Snoring and sleep apnea : A study of evolution and consequences in a male population

Abstract: Obstructive sleep apnea syndrome (OSAS) is characterized by snoring, repeated apneas during sleep and excessive daytime sleepiness (EDS). The available data suggest that there is a relationship between OSAS and cardiovascular morbidity and mortality, but the results diverge.In 1984, 3,201 men aged 30-69 answered a questionnaire on snoring, sleep disturbances and somatic diseases. A subsample of the men who reported symptoms related to OSAS were also investigated using whole-night polysomnography in 1985.Of the survivors in 1994, almost 90% participated in this 10-year follow-up and answered an identical questionnaire as well as questions about smoking, alcohol and physical activity. In both 1984 and 1994, the prevalence of snoring increased until age 50-60 and then decreased. At all ages, weight gain was an independent risk factor for developing habitual snoring. In men below age 50 at baseline, persistent smoking and a high BMI in 1984 were also significantly associated with the development of snoring.Among the men aged 30-59 in 1984, those who reported habitual snoring in both 1984 and 1994 ran a significantly increased risk of developing hypertension during the 10-year period (adjusted odds ratio 2.6, 95% CI 1.5-4.5). Among the subjects aged 50-69, no association was found between snoring and hypertension.Mortality data for the 10-year period were collected for the complete sample. Compared with subjects with no snoring or EDS, men with both snoring and EDS experienced a significant increase in overall mortality as well as cardiovascular mortality. However, the relative rates decreased with increasing age and, in men aged 60 and over, no effect on mortality was found. Isolated snoring or EDS did not influence mortality at any age.Of the men studied using polysomnography in 1985, 38 (70% of the survivors) were reinvestigated using polysomnography in 1995. In the group as a whole, a significant progression of the sleep disorder with time was found. Increasing EDS was strongly related to a deterioration in the sleep disorder.In conclusion, age strongly influences the prevalence of snoring in men, but the relationship is not linear. Risk factors for developing snoring differ with age and the cardiovascular health consequences appear to be most hazardous in the case of younger men. Sleepy male snorers are a high-risk group for developing OSAS, regardless of the results of the sleep recordings at baseline.