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Original Research: SLEEP MEDICINE |

Daytime Sleepiness Relates to Snoring Independent of the Apnea-Hypopnea Index in Women From the General Population

Malin Svensson, MD; Karl A. Franklin, PhD; Jenny Theorell-Haglöw, BSc; Eva Lindberg, PhD
Author and Funding Information

*From the Department of Surgical Sciences (Dr. Svensson), Otorhinolaryngology, Head and Neck Surgery, and Department of Medical Sciences (Mrs. Theorell-Haglöw and Dr. Lindberg), Respiratory Medicine and Allergology, Uppsala University, Uppsala; and Department of Respiratory Medicine (Dr. Franklin), University Hospital, Umeå, Sweden.

Correspondence to: Malin Svensson, MD, Department of Otorhinolaryngology, Head and Neck Surgery, Akademiska sjukhuset, SE 751 85 Uppsala, Sweden; e-mail: malin.l.svensson@akademiska.se


This work was performed at the Department of Medical Sciences, Respiratory Medicine and Allergology, Uppsala University.

This work was supported by grants from the Swedish Heart Lung Foundation.

Dr. Svensson has no conflicts of interest to disclose. Dr. Franklin received $7,000 from Umeå University and $100,000 from the Swedish Heart Lung Foundation in 2007. Mrs. Theorell-Haglöw has no conflicts of interest to disclose. Dr. Lindberg has no conflicts of interest to disclose.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/misc/reprints.shtml).


Chest. 2008;134(5):919-924. doi:10.1378/chest.08-0847
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Objectives:  The aim was to investigate the significance of snoring and sleep apnea on daytime symptoms in a population-based sample of women.

Method:  From the general population, 400 women aged 20 to 70 years were randomly selected, with oversampling of habitually snoring women. The women were investigated using full-night polysomnography and a questionnaire. The apnea-hypopnea index (AHI) was calculated, and women who acknowledged snoring loudly and disturbingly often or very often were considered habitual snorers.

Results:  Habitual snoring was independently related to excessive daytime sleepiness (odds ratio [OR], 2.28; 95% confidence interval [CI], 1.31 to 3.99), to falling asleep involuntarily during the day (OR, 2.11; 95% CI, 1.06 to 4.21), to waking up unrefreshed (OR, 2.14; 95% CI, 1.30 to 3.52), to daytime fatigue (OR, 2.77; 95% CI, 1.54 to 4.99), and to a dry mouth on awakening (OR, 2.00; 95% CI, 1.22 to 3.27) after adjustment for AHI, age, body mass index (BMI), smoking, total sleep time, percentage of slow-wave sleep, and percentage of rapid eye movement (REM) sleep. An AHI ≥ 15/h was only related to a dry mouth on awakening after adjustment for snoring, age, BMI, smoking, total sleep time, percentage of slow-wave sleep, and percentage of REM sleep (OR, 2.24; 95% CI, 1.14 to 4.40). An AHI of 5 to 15/h was not related to any daytime symptom.

Conclusions:  Excessive daytime sleepiness and daytime fatigue are related to habitual snoring independent of the apnea-hypopnea frequency, age, obesity, smoking, and sleep parameters in a population-based sample of women, but not to the AHI. This indicates that snoring is an independent cause of excess daytime sleepiness and not merely a proxy for sleep apnea.

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