Self-reported obstructive sleep apnea, simple snoring, and various markers of sleep-disordered breathing as predictors of cardiovascular risk
Open accessAbstract
Purpose Our objective was to investigate whether self-reported obstructive sleep apnea (OSA), simple snoring, and various markers of sleep-disordered breathing (SDB) are associated with cardiovascular risk.Methods We examined a representative nationwide cohort of 5177 Finnish adults aged ≥30 years. The participants underwent measurement of traditional cardiovascular risk factors and answered SDB-related questions derived from the Basic Nordic Sleep Questionnaire, which were used to operationalize self-reported OSA. The primary end point was incidence of a cardiovascular event (cardiovascular mortality, non-fatal myocardial infarction, non-fatal stroke, hospitalization for heart failure, or coronary interventions).Results During a median follow-up of 11.2 years and 52,910 person-years of follow-up, 634 participants suffered a cardiovascular event. In multivariable-adjusted Cox models, self-reported OSA (hazard ratio [HR] 1.34; 95 % confidence interval [CI] 1.04-1.73; p = 0.03) was an independent predictor of cardiovascular events. Self-reported simple snoring by itself was not associated with future cardiovascular events (HR 0.88 versus non-snorers, 95 % CI 0.75-1.04, p = 0.15). However, among snorers (n = 3152), frequent breathing cessations (HR 2.19, 95 % CI 1.26-3.81, p = 0.006) and very loud and irregular snoring (HR 1.82, 95 % CI 1.31-2.54, p < 0.001) were associated with cardiovascular risk.Conclusions Self-reported OSA and SDB-related snoring variables are associated with cardiovascular risk, whereas simple snoring is not. In clinical practice and in surveys, questions concerning only habitual snoring should be amended with questions focusing on respiratory pauses and snoring stertorousness, which can be used to estimate the risk of OSA and cardiovascular events.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Possible self-reported OSA was estimated using questions addressing the frequency and quality of snoring, as described earlier.
“Possible self-reported OSA was estimated using questions addressing the frequency and quality of snoring, as described earlier81.”
From Prolonged sleep restriction induces changes in pathways involved in cholesterol metabolism and inflammatory responses (2016) · cites this paper as [81]
Cites
Prospective Study of the Association between Sleep-Disordered Breathing and Hypertension
Peppard, P. E., Young, T., Palta, M., & Skatrud, J. (2000) · New England Journal of Medicine · doi:10.1056/nejm200005113421901 · Cited by 4,973 · see citing works
Marin, J. M., Carrizo, S. J., Vicente, E., & Agusti, A. G. (2005) · The Lancet · doi:10.1016/s0140-6736(05)71141-7 · Cited by 4,678 · see citing works
Obstructive Sleep Apnea as a Risk Factor for Stroke and Death
Yaggi, H. K., Concato, J., Kernan, W. N., Lichtman, J. H., Brass, L. M., & Mohsenin, V. (2005) · New England Journal of Medicine · doi:10.1056/nejmoa043104 · Cited by 3,004 · see citing works
Sleep Disordered Breathing and Mortality: Eighteen-Year Follow-up of the Wisconsin Sleep Cohort
(2008) · Sleep · doi:10.5665/sleep/31.8.1071 · Cited by 1,853 · see citing works
Sleep-Disordered Breathing and Mortality: A Prospective Cohort Study
Punjabi, N. M., Caffo, B. S., Goodwin, J. L., Gottlieb, D. J., Newman, A. B., O'Connor, G. T., Rapoport, D. M., Redline, S., Resnick, H. E., Robbins, J. A., et al. (2009) · PLoS Medicine · doi:10.1371/journal.pmed.1000132 · Cited by 1,482 · cited 2× · see citing works
“The role of intermittent hypoxia, usually measured with the apnea–hypopnea index (AHI, the number of periods of obstructed breathing per hour of sleep), has been shown to be independently associated with cardiovascular morbidity and mortality [5–10].”
BackgroundResultPost-Stroke Fatigue: Epidemiology, Clinical Characteristics and Treatment
Acciarresi, M., Bogousslavsky, J., & Paciaroni, M. (2014) · European Neurology · doi:10.1159/000363763 · Cited by 1,423 · see citing works
Obstructive Sleep Apnea–Hypopnea and Incident Stroke: The Sleep Heart Health Study
Redline, S., Yenokyan, G., Gottlieb, D. J., Shahar, E., O'Connor, G. T., Resnick, H. E., Diener-West, M., Sanders, M. H., Wolf, P. A., Geraghty, E. M., et al. (2010) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/rccm.200911-1746oc · Cited by 1,269 · see citing works
Basic Nordic Sleep Questionnaire (BNSQ): a quantitated measure of subjective sleep complaints
Partinen, M., & Gíslason, Þ. (1995) · Journal of Sleep Research · doi:10.1111/j.1365-2869.1995.tb00205.x · Cited by 528 · see citing works
Self-citationSnoring and Sleep Apnea. A Population Study in Australian Men
Bearpark, H., Elliott, L., Grunstein, R. R., Cullen, S., Schneider, H., Althaus, W., & Sullivan, C. E. (1995) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/ajrccm.151.5.7735600 · Cited by 488 · see citing works
Snoring as a risk factor for ischaemic heart disease and stroke in men.
Koskenvuo, M., Kaprio, J. A., Telakivi, T., Partinen, M., Heikkila, K. V., & Sarna, S. J. (1987) · BMJ · doi:10.1136/bmj.294.6563.16 · Cited by 482 · see citing works
Self-citationAn independent association between obstructive sleep apnoea and coronary artery disease
Peker, Y., Kraiczi, H., Hedner, J. A., Löth, S., Johansson, A., & Bende, M. (1999) · European Respiratory Journal · doi:10.1034/j.1399-3003.1999.14a30.x · Cited by 476 · see citing works
Association Between Sleep and Blood Pressure in Midlife: The CARDIA Sleep Study
Knutson, K. L., Van Cauter, E., Rathouz, P. J., Yan, L. L., Hulley, S. B., Liu, K., & Lauderdale, D. S. (2009) · Archives of Internal Medicine · doi:10.1001/archinternmed.2009.119 · Cited by 403 · see citing works
Sleep Apnea and Cardiovascular Disease
Kasai, T., Floras, J. S., & Bradley, T. D. (2012) · Circulation · doi:10.1161/circulationaha.111.070813 · Cited by 383 · see citing works
Pajunen, P., Koukkunen, H., Ketonen, M., Jerkkola, T., Immonen‐Räihä, P., K??rj??-Koskenkari, P., nen, M. M. H., Niemel, M., Kuulasmaa, K., ki, P. P. A., et al. (2005) · European Journal of Cardiovascular Prevention & Rehabilitation · doi:10.1097/00149831-200504000-00007 · Cited by 334 · see citing works
Snoring as a Risk Factor for Type II Diabetes Mellitus: A Prospective Study
Al‐Delaimy, W. K., Manson, J. E., Willett, W. C., Stampfer, M. J., & Hu, F. B. (2002) · American Journal of Epidemiology · doi:10.1093/aje/155.5.387 · Cited by 328 · see citing works
Increasing Sleep Duration for a Healthier (and Less Obese?) Population Tomorrow
Young, T. B. (2008) · SLEEP · doi:10.1093/sleep/31.5.593 · Cited by 327 · see citing works
Obstructive sleep apnea and cardiovascular risk: Meta-analysis of prospective cohort studies
Dong, J.-Y., Zhang, Y.-H., & Qin, L.-Q. (2013) · Atherosclerosis · doi:10.1016/j.atherosclerosis.2013.04.026 · Cited by 307 · see citing works
Zhang, X., Loberiza, F. R., Klein, J. P., & Zhang, M. (2007) · Computer Methods and Programs in Biomedicine · doi:10.1016/j.cmpb.2007.07.010 · Cited by 283 · see citing works
Snoring and risk of cardiovascular disease in women
Hu, F. B., Willett, W. C., Manson, J. E., Colditz, G. A., Rimm, E. B., Speizer, F. E., Hennekens, C. H., & Stampfer, M. J. (2000) · Journal of the American College of Cardiology · doi:10.1016/s0735-1097(99)00540-9 · Cited by 227 · see citing works
Methodology report : Health 2000 survey
Heistaro, S. (2008) · STM:n Hallinnonalan avoin julkaisuarkisto (Julkari) · Cited by 195 · see citing works
Tolonen, H. K., Salomaa, V. V., Torppa, J., Sivenius, J., Immonen‐Räihä, P., Lehtonen, A., & Finstroke, R. (2007) · European Journal of Cardiovascular Prevention & Rehabilitation · doi:10.1097/01.hjr.0000239466.26132.f2 · Cited by 177 · see citing works
Fogelholm, M., Kronholm, E., Kukkonen-Harjula, K., Partonen, T., Partinen, M., & Härmä, M. (2007) · International Journal of Obesity · doi:10.1038/sj.ijo.0803663 · Cited by 127 · see citing works
Self-citationHypertension and obstructive sleep apnea
Phillips, C. L., & O’Driscoll, D. M. (2013) · Nature and Science of Sleep · doi:10.2147/nss.s34841 · Cited by 108 · see citing works
Snoring, daytime sleepiness and stroke: a case–control study of first‐ever stroke
Davies, D. P., Rodgers, H., Walshaw, D., James, O., & Gibson, G. J. (2003) · Journal of Sleep Research · doi:10.1046/j.0962-1105.2003.00371.x · Cited by 86 · see citing works
An update on obstructive sleep apnea and the metabolic syndrome
Lam, J. C., & Ip, M. (2007) · Current Opinion in Pulmonary Medicine · doi:10.1097/mcp.0b013e3282efae9c · Cited by 75 · see citing works
Variability in home-measured blood pressure and heart rate
Johansson, J. K., Kronholm, E., & Jula, A. (2011) · Journal of Hypertension · doi:10.1097/hjh.0b013e32834abccd · Cited by 65 · see citing works
Self-citationSnoring and the metabolic syndrome in women
Leineweber, C., Kecklund, G., Åkerstedt, T., Janszky, I., & Orth‐Gomér, K. (2003) · Sleep Medicine · doi:10.1016/s1389-9457(03)00160-6 · Cited by 62 · see citing works
The validity of heart failure diagnoses obtained from administrative registers
Mähönen, M., Jula, A., Harald, K., Antikaínen, R., Tuomilehto, J. O., Zeller, T., Blankenberg, S., & Salomaa, V. V. (2012) · European Journal of Preventive Cardiology · doi:10.1177/2047487312438979 · Cited by 56 · see citing works
Self-citationSands, M., Loucks, E. B., Lü, B., Carskadon, M. A., Sharkey, K. M., Stefanick, M. L., Ockene, J. K., Shah, N. A., Hairston, K. G., Robinson, J. G., et al. (2012) · The American Journal of Cardiology · doi:10.1016/j.amjcard.2012.10.039 · Cited by 54 · see citing works
Marshall, N. S., WONG, K. K. H., Cullen, S. R. J., Knuiman, M. W., & Grunstein, R. R. (2012) · SLEEP · doi:10.5665/sleep.2076 · Cited by 52 · see citing works
Snoring without OSA and Health Consequences: The Jury Is Still Out
Kezirian, E. J., & Chang, J. L. (2013) · SLEEP · doi:10.5665/sleep.2560 · Cited by 6 · see citing works
Noise in the Signal or Bad Vibrations?
Rice, T. B. (2012) · SLEEP · doi:10.5665/sleep.2062 · Cited by 6 · see citing works
The Burden of Proof Lies with the Prosecution: Is Snoring Guilty?
Marshall, N. S., WONG, K. K. H., Cullen, S. R. J., Knuiman, M. W., & Grunstein, R. R. (2013) · SLEEP · doi:10.5665/sleep.2562 · Cited by 2 · see citing works
Flagged first, then by citations
1 of the 34 references couldn’t be matched to a known paper.
Cited by
Sorted by citations
Adams, R., Appleton, S., Taylor, A. W., Gill, T. K., Lang, C. J., McEvoy, R. D., & Antic, N. A. (2017) · Sleep Health · doi:10.1016/j.sleh.2016.11.005 · Cited by 289 · see citing works
Aho, V., Ollila, H. M., Kronholm, E., Bondia-Pons, I., Soininen, P., Kangas, A. J., Hilvo, M., Seppälä, I., Kettunen, J., Oikonen, M., et al. (2016) · Scientific Reports · doi:10.1038/srep24828 · Cited by 126 · see citing works
Self-citationSleep and Migraine: Assessment and Treatment of Comorbid Sleep Disorders
Rains, J. C. (2018) · Headache The Journal of Head and Face Pain · doi:10.1111/head.13357 · Cited by 115 · see citing works
Appleton, S., Gill, T. K., Lang, C. J., Taylor, A. W., McEvoy, R. D., Stocks, N., González‐Chica, D. A., & Adams, R. (2017) · Sleep Health · doi:10.1016/j.sleh.2017.10.006 · Cited by 110 · see citing works
Xiang, M., Hu, B., Liu, Y., Sun, J., & Song, J. (2017) · International Journal of Pediatric Otorhinolaryngology · doi:10.1016/j.ijporl.2017.04.009 · Cited by 78 · see citing works
Miettinen, T., Sverloff, J., Lappalainen, O.-P., Linton, S. J., Sipilä, K., & Kalso, E. A. (2021) · Pain · doi:10.1097/j.pain.0000000000002497 · Cited by 44 · see citing works
Marabita, F., James, T., Karhu, A., Virtanen, H., Kettunen, K., Stenlund, H. C., Boulund, F., Hellström, C., Neiman, M., Mills, R., et al. (2021) · Cell Systems · doi:10.1016/j.cels.2021.11.001 · Cited by 39 · see citing works
Self-reported Snoring Patterns Predict Stroke Events in High-Risk Patients With OSA
Li, J., McEvoy, R. D., Zheng, D., Loffler, K. A., Wang, X., Redline, S. S., Woodman, R. J., & Anderson, C. S. (2020) · CHEST Journal · doi:10.1016/j.chest.2020.05.615 · Cited by 27 · see citing works
Risk of Cardiovascular Disease in Apnoeic Individuals: Role of Comorbid Insomnia Disorder
Hein, M., Wacquier, B., Lanquart, J., & Loas, G. (2022) · Life · doi:10.3390/life12070944 · Cited by 22 · see citing works
Age-Specific Associations Between Habitual Snoring and Cardiovascular Diseases in China
Wei, Y., Lv, J., Guo, Y., Bian, Z., Fan, J., Du, H., Yang, L., Chen, Y., Qin, Y., Wang, P., et al. (2021) · CHEST Journal · doi:10.1016/j.chest.2021.04.070 · Cited by 23 · see citing works
Shokri, A., Mollabashi, V., Zahedi, F., & Tapak, L. (2020) · Imaging Science in Dentistry · doi:10.5624/isd.2020.50.2.105 · Cited by 19 · see citing works
Epidemiology: Principles and Application in Sleep Medicine
Partinen, M., & Kronholm, E. (2017) · Springer eBooks · doi:10.1007/978-1-4939-6578-6_28 · Cited by 10 · see citing works
Self-citationKim, C., Shin, S., Lee, H.-W., Lim, J., Lee, J., & Kang, D. (2017) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph14111294 · Cited by 10 · see citing works
Wang, I.-D., Chien, W., Chung, C., Tsai, P.-Y., Chang, S., Meng, F., & Peng, C. (2019) · PLoS ONE · doi:10.1371/journal.pone.0209673 · Cited by 9 · see citing works
Kang, J., Kang, H. K., Kang, H. K., Seo, W. J., Kang, J., & Kim, J. (2024) · Frontiers in Neurology · doi:10.3389/fneur.2024.1394345 · Cited by 8 · see citing works
Liao, F., Zhang, T., Huang, X., Sangwatanakul, J., Li, H., & Zhou, N. (2020) · CRANIO® · doi:10.1080/08869634.2020.1864165 · Cited by 3 · see citing works
Donovan, T. E., Marzola, R., Murphy, K. R., Cagna, D. R., Eichmiller, F. C., McKee, J. R., Metz, J. E., & Albouy, J.-P. (2016) · Journal of Prosthetic Dentistry · doi:10.1016/j.prosdent.2016.09.003 · Cited by 3 · see citing works
Stańczyk, M. B., Raczyński, P., Andrzejewski, J., Mazurek-Kula, A., Ostrowska, K., Konopka, W., & Tkaczyk, M. (2020) · Pediatria Polska · doi:10.5114/polp.2020.97167 · Cited by 2 · see citing works
[Progress in obstructive sleep apnea and atherosclerosis].
Sun, H., Qin, Y., & Wei, Y. (2020) · PubMed Central · doi:10.13201/j.issn.2096-7993.2020.10.023 · Cited by 2 · see citing works
Left heart ventricle function in children snoring due to adeno-tonsillar hypertrophy
Mirecka, J., Mazurek-Kula, A., Ostrowska, K., Andrzejewski, J., Konopka, W., Stańczyk, M. B., & Tkaczyk, M. (2019) · Pediatria Polska · doi:10.5114/polp.2019.83737 · Cited by 2 · see citing works
Non-Contact Screening of OSAHS Using Multi-Feature Snore Segmentation and Deep Learning
Xu, X. Y., Gan, Y., Yuan, X., Cheng, Y., & Zhou, L. J. (2025) · Sensors · doi:10.3390/s25175483 · Cited by 1 · see citing works
"A GREAT PERTURBATION IN NATURE" : PARKINSON'S DISEASE AND SLEEP DISORDERS
Ylikoski, A. (2016) · Työväentutkimus Vuosikirja · Cited by 1 · see citing works
Wang, H., Li, Z., Chen, Y., Ye, N., Wang, P., & Sun, Y. (2017) · Sleep And Breathing · doi:10.1007/s11325-017-1515-4
Diamond, J. A., & Natbony, L. R. (2021) · Springer eBooks · doi:10.1007/978-3-030-71513-7_6
Xi, X., Gan, Y., Cheng, Y., & Zhang, C. (2026) · International Conference on Computer Supported Cooperative Work in Design (CSCWD) · doi:10.1109/cscwd68734.2026.11582498
A Method for OSA Snore Monitoring and Grading Based on Ensemble Learning
王, 者. (2026) · Computer Science and Application · doi:10.12677/csa.2026.167237
- Authors
- Niiranen, T. J., Kronholm, E., Rissanen, H., Partinen, M., & Jula, A. M.
- Affiliations
- Finnish Institute for Health and Welfare (FI)
- University of Helsinki (FI)
- Corresponding author
- Niiranen, Teemu J.
- Venue
- Sleep and Breathing
- Published
- 2015-09-12
- Volume
- 20
- Issue
- 2
- Pages
- 589-596
- ISSN
- 1520-9512 (ISSN-L)
- 1522-1709
- OpenAlex
- W2198751818
- Cited by
- 26
- References
- 34
- Citations by year
- 2026: 2 · 2025: 1 · 2024: 1 · 2022: 1 · 2021: 4 · 2020: 5 · 2019: 2 · 2018: 1 · 2017: 6 · 2016: 3
- FWCI
- 2.46
- Type
- journal article
- Language
- en
- Open access
- green
- hdl.handle.net
- Licence
- other-oa
- www.springer.com/tdm (tdm)
- Locations
- Sleep And Breathing (publishedVersion)
- PubMed (publishedVersion)
- Työväentutkimus Vuosikirja (submittedVersion, other-oa)
- Topics
- Health Sciences › Medicine › Physiology › Obstructive Sleep Apnea Research
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Health Sciences › Medicine › Pharmacology › Apelin-related biomedical research
- Keywords
- obstructive sleep apnea, snoring, sleep-disordered breathing, cardiovascular risk, cardiovascular events, respiratory pauses, cardiovascular mortality, myocardial infarction, stroke, heart failure
- MeSH terms
- Adult, Aged, Cardiovascular Diseases, Cause of Death, Female, Finland, Follow-Up Studies, Humans, Male, Middle Aged, Surveys and Questionnaires, Risk, Snoring, Cohort Studies, Sleep Apnea, Obstructive, Self Report
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
