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Kim, Park, Park, Shin, Ha, Park, and Park: Has Snoring Significance for Predicting Obstructive Sleep Apnea Severity?
Original Article

Korean J Community Nutr 2015;17(2):61-67.

Published online: 18 December 2015

DOI: https://doi.org/10.14253/KJCN.2015.17.2.61

Has Snoring Significance for Predicting Obstructive Sleep Apnea Severity?

Si Eun Kim1, Bong Soo Park2, Si Hyung Park2, Kyong Jin Shin1, Sam Yeol Ha1, Jin Se Park1, Kang Min Park1

1Department of Neurology and Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea

2Internal Medicine, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea

Address for correspondence; Kang Min Park Department of Neurology, Haeundae Paik Hospital, Inje University College of Medicine, Haeundae-ro 875, Haeundae-gu, Busan 48108, Korea Tel: +82-51-797-1195 Fax: +82-51-797-1196 E-mail: smilepkm@hanmail.net

Received 1 September 2015       Revised 18 November 2015       Accepted 25 November 2015

Copyright © 2015 Journal of the Korean Society of Community Nutrition

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background:

The aim of this study was to investigate the predictive value of snoring frequency in the diagnosis and severity of obstructive sleep apnea.

Methods:

Patients who underwent polysomnography with one or more of the following characteristics were included: 1) sleepiness, non-restorative sleep, fatigue, or insomnia symptoms; 2) arousal due to cessation of breathing or the occurrence of gasping or choking when waking up; and 3) habitual snoring, breathing interruptions, or both, noted by a bed partner or other observer. We analyzed the differences in clinical and polysomno-graphic variables between patients with and without obstructive sleep apnea and investigated the associations of those variables with obstructive sleep apnea severity.

Results:

One hundred ninety-three patients met the inclusion criteria, and 145 of the 193 patients were diagnosed with obstructive sleep apnea. Multiple logistic regression analysis showed that large neck circumference (p = 0.0054) and high snoring index (p = 0.0119) were independent predictors for obstructive sleep apnea. Moreover, between the obstructive sleep apnea severity groups, there was a strong tendency of difference in body mass index (p = 0.0441) and neck circumference (p = 0.0846). However, there was no significant difference in snoring frequency according to obstructive sleep apnea severity (p = 0.4914).

Conclusions:

We confirmed that snoring frequency is a predictor of obstructive sleep apnea. In addition, we showed for the first time that snoring frequency is not associated with obstructive sleep apnea severity, thus it is not a valuable marker for predicting obstructive sleep apnea severity. (Korean J Clin Neurophysiol 2015;17:61-67)

Keywords: Snoring, Sleep apnea, Polysomnography

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Table 1.
Differences in clinical and polysomnographic variables between patients with and without obstructive sleep apnea
　Parameter With OSA (n = 145) Without OSA (n = 48) p-value
Men, n (%) 125.0 (86.2) 32.0 (66.7) 0.0051
Age, years (± SD) 47.3 ± 12.4 41.9 ± 17.7 0.0213
Hypertension, n (%) 38.0 (26.2) 10.0 (20.1) 0.5796
BMI, kg/m2 (range) 25.8 (17.6-36.4) 24.3 (17.7-32.2) 0.0020
Neck circumference, cm (range) 39.0 (30.5-58.0) 36.0 (28.0-42.0) < 0.0001
Total sleep time, minutes (± SD) 322.1 (± 60.4) 329.6 (± 67.4) 0.4675
Sleep latency, minutes (range) 5.5 (0.0-213.0) 5.8 (0.0-173.5) 0.9429
AHI, n/hour (range) 36.2 (5.3-126.7) 0.9 (0.0-4.8) < 0.0001
Minimum SpO2, % (range) 80.0 (51.0-89.0) 89.0 (77.0-95.0) < 0.0001
Time length of SpO2 < 90%, minutes (range) 30.1 (0.1-287.4) 0.2 (0.0-110.4) < 0.0001
Snoring index, n/hour (range) 78.8 (0.0-580.0) 1.8 (0.0-515.4) 0.0002
Epworth Sleepiness Scale, point (± SD) 8.4 ± 4.6 9.1 ± 4.8 0.3982

OSA; obstructive sleep apnea, BMI; body mass index, AHI; apnea-hypopnea index.

Table 2.
Multiple logistic regression analysis of predictive factors for obstructive sleep apnea
Independent variable Adjusted odds ratio 95% confidence interval p-value
Men 1.801 0.442-7.336 0.4115
Age 1.024 0.996-1.052 0.0908
BMI 0.972 0.817-1.157 0.7520
Neck circumference 1.421 1.110-1.821 0.0054
Snoring index 1.006 1.001-1.010 0.0119

BMI; body mass index.

Fig. 1.
A positive correlation between AHI and BMI (a), and neck circumference (b) was identified, whereas there was no correlation between AHI and snoring index. AHI; apnea-hypopnea index, BMI; body mass index.
kjcn-17-61f1.tif
Table 3.
Differences in clinical and polysomnographic variables between patients with mild, moderate, and severe obstructive sleep apnea
Parameter Mild OSA (n = 29) Modera OSA (n = 29) Severe OSA (n = 87) p-value
Men, n (%) 23.0 (79.3) 26.0 (89.7) 76 (87.4) 0.4615
Age, years (± SD) 47.9 ± 14.2 46.8 ± 13.2 47.3 ± 11.6 0.9470
Hypertension, n (%) 6.0 (20.7) 5.0 (17.2) 27.0 (31.0) 0.2579
BMI, kg/m2 (range) 24.6 (17.6-36.4) 25.3 (21.5-34.1) 26.7 (21.5-34.7) 0.0441
Neck circumference, cm (range) 38.0 (30.5-58.0) 38.0 (31.5-42.0) 39.0 (32.0-46.0) 0.0846
Total sleep time, minutes (± SD) 328.0 (± 69.2) 313.2 (± 51.2) 323.1 (± 60.5) 0.6310
Sleep latency, minutes (range) 7.0 (0.0-155.5) 6.0 (0.0-56.5) 5.5 (0.0-213.0) 0.4483
AHI, n/hour (range) 8.5 (5.3-14.8) 22.0 (15.4-29.5) 58.8 (30.2-126.7) < 0.0001
Minimum SpO2, % (range) 80.0 (51.0-89.0) 89.0 (77.0-95.0) 89.0 (77.0-95.0) < 0.0001
Time length of SpO2 < 90%, minutes (range) 5.6 (0.1-159.7) 11.9 (0.8-118.2) 53.0 (0.6-287.4) < 0.0001
Snoring index, n/hour (range) 80.6 (0.0-477.1) 36.3 (0.0-354.0) 88.0 (0.0-580.0) 0.4914
Epworth Sleepiness Scale, point (± SD) 6.9 ± 4.8 8.0 ± 3.9 9.0 ± 4.7 0.1260

OSA; obstructive sleep apnea, BMI; body mass index, AHI; apnea-hypopnea index.

Table 4.
Differences in clinical and polysomnographic variables between patients with obstructive sleep apnea who are snorers and non-snorers
Parameter With Snoring (n = 108) Without Snoring (n = 37) p-value
Men, n (%) 95.0 (88.0) 30.0 (81.1) 0.4404
Age, years (± SD) 47.0 ± 12.4 48.0 ± 12.3 0.6814
Hypertension, n (%) 30.0 (27.8) 8.0 (21.6) 0.6042
BMI, kg/m2 (range) 26.0 (17.6-36.4) 25.4 (21.5-34.6) 0.3620
Neck circumference, cm (range) 39.0 (32.0-58.0) 38.0 (30.5-46.0) 0.2920
Total sleep time, minutes (± SD) 323.5 (± 62.0) 318.0 (± 56.1) 0.6381
Sleep latency, minutes (range) 5.5 (0.0-213.0) 5.5 (0.0-81.0) 0.5386
AHI, n/hour (range) 43.1 (5.3-126.7) 33.7 (9.9-84.3) 0.3977
Minimum SpO2, % (range) 80.0 (51.0-89.0) 80.0 (53.0-89.0) 0.6621
Time length of SpO2 < 90%, minutes (range) 32.5 (0.1-287.4) 19.6 (0.3-236.6) 0.2123
Epworth Sleepiness Scale, point (± SD) 8.2 ± 4.6 8.9 ± 4.6 0.4340

BMI; body mass index, AHI; apnea-hypopnea index.

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