Sleep Apnea and Snoring Linked to Higher Risk of Hypertension, Coronary Artery Disease in New Study

Potentially driven by body mass index (BMI), sleep apnea (SA) and snoring were associated with an increased risk of hypertension (HTN) and coronary artery disease (CAD) in a Mendelian randomization study published in the European Journal of Preventive Cardiology.

On the other hand, researchers did not observe any evidence of cardiovascular disease (CVD) causally influencing SA or snoring.

In previous observational studies, associations between SA and CVD have been identified, however, whether the associations are causal remains unknown, according to first author Jiao Wang, PhD, School of Public Health, Sun Yat-sen University, Guangzhou, China, and colleagues.

Wang and colleagues conducted a bidirectional, 2-sample Mendelian randomization study to examine the relationship, including the potential for causality, between SA or snoring and CVD. Multivariable Mendelian randomization was used to assess the direct effect of SA on CVD after adjusting for BMI.

The cohort included 523 366 participants, of whom 25 008 had a single nucleotide polymorphism associated with SA and 172 050 had a single nucleotide polymorphism associated with snoring. The CVD outcomes of interest were HTN, atrial fibrillation (AF), CAD, stroke, and heart failure (HF).

After the research team corrected for multiple testing, the inverse-variance weighted average showed that SA and snoring increased the risk of HTN (odds ratio [OR] 1.03, 95% CI 1.02-1.05; OR 1.05, 95% CI 1.03-1.07) and CAD (OR 1.41, 95% CI 1.19-1.67; OR 1.61, 95% CI 1.26-2.07), with a false-discovery rate (FDR) <.05. However, these associations decreased “dramatically” after adjusting for BMI (.06<FDR_{BMI adjusted}<.20), noted investigators.

Snoring and SA were not associated with AF, HF, or stroke, according to the results. HTN was associated with an increased risk of SA (OR 1.53, 95% CI 1.04-2.25), but this association did not pass multiple comparisons (FDR >.05), according to authors.

Wang and colleagues noted that further studies clarifying the role of adiposity in the effect of SA and snoring on CVDs are needed.

Reference: Wang J, Campos AI, Rentería ME, Xu L. Causal associations of sleep apnea, snoring with cardiovascular diseases, and the role of body mass index: A two-sample Mendelian randomization study. Eur J Prev Cardiol. Published online January 5, 2023. doi: 10.1093/eurjpc/zwad005