Snoring sound characteristics are associated with common carotid artery profiles in patients with obstructive sleep apnea

Hai Hua Chuang, Chi Hung Liu, Chao Yung Wang, Yu Lun Lo, Guo She Lee, Yi Ping Chao, Hsueh Yu Li, Terry B.J. Kuo, CHeryl C.H. Yang, Liang Yu Shyu, Li Ang Lee*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

2 Scopus citations


Background: Obstructive sleep apnea (OSA) and snoring have been reported to be modifiable risk factors for thick carotid intima-media thickness (CIMT) and carotid atherosclerosis, which are closely linked to cardiovascular disease. Methods: This cross-sectional study prospectively recruited 70 participants with OSA and without a history of carotid artery disorder, who primarily sought surgical Intervention. OSA and snoring were assessed with the Epworth Sleepiness Scale, Snore Outcomes Survey, polysomnography, and snoring sound recording. The carotid arteries were evaluated with ultrasonography and divided into three types of carotid artery profiles (normal carotid artery, thick CIMT, or significant carotid atherosclerosis). Multivariate linear/logistic/categorical regressions were performed with the forward selection approaches/logistic least absolute shrinkage and selection operator, as appropriate. Results: Normalized snoring sound energy (301–850 Hz) was independently associated with the carotid intima-media thickness (regression coefficient [β] = 0.01, standard error [SE] = 0.004, P = 0.03; R2 = 0.067) and type of carotid profile (β = 0.40, SE = 0.09, P < 0.001; R2 = 0.156). Normalized snoring sound energy (4–300 Hz) (β = −0.10, SE = 0.04, P = 0.01) and female sex (β = 1.90, SE = 0.94, P = 0.04) were independently related to the presence of carotid stenosis (R2 = 0.159). The optimal regression model of the type of carotid artery profile included normalized snoring sound energy (301–850 Hz) (β = 0.33, SE = 0.14, P = 0.03), snoring time (β = 0.26, SE = 0.13, P = 0.047), female sex (β = 0.26, SE = 0.13, P = 0.047), and increased age (β = 0.20, SE = 0.10, P = 0.04) under the control of the Snore Outcomes Survey score, 3% oxygen desaturation index, snoring sound energy (4–1500 Hz), normalized snoring sound energy (851–1500 Hz), cigarette smoking, and hyperlipidemia (R2 = 0.427). Conclusion: Our findings suggested that snoring sound characteristics are associated with carotid artery profiles among early OSA patients who cannot be noticed by ultrasound because organic changes of the carotid artery have not yet started. Future studies are warranted to verify the clinical significance of the results.

Original languageEnglish
Pages (from-to)1243-1255
Number of pages13
JournalNature and Science of Sleep
StatePublished - Jul 2021


  • Atherosclerosis
  • Categorical regression
  • Common carotid artery
  • Obstructive sleep apnea
  • Snoring
  • Ultrasound


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