There is increasing evidence suggesting that snoring and sleep apnea are associated with cerebrovascular diseases. Alas this information is simply not being heard. It is suggested that Cardio Vascular Disease (CVD) is already underway in the snorer.
Snoring, sleep apnea syndrome, and stroke.
Increasing evidence suggests that snoring and sleep apnea are associated with cerebrovascular diseases. Several other factors may be involved in this association because many established or potential risk factors for stroke are related to snoring and sleep apnea.
These other factors include arterial hypertension, coronary heart disease, age, obesity, smoking, and alcohol consumption.
Recent epidemiological and clinical studies indicate, however, that snoring can increase the risk of stroke independently of these confounding factors.
Accumulating such evidence of long-term harmful effects of the obstructive sleep apnea syndrome appears to be related to increasing vascular morbidity and mortality.
Potential mediators among snoring, obstructive sleep apneas, and stroke include cardiac arrhythmias and other hemodynamic disturbances, increased levels of catecholamines, and disturbances in cerebral blood flow caused by sleep apneas, as well as hypoxemic periods that may potentiate atherosclerosis.
Habitual snoring as a risk factor for brain infarction
The risk of ischaemic stroke appears higher among older male patients with arterial hypertension who always snored. Habitual snoring was not significantly linked with sleep‐related stroke nor with the pathophysiology of strokes however.
Inquiring about habitual snoring should become a routine practice, especially among older male patients with arterial hypertension, and specific preventive measures should be instituted at an earlier stage.
Snoring Increases the Risk of Stroke and Adversely Affects Prognosis
In this case-controlled study we recruited 400 patients admitted to hospital with stroke and 400 community controls matched for age, gender and family practitioner. Snoring history was obtained from 326 patients and 345 controls.
Odds ratio for admission to hospital with stroke was 3.2 (95 per cent confidence intervals 2.3–4.4) for regular snorers against those who did not snore regularly. This risk was independent for age, gender and other risk factors for stroke.
Snoring did not increase the chances of stroke during sleep however.
But as the frequency of snoring increased so did the mortality to 6 months (p = 0.0006). Snoring is an important risk factor for stroke and adversely affects the prognosis in patients admitted to hospital with stroke.
Snoring, daytime sleepiness and stroke: A case–control study of first‐ever stroke
Previous reports have shown an association between snoring and stroke but it is not clear whether this reflects confounding factors nor whether the association is attributable to obstructive sleep apnoea (OSA).
This study performed a case–control study of 181 patients admitted to hospital with first‐ever stroke and community control subjects matched individually for age, sex and general practitioner.
Subjects were interviewed with a structured questionnaire to identify snoring, daytime sleepiness and stroke risk factors. The association between snoring alone and stroke was not statistically significant: odds ratio (95% CI) 1.44 (0.88, 2.41).
Daytime sleepiness was, however, significantly associated with stroke: odds ratio 3.07 (1.65, 6.08). Multiple logistic regression showed that hypertension, current smoking, taking alcohol regularly (negatively) and a higher Epworth sleepiness score were independently associated with stroke.
The results suggest that the previously reported association between ‘simple’ snoring and stroke might have been due to poor controlling for confounding variables. Our study suggests an association with greater sleepiness pre-stroke, the cause of which is unclear, although OSA is a possible candidate.
Snoring as a risk factor for ischaemic heart disease and stroke in men.
The association of snoring with ischaemic heart disease and stroke was studied prospectively in 4388 men aged 40-69. The men were asked, in a questionnaire sent to them, whether they snored habitually, frequently, occasionally, or never.
Hospital records and death certificates were checked for the next three years to establish how many of the men developed ischaemic heart disease or stroke: the numbers were 149 and 42, respectively.
Three categories of snoring were used for analysis: habitual and frequent snorers (n = 1294), occasional snorers (n = 2614), and non-snorers (n = 480). The age adjusted relative risk of ischaemic heart disease between habitual plus frequent snorers and non-snorers was 1.91 (p less than 0.01) and for ischaemic heart disease or stroke, or both, 2.38 (p less than 0.001).
There were no cases of stroke among the non-snorers.
Adjustment for age, body mass index, history of hypertension, smoking, and alcohol use did not significantly decrease the relative risks, which were 1.71 (p greater than 0.05) for ischaemic heart disease and 2.08 (p less than 0.01) for ischaemic heart disease and stroke combined.
At the beginning of follow up in 1981, 462 men reported a history of angina pectoris or myocardial infarction. For them the relative risk of ischaemic heart disease between habitual plus frequent snorers and non-snorers was 1.30 (NS); for men without previous ischaemic heart disease 2.72 (p less than 0.05).
Outcome – Snoring seems to be a potential determinant of risk of ischaemic heart disease and stroke.
Obstructive sleep apnoea and stroke – BMJ
Many patients with stroke have concomitant sleep apnoea, which can affect recovery potential.
Although stroke can lead to the development of sleep-disordered breathing, the current evidence suggests that sleep-disordered breathing may function as a risk factor for stroke.
In this review, the focus was on the association between obstructive sleep apnoea and stroke reviewing both the epidemiological data with respect to causation and the biological data, which explores pathogenesis.
There is convincing evidence to believe that sleep apnoea is a modifiable risk factor for stroke; however, prospective studies are needed to establish the cause-and-effect relationship.
Awareness of this growing association should be increased.
Dr. Stephen Bray 2020