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Observational Study
. 2025 Apr;30(4):346-358.
doi: 10.1111/resp.14893. Epub 2025 Feb 5.

Associations Between Snoring, Body Mass Index and Coronary Artery Diseases: Observational and Mendelian Randomization Study in Asia

Yunqing Zhu  1 , Yongbing Lan  1 , Jun Lv  1   2   3 , Dianjianyi Sun  1   2   3 , Pei Pei  2 , Ling Yang  4   5 , Iona Y Millwood  4   5 , Robin G Walters  4   5 , Yiping Chen  4   5 , Huaidong Du  4   5 , Jian Wang  6 , Xiaoming Yang  5 , Rebecca Stevens  5 , Junshi Chen  7 , Zhengming Chen  5 , Liming Li  1   2   3 , Canqing Yu  1   2   3 ; China Kadoorie Biobank Collaborative Group
Collaborators, Affiliations
Observational Study

Associations Between Snoring, Body Mass Index and Coronary Artery Diseases: Observational and Mendelian Randomization Study in Asia

Yunqing Zhu et al. Respirology. 2025 Apr.

Abstract

Background and objective: Previous observational studies reported a complex relationship between snoring and coronary artery disease (CAD). We aimed to estimate the causal associations between snoring and CAD among East Asian people, and the effects independent of BMI.

Methods: Based on 497,250 adults from China Kadoorie Biobank (CKB), we performed a conventional prospective analysis between snoring and CAD outcomes, using the multivariable Cox regression. We also leveraged genome-wide association (GWAS) summary statistics of snoring and BMI from CKB (n = 100,626, 47,208 snorers) and CAD outcomes from Biobank of Japan (BBJ, 5891-25,892 cases, 142,336-168,186 controls). Single-variable and multivariable two-sample bi-directional Mendelian randomization (MR) analyses were performed.

Results: During a median follow-up of 12.32 years, 48,997 participants developed CAD. Snoring and habitual snoring were associated with incident CAD and myocardial infarction (MI), habitual snoring was also associated with stable angina pectoris (SAP). The HRs (95% CIs) of habitual snoring were 1.06 (1.04, 1.08), 1.06 (1.04, 1.08) and 1.14 (1.03, 1.25). The associations remained among non-adiposity participants. Genetically predicted habitual snoring was associated with CAD and MI, the corresponding IVW-ORs (95% CIs) were 1.09 (1.005, 1.19) and 1.15 (1.05, 1.25). Further adjusted BMI, habitual snoring retained independent effects on MI and CAD, and showed impact on SAP (1.09 [1.01, 1.17]). No reverse associations were observed between CADs on snoring traits.

Conclusion: Habitual snoring elevated the risks of total CAD, MI and SAP. The causal associations were independent of BMI. These findings indicated that snoring intervention might contribute to the decrease of CAD risk among Asians.

Keywords: body mass index; coronary artery disease; mendelian randomization; snoring.

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Conflict of interest statement

Competing interests

None declared.

Figures

Figure 1
Figure 1. Graphical abstract
Notes: CKB, China Kadoorie Biobank; BBJ study; MR, Mendelian randomization; BMI, body mass index; CAD, coronary artery disease; MI, myocardial infarction; SAP, stable angina pectoris. SVMR, single variable MR; MVMR, multivariable MR. The percent in blue meant the elevated risk of CAD per 1.5 of the odds of snoring (for example, an increase in the snoring probability from 20% to 30%). For the conventional observational analysis, we showed the associations in the main analysis, which were robust among the non-adiposity group. For the Mendelian randomization analysis, we showed the associations in the MVMR analysis adjusting for BMI.
Figure 2
Figure 2. Associations of genetically predicted BMI and snoring with CAD outcomes by SVMR and MVMR.
Notes: BMI, body mass index; CAD, coronary artery disease; MI, myocardial infarction; CHF, chronic heart failure; UAP, unstable angina pectoris; SAP, stable angina pectoris; SVMR, single variable MR; MVMR, multivariable MR; IVW, inverse variance weighted; RAPS, MR robust adjusted profile score. For snoring, estimates were expressed per 0.5-fold increase in the probability of snoring (MVMR adjusted for BMI) on the risk of outcomes (CAD, MI, CHF, angina, UAP, SAP). For BMI, estimates were expressed per one SD increase in the BMI (MVMR adjusted for snoring) on the risk of outcomes.
Figure 3
Figure 3. Associations of genetically predicted BMI and habitual snoring with CAD outcomes by SVMR and MVMR.
Notes: BMI, body mass index; CAD, coronary artery disease; MI, myocardial infarction; CHF, chronic heart failure; UAP, unstable angina pectoris; SAP, stable angina pectoris; SVMR, single variable MR; MVMR, multivariable MR; IVW, inverse variance weighted; RAPS, MR.robust adjusted profile score. For habitual snoring, estimates were expressed per 0.5-fold increase in the probability of habitual snoring (MVMR adjusted for BMI) on the risk of outcomes (CAD, MI, CHF, angina, UAP, SAP). For BMI, estimates were expressed per one SD increase in the BMI (MVMR adjusted for habitual snoring) on the risk of outcomes.
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