Causal associations of sleep apnea, snoring with cardiovascular diseases, and the role of body mass index: a two-sample Mendelian randomization study

Jan 7, 2023European journal of preventive cardiology

Sleep apnea and snoring linked to heart diseases and how body weight may influence this relationship

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Abstract

Among 523,366 individuals, sleep apnea and snoring increased the risk of hypertension and coronary artery disease with odds ratios of 1.03 and 1.41, respectively.

Sleep apnea and snoring are associated with an increased risk of hypertension and coronary artery disease.
The odds ratios for hypertension were 1.03 for sleep apnea and 1.05 for snoring.
For coronary artery disease, the odds ratios were 1.41 for sleep apnea and 1.61 for snoring.
Adjusting for body mass index significantly reduced the strength of these associations.
No associations were found between sleep apnea or snoring and atrial fibrillation, heart failure, or stroke.
There may be a reverse association where hypertension increases the risk of sleep apnea, though this finding was not statistically significant.

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AIMS: Previously, observational studies have identified associations between sleep apnea (SA) and cardiovascular diseases (CVDs), whereas whether the associations are causal remain unclear.

METHODS AND RESULTS: We used the bi-directional, two-sample Mendelian randomization (MR) study to assess the existence and direction of the causal relationship between SA or snoring and CVDs. Multivariable MR (MVMR) was used to assess the direct effect of SA on CVDs after adjusting for body mass index (BMI). Single-nucleotide polymorphisms (SNPs) associated with SA and snoring were obtained from the latest genome-wide association study, which combined five cohorts with a total number of 25 008 SA cases and 172 050 snoring cases (total = 523 366). Among the analytic sample of 523 366 individuals (25 008 SA cases and 172 050 snoring cases), and after correcting for multiple testing, inverse-variance weighted (IVW) showed that SA and snoring increased the risk of hypertension [odds ratio (OR) = 1.03, 95% CI 1.02-1.05 and 1.05, 1.03-1.07], and coronary artery disease (CAD) (1.41,1.19-1.67 and 1.61,1.26-2.07) with all false-discovery rate (FDR) < 0.05, but such associations were decreased dramatically after adjusting for BMI using MVMR-IVW (0.06 < FDRBMI adjusted < 0.20). SA and snoring were not associated with atrial fibrillation (AF), heart failure (HF), or stroke. The presence of hypertension may increase the risk of SA (1.53, 1.04-2.25), but this association did not pass multiple comparisons (FDR > 0.05).

DISCUSSION: Our results suggest that SA and snoring increased the risk of hypertension and CAD, and these associations may partly be driven by BMI. Conversely, no evidence of CVDs causally influencing SA or snoring was found.

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Causal associations of sleep apnea, snoring with cardiovascular diseases, and the role of body mass index: a two-sample Mendelian randomization study

Abstract

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