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

Hai-Hua Chuang^{1

2

3}, Chi-Hung Liu⁴, Chao-Yung Wang⁵, Yu-Lun Lo⁶, Guo-She Lee^{7

8}, Yi-Ping Chao^{4

9}, Hsueh-Yu Li¹⁰, Terry B J Kuo¹¹, Cheryl C H Yang¹¹, Liang-Yu Shyu¹², Li-Ang Lee^{10

11}

Affiliations

¹ Department of Family Medicine, Chang Gung Memorial Hospital, Taipei Branch and Linkou Main Branch, Chang Gung University, Taoyuan, Taiwan.
² Department of Industrial Engineering and Management, National Taipei University of Technology, Taipei, Taiwan.
³ Genomic Medicine Institute & Obesity Institute, Geisinger Medical, Danville, PA, USA.
⁴ Department of Neurology, Chang Gung Memorial Hospital, Linkou Main Branch, Chang Gung University, Taoyuan, Taiwan.
⁵ Department of Cardiology, Chang Gung Memorial Hospital, Linkou Main Branch, Chang Gung University, Taoyuan, Taiwan.
⁶ Department of Pulmonary and Critical Care Medicine, Chang Gung Memorial Hospital, Linkou Main Branch, Chang Gung University, Taoyuan, Taiwan.
⁷ Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan.
⁸ Department of Otolaryngology, Taipei City Hospital, Ren-Ai Branch, Taipei, Taiwan.
⁹ Department of Computer Science and Information Engineering, Chang Gung University, Taoyuan, Taiwan.
¹⁰ Department of Otorhinolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Linkou Main Branch, Chang Gung University, Taoyuan, Taiwan.
¹¹ Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan.
¹² Department of Biomedical Engineering, Chung Yuan Christian University, Taoyuan, Taiwan.

PMID: 34335064
PMCID: PMC8318214
DOI: 10.2147/NSS.S311125

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

Hai-Hua Chuang et al. Nat Sci Sleep. 2021.

. 2021 Jul 24:13:1243-1255.

doi: 10.2147/NSS.S311125. eCollection 2021.

Authors

Affiliations

¹ Department of Family Medicine, Chang Gung Memorial Hospital, Taipei Branch and Linkou Main Branch, Chang Gung University, Taoyuan, Taiwan.
² Department of Industrial Engineering and Management, National Taipei University of Technology, Taipei, Taiwan.
³ Genomic Medicine Institute & Obesity Institute, Geisinger Medical, Danville, PA, USA.
⁴ Department of Neurology, Chang Gung Memorial Hospital, Linkou Main Branch, Chang Gung University, Taoyuan, Taiwan.
⁵ Department of Cardiology, Chang Gung Memorial Hospital, Linkou Main Branch, Chang Gung University, Taoyuan, Taiwan.
⁶ Department of Pulmonary and Critical Care Medicine, Chang Gung Memorial Hospital, Linkou Main Branch, Chang Gung University, Taoyuan, Taiwan.
⁷ Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan.
⁸ Department of Otolaryngology, Taipei City Hospital, Ren-Ai Branch, Taipei, Taiwan.
⁹ Department of Computer Science and Information Engineering, Chang Gung University, Taoyuan, Taiwan.
¹⁰ Department of Otorhinolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Linkou Main Branch, Chang Gung University, Taoyuan, Taiwan.
¹¹ Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan.
¹² Department of Biomedical Engineering, Chung Yuan Christian University, Taoyuan, Taiwan.

PMID: 34335064
PMCID: PMC8318214
DOI: 10.2147/NSS.S311125

Erratum in

Erratum: Snoring Sound Characteristics are Associated with Common Carotid Artery Profiles in Patients with Obstructive Sleep Apnea [Corrigendum].
[No authors listed] [No authors listed] Nat Sci Sleep. 2021 Aug 12;13:1429-1430. doi: 10.2147/NSS.S333587. eCollection 2021. Nat Sci Sleep. 2021. PMID: 34408518 Free PMC article.

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**
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**
Flow diagram of study participants.

**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**
Snoring sound characteristics and carotid atherosclerosis in patients with obstructive sleep apnea.

See this image and copyright information in PMC

References

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

Affiliations

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

Authors

Affiliations

Erratum in

Abstract

Conflict of interest statement

Figures

References

LinkOut - more resources

Full Text Sources