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. 2021 Jul 24:13:1243-1255.
doi: 10.2147/NSS.S311125. eCollection 2021.

Snoring Sound Characteristics are Associated with Common Carotid Artery Profiles in Patients with Obstructive Sleep Apnea

Hai-Hua Chuang  1   2   3 , Chi-Hung Liu  4 , Chao-Yung Wang  5 , Yu-Lun Lo  6 , Guo-She Lee  7   8 , Yi-Ping Chao  4   9 , Hsueh-Yu Li  10 , Terry B J Kuo  11 , Cheryl C H Yang  11 , Liang-Yu Shyu  12 , Li-Ang Lee  10   11
Affiliations

Snoring Sound Characteristics are Associated with Common Carotid Artery Profiles in Patients with Obstructive Sleep Apnea

Hai-Hua Chuang et al. Nat Sci Sleep. .

Erratum in

Abstract

Background: Obstructive sleep apnea (OSA) and snoring have been reported to be modifiable risk factors for thick carotid intima-media thickness (CIMT) and carotid atherosclerosis, which are closely linked to cardiovascular disease.

Methods: This cross-sectional study prospectively recruited 70 participants with OSA and without a history of carotid artery disorder, who primarily sought surgical Intervention. OSA and snoring were assessed with the Epworth Sleepiness Scale, Snore Outcomes Survey, polysomnography, and snoring sound recording. The carotid arteries were evaluated with ultrasonography and divided into three types of carotid artery profiles (normal carotid artery, thick CIMT, or significant carotid atherosclerosis). Multivariate linear/logistic/categorical regressions were performed with the forward selection approaches/logistic least absolute shrinkage and selection operator, as appropriate.

Results: Normalized snoring sound energy (301-850 Hz) was independently associated with the carotid intima-media thickness (regression coefficient [β] = 0.01, standard error [SE] = 0.004, P = 0.03; R 2 = 0.067) and type of carotid profile (β = 0.40, SE = 0.09, P < 0.001; R 2 = 0.156). Normalized snoring sound energy (4-300 Hz) (β = -0.10, SE = 0.04, P = 0.01) and female sex (β = 1.90, SE = 0.94, P = 0.04) were independently related to the presence of carotid stenosis (R 2 = 0.159). The optimal regression model of the type of carotid artery profile included normalized snoring sound energy (301-850 Hz) (β = 0.33, SE = 0.14, P = 0.03), snoring time (β = 0.26, SE = 0.13, P = 0.047), female sex (β = 0.26, SE = 0.13, P = 0.047), and increased age (β = 0.20, SE = 0.10, P = 0.04) under the control of the Snore Outcomes Survey score, 3% oxygen desaturation index, snoring sound energy (4-1500 Hz), normalized snoring sound energy (851-1500 Hz), cigarette smoking, and hyperlipidemia (R 2 = 0.427).

Conclusion: Our findings suggested that snoring sound characteristics are associated with carotid artery profiles among early OSA patients who cannot be noticed by ultrasound because organic changes of the carotid artery have not yet started. Future studies are warranted to verify the clinical significance of the results.

Keywords: atherosclerosis; categorical regression; common carotid artery; obstructive sleep apnea; snoring; ultrasound.

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Conflict of interest statement

The authors declare no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Distribution of long-term energy spectrum of the snoring sounds before and after normalization in 70 adults with obstructive sleep apnea. (A), Before normalization, the distributions of all frequency-domains of snoring sound energies were very heterogenous between different subjects. (B) After normalization, heterogeneity of all frequency-domains of snoring sound energies had been reduced to evaluate both the amount and characteristics of energy conveyed by snoring. Frequency domain: B1, 4–300 Hz; B2: 301–850 Hz; B3: 851–1500 Hz.
Figure 2
Figure 2
Flow diagram of study participants.
Figure 3
Figure 3
Logistic least absolute shrinkage and selection operator (LASSO) paths for the type of the carotid artery profiles. Fifteen variables, including studied variables and traditional atherosclerotic cardiovascular disease risk factors, were analyzed using the multivariate categorical regression models. X-axis reference lines indicate the optimal model (ten variables) and the most parsimonious model (one variable) within one standard error.
Figure 4
Figure 4
Snoring sound characteristics and carotid atherosclerosis in patients with obstructive sleep apnea.
See this image and copyright information in PMC

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