Metabolic consequences of snoring in adolescents and younger adults: a population study in Chile

Elevated fasting insulin results in snoring: A view emerged from causal evaluation of glycemic traits and snoring

BACKGROUND

Snoring and impaired glucose metabolism are common clinical manifestations and associated. The purpose of our study is to estimate the causal associations between snoring and glycemic traits.

METHODS

We compared the weighted mean differences (WMD) for fasting insulin (FINS), glycosylated haemoglobin (HbA1c), fasting blood glucose (FBG) and 2 h-glucose post-challenge (2hGlu) levels between snorers and non-snorers by meta-analysis. Then, we obtained summary statistics from published GWAS of snoring and glycemic traits to perform bidirectional two-sample MR. Inverse variance weighting (IVW) method was applied as major estimate while MR Egger, Weighted median and MR-Robust Adjusted Profile Score (RAPS) played a subsidiary role.

RESULTS

Snoring participants had higher FBG (WMD = 0.14 mmol/L, 95%CI = [0.10,0.19]), HbA1c (WMD = 0.10%, 95%CI = [0.07,0.13]), FINS (WMD = 0.92μIU/mL, 95%CI = [0.59,1.26]) and 2hGlu (WMD = 0.30 mmol/L, 95%CI = [0.06,0.55]) levels than non-snorers. Further, elevated FINS levels shown robust causal effect on snoring (IVW: OR = 1.07, 95%CI = [1.02,1.12], p = 2.2 × 10^-3 ), which was consistent by complementary methods of MR Egger (OR = 1.14, 95%CI = [1.01-1.30], p = 4.72 × 10^-2 ), Weighted median (OR = 1.11, 95%CI = [1.07,1.15], p = 1.53 × 10^-7 ) and MR RAPS (OR = 1.07, 95% CI = [1.05,1.10], p = 2.81 × 10^-9 ). Such causal situation was stable after identifying and removing the outliers in sensitivity analysis. However, there was no causality of snoring on increasing FINS levels. Additionally, there were no causal associations between snoring and other three traits of FBG, HbA1c and 2hGlu levels from either direction.

CONCLUSIONS

Snorers are subjected to higher FBG, HbA1c, FINS and 2hGlu levels, and elevated FINS levels further provides robust causality on snoring, suggesting that behind common snoring may lie hyperinsulinemia or insulin resistance.

Impact of Snoring on Telomere Shortening in Adolescents with Atopic Diseases

Atopic diseases can impose a significant burden on children and adolescents. Telomere length is a cellular marker of aging reflecting the impact of cumulative stress exposure on individual health. Since elevated oxidative stress and inflammation burden induced by chronic atopy and snoring may impact telomere length, this study aimed to investigate whether snoring would moderate the relationship between atopic diseases and telomere length in early adolescence. We surveyed 354 adolescents and their parents. Parents reported the adolescents' history of atopic diseases, recent snoring history as well as other family sociodemographic characteristics. Buccal swab samples were also collected from the adolescents for telomere length determination. Independent and combined effects of atopic diseases and snoring on telomere length were examined. Among the surveyed adolescents, 174 were reported by parents to have atopic diseases (20 had asthma, 145 had allergic rhinitis, 53 had eczema, and 25 had food allergy). Shorter TL was found in participants with a history of snoring and atopic diseases (β = -0.34, p = 0.002) particularly for asthma (β = -0.21, p = 0.007) and allergic rhinitis (β = -0.22, p = 0.023). Our findings suggest that snoring in atopic patients has important implications for accelerated telomere shortening. Proper management of atopic symptoms at an early age is important for the alleviation of long-term health consequences at the cellular level.

Association Between Self-Reported Snoring and Metabolic Syndrome: A Systematic Review and Meta-Analysis

Background: Snoring is a common condition. Previous studies have reported the relationships between snoring and metabolic syndrome (MetS) and/or its five components: hypertension, hyperglycemia, low-high density lipoprotein (low-HDL), high-triglyceride level, and abdominal obesity. However, conclusions have been inconsistent, and there has been no comprehensive summary on this. Therefore, we performed a systematic review on the relationships between snoring and MetS, including each of MetS' components.

Methods: A systematic review and a meta-analysis were conducted following the Meta-analysis of Observational Studies in Epidemiology group and Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines. Electronic databases including PubMed, Embase, and the Cochrane Library were searched for publications from inception to 15 July 2020. The inverse-variance weighted method was used in the meta-analysis to calculate the pooled odds ratios (ORs) and their 95% confidence intervals (CIs) to determine the association between snoring and MetS (and its components) through a fixed or random effect model. A restricted cubic spline regression model and the linear regression model were used in a two-stage dose–response meta-analysis to evaluate the non-linear and the linear trends between snoring frequency and MetS and its components.

Results: A total of 40 studies with 966,652 participants were included in this study. The pooled ORs between snoring and MetS and its components, hypertension, hyperglycemia, low-HDL, high-triglyceride level, and abdominal obesity, were 1.61 (95% CI, 1.43–1.78), 1.23 (95% CI, 1.15–1.31), 1.05 (95% CI, 1.04–1.07), 1.09 (95% CI, 1.00–1.18), 1.08 (95% CI, 1.00–1.17), and 1.75 (95% CI, 1.46–2.05), respectively. Non-linear trends were detected in the five associations except for low-HDL. A linear trend was detected in the association of snoring with hypertension, hyperglycemia, low-HDL, or abdominal obesity, with ORs of 1.07 (95% CI, 1.01–1.13), 1.05 (95% CI, 1.02–1.08), 1.03 (95% CI, 1.02–1.04), and 1.17 (95% CI, 1.16–2.89), respectively.

Conclusion: Snoring was a risk factor of MetS, and a dose–response relationship existed between the two. Timely intervention in identifying snorers can minimize as much as possible the risk of metabolic syndrome in those who snore.

Oral appliance therapy in obstructive sleep apnea and snoring - systematic review and new directions of development

Objective: Oral appliance therapy is a non-invasive treatment that offers a wide variety of oral devices for the treatment of obstructive sleep apnea (OSA). The present review focuses on the effectiveness of mandibular advancement devices for the treatment of OSA. Methods: A systematic review based on the PRISMA checklist was carried out. A detailed electronic database search was conducted using "Obstructive sleep apnea" AND "Oral appliance" AND "Dentistry" as keywords. Results: The initial search in the electronic databases resulted in a total of 262 papers. After the title and abstract analysis and full-text review, the number of eligible papers was reduced to 15. Conclusion: The mandibular advancement device is an effective treatment, improving the Apnea Hypopnea Index and the symptoms of patients with OSA in 92% of the subjects from all the investigated studies. The future may include the integration of a biosensor for the diagnosis and follow-up. Abbreviations: OSA: Obstructive sleep apnea; MADs: Mandibular advancement devices; CPAP: Continuous positive airway pressure; OAT: Oral appliance therapy; MRD: Mandibular repositioning devices; MAS: Mandibular advancement splints; MAA: Mandibular advancement appliances; OA: Oral appliances; AASM: American Academy of Sleep Medicine; AHI: Apnea-hypopnea index; EEG: Sleep-related breathing disorder SRBD; Electroencephalogram; EOG: Electrooculogram; ECG: Electrocardiogram; QOL: Quality of life; TMJ: Temporomandibular joint.

The association between obstructive sleep apnea syndrome and metabolic syndrome: a confirmatory factor analysis

BACKGROUND

Growing evidence suggests an independent relationship between obstructive sleep apnea syndrome (OSAS) and metabolic syndrome (MS). Patients with OSAS always show clustering of metabolic components. However, the understanding of interplay between OSAS and metabolic components is still lacking.

METHODS

Participants were consecutively enrolled from our sleep center during the period 2009-2013. Anthropometric variables, metabolic indicators, and sleep parameters were collected from all participants. The factor structure for MS in OSAS and non-OSAS was examined by confirmatory factor analysis.

RESULTS

The OSAS and non-OSAS demonstrated clustering of metabolic components. MS in patients with OSAS was strongly associated with insulin resistance (standardized factor loading = 0.93, p < 0.001), obesity (loading = 0.92, p < 0.001), and the lipid profile (loading = 0.72, p < 0.001). Furthermore, insulin resistance was correlated with obesity and lipid profile (r = 0.86, p < 0.001; r = 0.68, p < 0.001, respectively). Obesity and lipid profile were also highly correlated in OSAS (r = 0.66, p < 0.001). In non-OSAS, MS was strongly associated with insulin resistance, obesity, and lipid profile (loading = 0.95, p < 0.001; loading = 0.74, p < 0.001; loading = 0.68, p < 0.001, respectively). Insulin resistance was most strongly associated with fasting insulin (loading = 0.65, p < 0.001). Lipid profile was most strongly associated with TG (loading = 0.88, p < 0.001). Obesity was most strongly associated with BMI (loading = 0.80, p < 0.001).

CONCLUSIONS

OSAS is more prone to show clustering of metabolic components compared with non-OSAS. In particular, insulin resistance, obesity, and the lipid profile were independently and strongly correlated with MS in OSAS.

Role of sleep duration and sleep-related problems in the metabolic syndrome among children and adolescents

BACKGROUND

There is increasing recognition that sleep is a risk factor for metabolic syndrome (MetS). The aim of the present study was to analyze the relationship between self-reported sleep duration, sleep-related problems and the presence of MetS in children and adolescents from Bogotá, D.C., Colombia.

METHODS

This is a cross-sectional analysis from the FUPRECOL study (2014-15). Participants included 2779 (54.2% girls) youth from Bogota (Colombia). MetS was defined as the presence of ≥3 of the metabolic abnormalities (hyperglycemia, hypertriglyceridemia, low high-density lipoprotein cholesterol [HDL-c], hypertension, and increased waist circumference) according to the criteria of de Ferranti/Magge and colleges. Self-reported sleep duration and sleep-related problems were assessed with the BEARS questionnaire.

RESULTS

Logistic regression analysis showed that boys who meet recommended duration of sleep had a decreased risk of elevated blood glucose levels (Odds Ratio [OR] = 0.71, 95%CI [0.40-0.94]; p = 0.031) compared to boys who have short-long sleep duration. Also, compared to young without sleep problems, excessive sleepiness during the day was related to low HDL-c levels in boys (OR = 1.36, 95%CI [1.02-1.83]; p = 0.036) and high triglyceride levels in girls (OR = 1.28, 95%CI [1.01-1.63]; p = 0.045). Girls with irregular sleep patterns had decreased HDL-c levels (OR = 0.71, 95%CI [0.55-0.91]; p = 0.009).

CONCLUSIONS

Recommended sleep duration was associated with a decreased risk of elevated fasting glucose levels in boys, and sleep problems was related to lower HDL-c in girls and higher triglyceride levels in boys. These findings suggested the clinical importance of improving sleep hygiene to reduce metabolic risk factors in children and adolescents.

Frequency of Loud Snoring and Metabolic Syndrome among Korean Adults: Results from the Health Examinees (HEXA) Study

Studies regarding the association between snoring and metabolic abnormalities have been inconsistent. We examine whether snoring frequency and obstructive sleep apnea markers are associated with metabolic syndrome (MetS) among Koreans aged 40-69 years. A total of 72,885 subjects (24,856 men, 48,029 women) from the Health Examinees Gem study between 2009 and 2013 were included. Snoring frequency was grouped into five categories (never, 1-3/month, 1-3/week, 4-5/week, 6+/week). Obstructive sleep apnea markers included breathing interruptions and awakenings. Adjusted odds ratios (ORs) and 95% confidence intervals (95% CIs) were calculated through logistic regression. Compared with non-snorers, those who snore 6+/week were associated with increased odds for MetS (OR: 2.07, 95% CI: 1.91-2.25, p-trend < 0.0001 among men; OR: 1.45, CI: 1.33-1.58, p-trend < 0.0001 among women). Snoring frequency is associated with MetS and its components in both men and women. Snoring and obstructive sleep apnea markers are important indicators of sleep quality, which may facilitate early detection of sleep disorders and further complications such as MetS.