Association Between Self-Reported Snoring and Metabolic Syndrome: A Systematic Review and Meta-Analysis

Background: Snoring is a common condition. Previous studies have reported the relationships between snoring and metabolic syndrome (MetS) and/or its five components: hypertension, hyperglycemia, low-high density lipoprotein (low-HDL), high-triglyceride level, and abdominal obesity. However, conclusions have been inconsistent, and there has been no comprehensive summary on this. Therefore, we performed a systematic review on the relationships between snoring and MetS, including each of MetS' components. Methods: A systematic review and a meta-analysis were conducted following the Meta-analysis of Observational Studies in Epidemiology group and Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines. Electronic databases including PubMed, Embase, and the Cochrane Library were searched for publications from inception to 15 July 2020. The inverse-variance weighted method was used in the meta-analysis to calculate the pooled odds ratios (ORs) and their 95% confidence intervals (CIs) to determine the association between snoring and MetS (and its components) through a fixed or random effect model. A restricted cubic spline regression model and the linear regression model were used in a two-stage dose-response meta-analysis to evaluate the non-linear and the linear trends between snoring frequency and MetS and its components. Results: A total of 40 studies with 966,652 participants were included in this study. The pooled ORs between snoring and MetS and its components, hypertension, hyperglycemia, low-HDL, high-triglyceride level, and abdominal obesity, were 1.61 (95% CI, 1.43-1.78), 1.23 (95% CI, 1.15-1.31), 1.05 (95% CI, 1.04-1.07), 1.09 (95% CI, 1.00-1.18), 1.08 (95% CI, 1.00-1.17), and 1.75 (95% CI, 1.46-2.05), respectively. Non-linear trends were detected in the five associations except for low-HDL. A linear trend was detected in the association of snoring with hypertension, hyperglycemia, low-HDL, or abdominal obesity, with ORs of 1.07 (95% CI, 1.01-1.13), 1.05 (95% CI, 1.02-1.08), 1.03 (95% CI, 1.02-1.04), and 1.17 (95% CI, 1.16-2.89), respectively. Conclusion: Snoring was a risk factor of MetS, and a dose-response relationship existed between the two. Timely intervention in identifying snorers can minimize as much as possible the risk of metabolic syndrome in those who snore.