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Wang, H., Li, Z., Chen, Y. et al. Sex-specific association between serum uric acid and self-reported snoring in rural China: a cross-sectional study. Sleep Breath 21, 939–947 (2017). https://doi.org/10.1007/s11325-017-1515-4

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11325-017-1515-4

Keywords

Search

Navigation