Snoring severity is associated with carotid vascular remodeling in young adults with overweight and obesity

Background: Snoring is often used as a surrogate measure for obstructive sleep apnea (OSA), a sleep disorder associated with cardiovascular disease (CVD) risk. Whether snoring is linked to CVD independent of OSA remains unclear. We aimed to explore the snoring and subclinical CVD association in adults with and without OSA.

Methods: We conducted a cross-sectional study in 122 overweight/obese participants (24% male; mean age 40.1 years) attending the 24-month follow-up visit of a lifestyle intervention. Using home-based objective measures of sleep-disordered breathing, we stratified participants into 3 snoring/OSA categories using the snoring index (SI), a measure of snoring vibration, and oxygen desaturation index (ODI): (1) OSA (ODI ≥ 5), (2) non-OSA heavy snorer (ODI <5, above-median SI), and (3) non-OSA low snorer (ODI <5, below-median SI). Vascular measures including pulse wave velocity ([PWV]; carotid-femoral [cf], femoral-ankle [fa], brachial-ankle [ba]), carotid intima-media thickness (IMT), and carotid interadventitial diameter (IAD) were compared across snoring/OSA categories. Linear regressions assessed the association between snoring and subclinical CVD independent of traditional CVD risk factors.

Results: Compared to non-OSA low snorers, common carotid IMT and IAD were higher in non-OSA heavy snorers, and faPWV, IMT, and IAD were higher among those with OSA. The difference between non-OSA heavy snorers and low snorers persisted after adjusting for age, race, sex, blood pressure, body mass index, lipids, and insulin resistance (P < .05 for IMT and IAD).

Conclusions: In overweight/obese young to middle-aged adults, objectively measured snoring was related to vascular remodeling in those without OSA. Snoring may contribute to CVD risk but warrants further examination in larger prospective cohorts.