The Relation of Carotid Arteries' Intima-Media Thickness With Snoring and Obstructive Sleep Apnea in Type 2 Diabetes Patients

  • Leila Ghofraniha Department of Lung Diseases, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran.
  • Mahnaz Amini Department of Lung Diseases, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran.
  • Yasamin Davoudi Department of Radiology, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran.
  • Saeed Eslami School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran.
  • Parvin Layegh Department of Endocrinology, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran.
  • Zahra Lotfi Department of Nephrology, Imam Reza Hospital Mashhad University of Medical Sciences, Mashhad, Iran.
  • Farnoush Firouzi Mail Department of Internal Medicine, Students’ Research Committee, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran.
  • Samaneh Khajehnasiri Department of Radiology, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran.
Intima-media thickness of carotid arteries, Snoring, Type 2 diabetes


In recent decades, the relation of carotid artery intima-media thickness (IMT) as a marker of atherosclerosis with snoring and sleep disorders has been drawing attention. The aim of this study was to evaluate the relation of carotid arteries IMT with snoring in type 2 diabetic patients. This cross-sectional study was performed on type 2 diabetes patients referring to Mashhad University of Medical Sciences' clinics. The stop Bang, Epworth sleepiness scale, and Stanford questionnaires were used for evaluation of daily sleepiness and snoring. For assessment of carotid artery thickness, Madison X8 ultrasound with 10 MHz superficial probes was utilized. The data were entered into SPSS software, and then the ANOVA test with Turkey, chi-square comparison technique, and Kruskal Wallis with Mann-Whitney U technique was used. The level of significance was considered P≤0.05. In total 80 patients (37 snorers and 43 non-snorers) entered the study. The mean carotid artery IMT in the group of snoring patients (0.72±0.17) was significantly higher than non-snorers (0.56±0.17) (P<0.001). Frequency of daily based on Stanford and ESS questionnaires was 23.8% and 39.2%. The association of sleepiness and snoring was confirmed by Stanford and ESS questionnaires with P=0.026 and P=0.007. Patients with higher risk of apnea had higher thickness of the mean carotid artery IMT (P<0.001). The mean carotid artery IMT had a positive significant relation with age (P=0.002), serum creatinine level (P<0.002), blood cholesterol (P=0.02) and HbAIC level (P=0.04). Findings of this study provides evidence on the relation of carotid artery IMT in diabetic patients with snoring independent of other effective factors. Also, results showed that snoring is associated with increased daily sleepiness and patients with higher risk of apnea had higher thickness of the mean carotid artery IMT.


Bullon P, Newman HN, Battino M. Obesity, diabetes mellitus, atherosclerosis and chronic periodontitis: a shared pathology via oxidative stress and mitochondrial dysfunction? Periodontology 2000;64:139-53.

Diagnosis and Classification of Diabetes Mellitus. Diabetes Care 2012;35:S64-71.

Syed Ikmal SIQ, Zaman Huri H, Vethakkan SR, Wan Ahmad WA. Potential Biomarkers of Insulin Resistance and Atherosclerosis in Type 2 Diabetes Mellitus Patients with Coronary Artery Disease. Int J Endocrinol 2013;2013:11.

Federici M, Menghini R, Mauriello A, Hribal ML, Ferrelli F, Lauro D, et al. Insulin-dependent activation of endothelial nitric oxide synthase is impaired by O-linked glycosylation modification of signaling proteins in human coronary endothelial cells. Circulation 2002;106:466-72.

Uemura S, Matsushita H, Li W, Glassford AJ, Asagami T, Lee KH, et al. Diabetes mellitus enhances vascular matrix metalloproteinase activity: role of oxidative stress. Circ Res 2001;88(:1291-8.

Kadoglou NPE, Fotiadis G, Kapelouzou A, Kostakis A, Liapis CD, Vrabas IS. The differential anti-inflammatory effects of exercise modalities and their association with early carotid atherosclerosis progression in patients with Type 2 diabetes. Diabet Med 2013;30:e41-50.

Kadoglou NP, Sailer N, Moumtzouoglou A, Kapelouzou A, Tsanikidis H, Vitta I, et al. Visfatin (nampt) and ghrelin as novel markers of carotid atherosclerosis in patients with type 2 diabetes. Exp Clin Endocrinol Diabetes 2010;118:75-80.

Rohrmeier C, Herzog M, Ettl T, Kuehnel TS. Distinguishing snoring sounds from breath sounds: a straightforward matter? Sleep Breath 2014;18:169-76.

Young T, Peppard PE, Gottlieb DJ. Epidemiology of obstructive sleep apnea: a population health perspective. Am J Respir Crit Care Med 2002;165:1217-39.

Young T, Finn L, Hla KM, Morgan B, Palta M. Snoring as part of a dose-response relationship between sleep-disordered breathing and blood pressure. Sleep 1996;19:S202-5.

Hu FB, Willett WC, Manson JE, Colditz GA, Rimm EB, Speizer FE, et al. Snoring and risk of cardiovascular disease in women. JACC 2000;35:308-13.

Al-Delaimy WK, Manson JE, Willett WC, Stampfer MJ, Hu FB. Snoring as a risk factor for type II diabetes mellitus: a prospective study. Am J Epidemiol 2002;155:387-93.

Leineweber C, Kecklund G, Akerstedt T, Janszky I, Orth-Gomer K. Snoring and the metabolic syndrome in women. Sleep Med 2003;4:531-6.

Lee GS, Lee LA, Wang CY, Chen NH, Fang TJ, Huang CG, et al. The Frequency and Energy of Snoring Sounds Are Associated with Common Carotid Artery Intima-Media Thickness in Obstructive Sleep Apnea Patients. SciRep 2016;6:30559.

Amatoury J, Howitt L, Wheatley JR, Avolio AP, Amis TC. Snoring-related energy transmission to the carotid artery in rabbits. J Appl Physiol 2006;100:1547-53.

Li Y, Liu J, Wang W, Yong Q, Zhou G, Wang M, et al. Association of self-reported snoring with carotid artery intima-media thickness and plaque. J Sleep Res 2012;21:87-93.

Apaydin M, Ayik SO, Akhan G, Peker S, Uluc E. Carotid intima-media thickness increase in patients with habitual simple snoring and obstructive sleep apnea syndrome is associated with metabolic syndrome. JCU 2013;41:290-6.

Lee SA, Amis TC, Byth K, Larcos G, Kairaitis K, Robinson TD, et al. Heavy snoring as a cause of carotid artery atherosclerosis. Sleep 2008;31:1207-13.

Kim J, Pack AI, Riegel BJ, Chirinos JA, Hanlon A, Lee SK, et al. Objective snoring time and carotid intima-media thickness in non-apneic female snorers. J Sleep Res 2017;26:147-150.

Mason RH, Mehta Z, Fonseca AC, Stradling JR, Rothwell PM. Snoring and severity of symptomatic and asymptomatic carotid stenosis: a population-based study. Sleep 2012;35:1147-51.

Jacoby SC. Association of Habitual Snoring with Carotid Intima-Media Thickness in Young Men. Public university in Harrisonbur [Dissertation]. Virginia: James Madison Univ., 2013.

Kim J, Pack A, Maislin G, Lee SK, Kim SH, Shin C. Prospective observation on the association of snoring with subclinical changes in carotid atherosclerosis over four years. Sleep Med 2014;15:769-75.

Lee YH, Kweon SS, Choi BY, Kim MK, Chun BY, Shin DH, et al. Self-reported snoring and carotid atherosclerosis in middle-aged and older adults: the Korean Multi-Rural Communities Cohort Study. J Epidemiol 2014;24:281-6.

Polak JF, Backlund J-YC, Cleary PA, Harrington AP, O’Leary DH, Lachin JM, et al. Progression of Carotid Artery Intima-Media Thickness During 12 Years in the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) Study. Diabetes 2011;60:607-13.

Su T-C, Chien K-L, Jeng J-S, Chen M-F, Hsu H-C, Torng P-L, et al. Age-and Gender-Associated Determinants of Carotid Intima-Media Thickness: A Community-Based Study. J Atheroscler Thromb 2012;19:872-80.

Homma S, Hirose N, Ishida H, Ishii T, Araki G. Carotid Plaque and Intima-Media Thickness Assessed by B-Mode Ultrasonography in Subjects Ranging From Young Adults to Centenarians. Stroke 2001;32:830-5.

Svensson M, Franklin KA, Theorell-Haglöw J, Lindberg E. DAytime sleepiness relates to snoring independent of the apnea-hypopnea index in women from the general population. Chest 2008;134:919-24.

Choi JB, Nelesen R, Loredo JS, Mills PJ, Ancoli-Israel S, Ziegler MG, et al. Sleepiness in obstructive sleep apnea: a harbinger of impaired cardiac function? Sleep 2006;29:1531-6.

Minoguchi K, Yokoe T, Tazaki T, Minoguchi H, Tanaka A, Oda N, et al. Increased carotid intima-media thickness and serum inflammatory markers in obstructive sleep apnea. Am J Respir Crit Care Med 2005;172:625-30.

Nathan DM, Lachin J, Cleary P, Orchard T, Brillon DJ, Backlund JY. Intensive Diabetes Therapy and Carotid Intima–Media Thickness in Type 1 Diabetes Mellitus. N Engl J Med 2003;348:2294-303.

How to Cite
Ghofraniha L, Amini M, Davoudi Y, Eslami S, Layegh P, Lotfi Z, Firouzi F, Khajehnasiri S. The Relation of Carotid Arteries’ Intima-Media Thickness With Snoring and Obstructive Sleep Apnea in Type 2 Diabetes Patients. Acta Med Iran. 55(12):765-771.