ORIGINAL ARTICLE
Joint effects of body mass index, exercise, and alcohol
drinking on the development of snoring
Soo J KIM,
1
Inkyung BAIK,
2
Jehyeong KIM,
3,4
Kihwan JUNG,
3,4
Seung H LEE,
3,5
Se J KIM
3,4
and
Chol SHIN
3,4,6
1
Department of Occupational and Environmental Medicine, Ajou University School of Medicine, Suwon, and
2
Department of Food and Nutrition, College of Natural Sciences, Kookmin University, and
3
College of Medicine,
Korea University, Seoul, and Departments of
4
Internal Medicine and
5
Otolaryngology-Head and Neck Surgery,
Korea University Ansan Hospital, and
6
Institute of Human Genomic Study, Korea University Ansan Hospital,
Ansan, Korea
Abstract
Obesity is consistently reported to have a positive association with the development of habitual
snoring. Whether lifestyle factors modify the association between body weight and the future risk of
snoring has not been examined. In a prospective cohort study, we evaluated the association of
lifestyle factors and body mass index (BMI) with the development of snoring. The study population
(497 men and 670 women aged 40–69 years) were drawn from an ongoing population-based cohort.
At baseline, all participants were free of cardiovascular disease and snoring at night. Information on
lifestyle factors and snoring frequencies was obtained from interviewer-based questionnaires.
During the 4-year follow-up, 533 participants reported new onset snoring. After adjusting for age,
sex, and other potential risk factors, overweight persons with a BMI of 25 kg/m
2
were found to
have a 48% excess (95% confidence interval, 10% to 100%) in the odds of developing snoring
compared with those with a BMI of <23 kg/m
2
. In particular, we found that alcohol drinking and
frequent exercise modify the association between BMI and the development of snoring; alcohol
drinkers showed a stronger association than abstainers and persons who did not frequently exercise
showed a stronger association than those exercising 4 days per week. We observed that even
overweight persons who drink alcohol or do not exercise frequently had a higher chance of
becoming snorers. Further evaluations are warranted to confirm whether abstaining from alcohol
and frequent exercise can help prevent future snoring.
Key words: alcohol, body mass index, exercise, sleep-disordered breathing, smoking.
INTRODUCTION
Snoring is a prevalent sleep-associated disorder in the
general population
1
and is reportedly associated not
only with minor health problems, such as excessive
daytime sleepiness
2
and morning headaches,
3
but also
with the risk of more serious diseases, including chronic
bronchitis, hypertension, and cardiovascular disease,
4–10
and mortality.
11
A number of epidemiologic studies have
sought to identify determinants of the development of
snoring and found a positive association of body weight
with prevalence and incidence of snoring.
12–16
Among
these studies, furthermore, some have explored whether
lifestyle factors, such as cigarette smoking, alcohol
drinking, and exercise, play a role in the development of
Correspondence: Dr Chol Shin MD, PhD, Division of
Pulmonary and Critical Care Medicine, Department of
Internal Medicine, Korea University Ansan Hospital, 516,
Gojan-1-dong, Danwon-gu, Ansan, Gyeonggi-do, 425-707,
Korea. Email: shinchol@pol.net
Accepted for publication 31 January 2010
Sleep and Biological Rhythms 2010; 8: 144–150 doi:10.1111/j.1479-8425.2010.00441.x
144 © 2010 The Authors
Journal compilation © 2010 Japanese Society of Sleep Research