Habitual snoring, adiposity measures and risk of type 2 diabetes in 0.5 million Chinese adults: a 10-year cohort

Abstract

Objectives: The present study aimed to examine whether habitual snoring was independently associated with risk of type 2 diabetes among Chinese adults, and to assess the role that adiposity measures play in the snoring-diabetes association, as well as to evaluate the joint influence of snoring and adiposity measures on diabetes.

Research design and methods: The China Kadoorie Biobank study recruited 512 715 adults aged 30-79 years from 10 regions in China during 2004 and 2008. Data from 482 413 participants without baseline diabetes were analyzed in the present study. Autoregressive cross-lagged panel analysis was used to assess the longitudinal relationship between adiposity measures and habitual snoring. Cox proportional hazards models were used to examine the association between habitual snoring and diabetes risk.

Results: Both higher body mass index and waist circumference were associated with higher risks of subsequent habitual snoring, whereas no reverse association was detected. A total of 16 479 type 2 diabetes cases were observed during a 10-year follow-up. Habitual snoring was independently associated with 12% (95% CI 6% to 18%) and 14% (95% CI 9% to 19%) higher risks of diabetes among men and women, respectively. Habitual snorers who had general obesity or central obesity were about twice as likely to develop diabetes as non-snorers at the lowest levels of adiposity measures.

Conclusion: Habitual snoring was independently associated with a higher risk of type 2 diabetes among Chinese adults. It is important to maintain both a healthy weight and a normal waist circumference to prevent or alleviate habitual snoring and ultimately prevent diabetes among Chinese adults.

Keywords: Chinese; adiposity; sleep; type 2 diabetes.

Figure 1

The autoregressive cross-lagged model between BMI (kg/m²), waist circumference (cm), and habitual snoring. The model was adjusted for baseline characteristics including age, gender, study region, educational attainment, household income, marital status, smoking status, alcohol consumption, and physical activity level. Solid lines show coefficients with p values ≤0.05 while dashed lines present coefficients with p values >0.05. BMI, body mass index.

Figure 2

Subgroup analyses of the association between habitual snoring and type 2 diabetes according to different adiposity measures. *Total incident diabetes cases for participants with habitual snoring and non-snoring. Models were stratified by age and 10 study regions, and adjusted for the same factors as in model 5 of table 2, except the subgrouping variables. BMI, body mass index.

Figure 3

Adjusted HRs of diabetes for participants with different combinations of snoring status and adiposity measures. (A) Combination of snoring status and BMI subgroups. (B) Combination of snoring status and waist circumference subgroups. The Cox proportional hazards models were stratified by age and study region and were adjusted for the same factors as in model 5 of table 2, except baseline BMI and waist circumference. Baseline BMI was adjusted for in joint analyses of waist circumference and snoring while baseline waist circumference was adjusted for in joint analyses of BMI and snoring. BMI, body mass index.