Elsevier

Sleep Medicine

Volume 9, Issue 3, March 2008, Pages 290-296
Sleep Medicine

Original article
Risk factors and correlates of snoring and observed apnea

https://doi.org/10.1016/j.sleep.2007.04.018Get rights and content

Abstract

Background and purpose

Risk factors and correlates of snoring and observed apnea in the population are not well known. This study aimed to assess risk factors and correlates of snoring and observed apnea.

Methods

Parents and grandparents of students from 20 randomly selected primary schools in urban and rural areas of Kirikkale, Turkey were asked about respiratory diseases, psychological distress and sleep-related disorders, using the Respiratory Questionnaire, Hospital Anxiety and Depression (HAD) scale and Sleep Questionnaire, respectively, which were returned by their children.

Results

Out of 13,225 parents and grandparents of primary school students 12,270 returned the questionnaires, for an overall response rate of 92.7%. Snoring and the observed apnea were more prevalent among subjects from rural than those from urban areas (52.6% vs. 46.6%, odds ratio (OR): 1.2, p < 0.001 and 16.2% vs. 10.1%, OR: 1.7, p < 0.001, respectively). Exposure to biomass smoke and smoking were associated with an increased risk of snoring and observed apnea, after adjusting for gender, age, body mass index, income and education in the multivariate linear model. In all subjects, increases in performance ability, daytime sleepiness, psychological distress and dyspnea scores observed in categories indicating increases in snoring intensity and observed apnea frequency constituted a trend but did always not reach statistical significance. Lastly, prevalence of traffic accidents, falling asleep at the wheel and morning headaches increased with the increments of snoring intensity and apnea frequency.

Conclusions

Exposure to biomass smoke in rural areas may account for the higher prevalence of snoring and observed apnea. Snoring intensity and observed apnea frequency may increase prevalence of traffic accidents along with many unfavorable symptoms.

Introduction

Sleep apnea and snoring are sleep-related breathing disorders. Snoring occurs in at least 20–40 % of the general population [1], [2], [3]. Most snorers are “simple” or “nonapneic”, as the prevalence of snoring is much higher than that of sleep apnea [4]. There is a continuous spectrum from simple to disease-causing snoring ranging from merely disturbing noises to pharyngeal obstructions and breathing pauses [5]. Snoring during sleep is an important manifestation of obstructive sleep apnea syndrome [6]. There is significant evidence that snoring is a cause of sleepiness, even in the absence of conventional sleep apnea [7]. Many snorers complain of tiredness during the day, but little is known about the impact of snoring on daily life in other respects [8], [9].

The risk factors for snoring and apnea have been investigated in many studies [10], [11], [12], [13], [14]. Several population-based studies indicated that current and past smoking were risk factors for snoring and apnea [15], [16], [17]. However, no data, as far as we know, are available that show that exposure to biomass smoke is a risk factor for snoring and observed apnea.

The risk factors and correlates of snoring and observed apnea in the population are not well known. This study aimed to assess risk factors and correlates of snoring and observed apnea.

Section snippets

Subjects

This study was carried out as a part of an epidemiologic survey conducted to assess the characteristics of sleep-related breathing symptoms and other diseases in Kirikkale, Turkey in 2004. Questionnaires concerning respiratory symptoms, sleep-related breathing symptoms, and psychological distress were distributed to students from 20 randomly selected primary schools in Kirikkale (14 schools in urban, 6 schools in rural areas). The students were asked to interview their parents and grandparents

Results

Out of 13,225 parents and grandparents of primary school students 12,270 returned the questionnaires, for an overall response rate of 92.7%. However, eligible data for all analyses were obtained from 9187 subjects.

Discussion

The present study revealed that snoring and observed apnea were more prevalent among subjects living in rural than among those living in urban Kirikkale. Exposure to biomass smoke in rural areas may account for the higher prevalence rates of snoring and observed apnea. Smoking rates in both regions were similar. Some of the women, however, in rural areas were exposed to biomass smoke. Higher prevalence rates of snoring and observed apnea in women exposed to biomass smoke in rural areas than

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