- Email: [email protected]
Snoring may be linked to culture
Medical Hypotheses 1
I
Medical Hypotheses (1994) 42, 24-26 0 Longman Gmup UK Ltd 1993
Snoring may be Linked to Culture R. A. HICKS, J. BAUTISTA and M. MCCULLOUGH Department of Psychology, San Jose State University, San Jose, CA 951924189, RAH).
USA (Reprint requests to
Abstract-The estimates of the incidence of snoring in adults that have been provided by four epidemiological studies vary from 1649% of the population. Collectively, these data are completely confounded by country of origin and thus may reflect cultural differences that contribute to snoring. While the etiology of snoring is not fully known, speculation has focused on gender and age as primary factors that contribute to this behavior. Within the limitations imposed by the designs of these four studies, we compared the relative strength of the relationships between snoring and gender, age, and culture. These analyses suggest that certain variables associated with cultures appear to be more salient than both gender and age, as determinants of snoring.
ing, conveying the meaning of ‘men asleep’, could attract females and scare away other males’. In reviewing this literature on snoring we were impressed by both the lack of validating evidence for these explanations of snoring and by the possibility that an alternative explanation of snoring, that seemed apparent in the existing data, had been overlooked. To elaborate, as is mentioned above, the estimates of incidence of self-reported snoring in adults differ substantially, i.e. range from 16-89% (1, 2, 5, 6). Apparently, the disparity in these reports of the incidence of snoring have either been ignored or dismissed as sampling error. However, a careful reading of each of these studies suggests another set of factors that may contribute to the incidence of snoring. Specifically, each of these studies was completed using large samples of adults in four different countries. Thus, the collective literature on the incidence of self-reported snoring is completely confounded by the cultural differences that may exist between these countries. As
Snoring is a common sleep-related behavior that some feel may be associated with cardiovascular diseases (e.g. (3, 4, 8)) but, surprisingly, very little is known about either the incidence or the etiology of this behaviour. For example, the estimates of the incidence of self-reported habitual and occasional snoring in adults range from 1689% of the population (1, 2, 5, 6) and recently, Perez-Padilla (7) suggested that the true incidence of snoring may even be higher. In his discussion of the etiology of snoring, without confirming data, Perez-Padilla stated that the prevalence of snoring is ‘much higher’ for men than for women and ‘explained’ this presumption by arguing that ‘snoring can be interpreted as a masculine secondary sexual characteristic’. In developing this hypothesis, Perez-Padilla acknowledged that snoring seemed to be positively correlated with both age and obesity, but he failed to specify how these variables were integrated into his theory that snoring had evolved in men as a method of ‘..., in other times snorDate received
10 May 1993
Date accepted 24 June 1993
24
25
SNORING MAY BE LINKED TO CULTURE
a means of expressing the relative salience of this variable and the more commonly ascribed causes of snoring, i.e. age and gender, we computed as best we could, the relationships between each of these variables and the distributions of the severity of snoring that were reported in the aforementioned studies.
Table 2 The frequency of self-reported Koskenvuo
et al (5)
Age group
Habitual
40-49 years SO-59 years 60+ years
Snoring and gender Two of the epidemilogical studies under consideration reported the incidence of snoring for both men and women (2,6). However, only one of these (2) reported these data in sufficient detail so that the response distributions for men and women could be compared statistically. This set of distributions is summarized in Table 1.
level of snoring for
Finnish men in three age groups as derived from a study by
598 496 200
Level of snoring Occasional Never 1344 921 349
260 131 89
Total 2202 1548 638
th’IS relationship is relatively low (Q’ = 0.054) and the snoring was slightly less prevalent among the oldest group, i.e. a finding which is inconsistent with the hypothesis that snoring increases as a function of age. Snoring and culture
Table 1 The frequency
of self-reported level of snoring for American male and female university students as derived from a study by Hicks (2)
Gender group Men Women
Habitual
Frequent
26 16
32 20
Level of snoring Occasional Seldom 50 38
97 85
Never
Total
151 234
356 393
To measure the relationship between culture and snoring, we included the data that were the same for all four samples. That is, we used only the responses of men to the question ‘I snore during my sleep’ who classified themselves as either habitual, occasional or non-snorers, (these response alternatives were the three that were common to all four studies). This set of distributions is summarized in Table 3.
As can be seen from this table, the majority (51.4%) of these young adults (all were American college students) reported that they never snore and only 24.2% classified themselves as either occasional, frequent, or habitual snorers. The difference between these response distributions for men and women is significant (x;! (4) = 23.70, p
Table 3 The frequency of self-reported
Snoring and age
This difference between these response distributions for these samples drawn from four different countries is significant (Xz (6) = 2127.28, p
Two of these four epidemiological studies (5, 6) reported the incidence of snoring as a function of age. However, only one study (5) reported these data (for men only) in sufficient detail so that the response distributions for three age groups of men could be compared statistically. This set of distributions is summarized in Table 2. As can be seen from this table, the majority of these older Finnish men (89.1%) classified themselves as either occasional or frequent snorers and only 10.9% stated they never snore. The difference between these response distributions for these age groups is significant (x;! (4) = 25.61, p
level of snoring for men
from four countries Origin of the sample (study) San Marino (6) Finland (5) Sweden (1) United States (2)
Habitual 688 1294 487 26
Level of snoring Occasional Never 480 2614 928 179
1688 480 719 151
Total 2856 4388 2134 356
MEDICAL HYPOTHESES
26 Acknowledgement
3.
In part, the research that formed the basis for this paper was supported by NIH-MBRS Grant 08192-13 (to RAH) and a grant from the San Jose State University Foundation’s Graduate Student Stipend Program (to MM).
4.
5.
6. 1.
2.
Gislason T, Aberg H, Taube A. Snoring and systematic hypertension: an epidemiological study. Acta Medica Scandinavica 1987; 222: 415-421. Hicks R A. Incidence and severity of self-reported snoring in male and female college students. Perceptual and Motor Skills 1992: 74: 770.
7. 8.
Hoffstein V, Rubinstein I, Mateika S, Slutsky A S. Determinants of blood pressure in snorers. Lancet 1988; 2: 992-994. Koskenvuo M, Kaprio J, Pardnen M, Langinvainio H, Sarna S, Heikkila K. Snoring as a risk factor for hypertension and angina pectoris. Lancet 1985; 1: 893-896. Koskenvuo M, Kaprio J, Telaviki T, Pertinen M, Heikkila K, Santa S. Snoring as a risk factor for ischaemic heart disease and stroke in men. BMJ 1987; 294: 16-19. Lugamsi E, Cirignotta F, Coccagna G, Piana C. Some epidemiologicai data on snoring and cardiocirculatory disturbances. Sleep 1980; 3: 221-224. Perez-Padilla R. Why do humans snore so commonly? Association of Professional Sleep Societies Newsletter 1991; 6: 37. Waller P C, Bhopal R S. Is snoring a cause of vascular disease? Lancet 1989; I: 143-146.
I
Medical Hypotheses (1994) 42, 24-26 0 Longman Gmup UK Ltd 1993
Snoring may be Linked to Culture R. A. HICKS, J. BAUTISTA and M. MCCULLOUGH Department of Psychology, San Jose State University, San Jose, CA 951924189, RAH).
USA (Reprint requests to
Abstract-The estimates of the incidence of snoring in adults that have been provided by four epidemiological studies vary from 1649% of the population. Collectively, these data are completely confounded by country of origin and thus may reflect cultural differences that contribute to snoring. While the etiology of snoring is not fully known, speculation has focused on gender and age as primary factors that contribute to this behavior. Within the limitations imposed by the designs of these four studies, we compared the relative strength of the relationships between snoring and gender, age, and culture. These analyses suggest that certain variables associated with cultures appear to be more salient than both gender and age, as determinants of snoring.
ing, conveying the meaning of ‘men asleep’, could attract females and scare away other males’. In reviewing this literature on snoring we were impressed by both the lack of validating evidence for these explanations of snoring and by the possibility that an alternative explanation of snoring, that seemed apparent in the existing data, had been overlooked. To elaborate, as is mentioned above, the estimates of incidence of self-reported snoring in adults differ substantially, i.e. range from 16-89% (1, 2, 5, 6). Apparently, the disparity in these reports of the incidence of snoring have either been ignored or dismissed as sampling error. However, a careful reading of each of these studies suggests another set of factors that may contribute to the incidence of snoring. Specifically, each of these studies was completed using large samples of adults in four different countries. Thus, the collective literature on the incidence of self-reported snoring is completely confounded by the cultural differences that may exist between these countries. As
Snoring is a common sleep-related behavior that some feel may be associated with cardiovascular diseases (e.g. (3, 4, 8)) but, surprisingly, very little is known about either the incidence or the etiology of this behaviour. For example, the estimates of the incidence of self-reported habitual and occasional snoring in adults range from 1689% of the population (1, 2, 5, 6) and recently, Perez-Padilla (7) suggested that the true incidence of snoring may even be higher. In his discussion of the etiology of snoring, without confirming data, Perez-Padilla stated that the prevalence of snoring is ‘much higher’ for men than for women and ‘explained’ this presumption by arguing that ‘snoring can be interpreted as a masculine secondary sexual characteristic’. In developing this hypothesis, Perez-Padilla acknowledged that snoring seemed to be positively correlated with both age and obesity, but he failed to specify how these variables were integrated into his theory that snoring had evolved in men as a method of ‘..., in other times snorDate received
10 May 1993
Date accepted 24 June 1993
24
25
SNORING MAY BE LINKED TO CULTURE
a means of expressing the relative salience of this variable and the more commonly ascribed causes of snoring, i.e. age and gender, we computed as best we could, the relationships between each of these variables and the distributions of the severity of snoring that were reported in the aforementioned studies.
Table 2 The frequency of self-reported Koskenvuo
et al (5)
Age group
Habitual
40-49 years SO-59 years 60+ years
Snoring and gender Two of the epidemilogical studies under consideration reported the incidence of snoring for both men and women (2,6). However, only one of these (2) reported these data in sufficient detail so that the response distributions for men and women could be compared statistically. This set of distributions is summarized in Table 1.
level of snoring for
Finnish men in three age groups as derived from a study by
598 496 200
Level of snoring Occasional Never 1344 921 349
260 131 89
Total 2202 1548 638
th’IS relationship is relatively low (Q’ = 0.054) and the snoring was slightly less prevalent among the oldest group, i.e. a finding which is inconsistent with the hypothesis that snoring increases as a function of age. Snoring and culture
Table 1 The frequency
of self-reported level of snoring for American male and female university students as derived from a study by Hicks (2)
Gender group Men Women
Habitual
Frequent
26 16
32 20
Level of snoring Occasional Seldom 50 38
97 85
Never
Total
151 234
356 393
To measure the relationship between culture and snoring, we included the data that were the same for all four samples. That is, we used only the responses of men to the question ‘I snore during my sleep’ who classified themselves as either habitual, occasional or non-snorers, (these response alternatives were the three that were common to all four studies). This set of distributions is summarized in Table 3.
As can be seen from this table, the majority (51.4%) of these young adults (all were American college students) reported that they never snore and only 24.2% classified themselves as either occasional, frequent, or habitual snorers. The difference between these response distributions for men and women is significant (x;! (4) = 23.70, p
Table 3 The frequency of self-reported
Snoring and age
This difference between these response distributions for these samples drawn from four different countries is significant (Xz (6) = 2127.28, p
Two of these four epidemiological studies (5, 6) reported the incidence of snoring as a function of age. However, only one study (5) reported these data (for men only) in sufficient detail so that the response distributions for three age groups of men could be compared statistically. This set of distributions is summarized in Table 2. As can be seen from this table, the majority of these older Finnish men (89.1%) classified themselves as either occasional or frequent snorers and only 10.9% stated they never snore. The difference between these response distributions for these age groups is significant (x;! (4) = 25.61, p
level of snoring for men
from four countries Origin of the sample (study) San Marino (6) Finland (5) Sweden (1) United States (2)
Habitual 688 1294 487 26
Level of snoring Occasional Never 480 2614 928 179
1688 480 719 151
Total 2856 4388 2134 356
MEDICAL HYPOTHESES
26 Acknowledgement
3.
In part, the research that formed the basis for this paper was supported by NIH-MBRS Grant 08192-13 (to RAH) and a grant from the San Jose State University Foundation’s Graduate Student Stipend Program (to MM).
4.
5.
6. 1.
2.
Gislason T, Aberg H, Taube A. Snoring and systematic hypertension: an epidemiological study. Acta Medica Scandinavica 1987; 222: 415-421. Hicks R A. Incidence and severity of self-reported snoring in male and female college students. Perceptual and Motor Skills 1992: 74: 770.
7. 8.
Hoffstein V, Rubinstein I, Mateika S, Slutsky A S. Determinants of blood pressure in snorers. Lancet 1988; 2: 992-994. Koskenvuo M, Kaprio J, Pardnen M, Langinvainio H, Sarna S, Heikkila K. Snoring as a risk factor for hypertension and angina pectoris. Lancet 1985; 1: 893-896. Koskenvuo M, Kaprio J, Telaviki T, Pertinen M, Heikkila K, Santa S. Snoring as a risk factor for ischaemic heart disease and stroke in men. BMJ 1987; 294: 16-19. Lugamsi E, Cirignotta F, Coccagna G, Piana C. Some epidemiologicai data on snoring and cardiocirculatory disturbances. Sleep 1980; 3: 221-224. Perez-Padilla R. Why do humans snore so commonly? Association of Professional Sleep Societies Newsletter 1991; 6: 37. Waller P C, Bhopal R S. Is snoring a cause of vascular disease? Lancet 1989; I: 143-146.