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Snoring increases the development of coronary artery disease: a systematic review with meta-analysis of observational studies

Sleep and Breathing volume 25, pages 2073–2081 (2021)Cite this article

Abstract

Purpose

Snoring is one of the cardinal presentations of obstructive sleep apnea (OSA) and is more common than OSA. Abundant evidence has suggested a robust association between OSA and coronary artery disease (CAD). However, whether or not snoring alone is related to a higher risk of CAD is unknown. This study systematically reviewed observational studies with meta-analysis to evaluate the linkage between snoring and CAD.

Methods and results

We searched PubMed and Embase and retrieved 13 articles focusing on the relationship between snoring and CAD. These articles included a total of 151,366 participants and 9099 CAD patients. Quantitative analysis indicated that snoring was associated with a 28% (RR: 1.28, 95% CI: 1.13 to 1.45, P < 0.001) increase in the risk of developing CAD.

Conclusions

Snorers are exposed to a 28% increased risk for CAD. Although the association may be partly mediated through OSA, most snorers are not affected by apnea. Given the high prevalence of snoring and the disease burden of CAD in the general population, screening for snoring may be worthwhile for the early prevention of CAD.

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Code availability

Stata Version 12.0, RRID: SCR_012763.

Abbreviations

CAD:

coronary artery disease

CI:

confidence interval

GRADE:

the Grading of Recommendations Assessment, Development, and Evaluation system of rating quality of evidence and grading strength of recommendations

OSA:

obstructive OSA

OR:

odds ratio

PRISMA:

Preferred Reporting Items for Systematic Reviews and Meta-Analyses

RR:

relative risk

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Funding

This study was funded by research grants from the National Nature Science Foundation of China (81803318) and the Health Committee of Henan Province (2018021023).

Author information

Author notes

  1. Junxiang Liu and Yangzhen Shao contributed equally to this work.

Affiliations

  1. Department of Ultrasound, Cardiovascular Institute of Luohe, Luohe Central Hospital, Luohe Medical College, Luohe, China

    Junxiang Liu & Yifei Chen

  2. Department of Endocrinology and Diabetes, Sahlgrenska University Hospital, Gothenburg, Sweden

    Yangzhen Shao

  3. Department of Endocrinology and Diabetes, Cardiovascular Institute of Luohe, Luohe Central Hospital, Luohe Medical College, Luohe, China

    Jing Bai & Yafei Shen

  4. Henan University of Science and Technology, Luoyang, China

    Yifei Chen

  5. Department of Cardiology, Cardiovascular Institute of Luohe, Luohe Central Hospital, Luohe Medical College, 56# Renmin Ave., Luohe, 462000, China

    Dongliang Liu & Haoran Wang

Authors
  1. Junxiang Liu
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  2. Yangzhen Shao
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  3. Jing Bai
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  4. Yafei Shen
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Contributions

All authors have contributed to data collection and drafted the manuscript. D.L. and H.W. developed the study protocol. J.L. and Y.C. searched related databases. J.L. and Y.S. (Yangzhen Shao) extracted data. J.L., Y.S. (Yangzhen Shao), J.B., Y.S. (Yafei Shen), and Y.C. performed the analyses. J.L., Y.S. (Yangzhen Shao), J.B., Y.S. (Yafei Shen), and H.W. drafted the paper. All authors thoroughly reviewed the paper and approved the publishment of the current study. D.L. and H.W. are the guarantors of the paper, taking responsibility for the integrity and the accuracy of the data and the data analysis progress. All authors attested that they have substantially contributed to the work.

Corresponding authors

Correspondence to Dongliang Liu or Haoran Wang.

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Liu, J., Shao, Y., Bai, J. et al. Snoring increases the development of coronary artery disease: a systematic review with meta-analysis of observational studies. Sleep Breath 25, 2073–2081 (2021). https://doi.org/10.1007/s11325-021-02345-9

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  • DOI: https://doi.org/10.1007/s11325-021-02345-9

Keywords

  • Snoring
  • Coronary artery disease
  • Meta-analysis
  • Risk factor