The Lancet Regional Health. Western Pacific (Mar 2024)

Causal association between snoring and stroke: a Mendelian randomization study in a Chinese populationResearch in context

  • Yunqing Zhu,
  • Zhenhuang Zhuang,
  • Jun Lv,
  • Dianjianyi Sun,
  • Pei Pei,
  • Ling Yang,
  • Iona Y. Millwood,
  • Robin G. Walters,
  • Yiping Chen,
  • Huaidong Du,
  • Xianping Wu,
  • Dan Schmidt,
  • Daniel Avery,
  • Junshi Chen,
  • Zhengming Chen,
  • Liming Li,
  • Canqing Yu,
  • Junshi Chen,
  • Zhengming Chen,
  • Robert Clarke,
  • Rory Collins,
  • Yu Guo,
  • Liming Li,
  • Jun Lv,
  • Richard Peto,
  • Robin Walter,
  • Daniel Avery,
  • Derrick Bennett,
  • Ruth Boxall,
  • Sue Burgess,
  • Ka Hung Chan,
  • Yumei Chang,
  • Yiping Chen,
  • Zhengming Chen,
  • Johnathan Clarke,
  • Robert Clarke,
  • Huaidong Du,
  • Ahmed Edris Mohamed,
  • Zammy Fairhurst-Hunter,
  • Hannah Fry,
  • Mike Hill,
  • Michael Holmes,
  • Pek Kei Im,
  • Andri Iona,
  • Maria Kakkoura,
  • Christiana Kartsonaki,
  • Rene Kerosi,
  • Kuang Lin,
  • Mohsen Mazidi,
  • Iona Millwood,
  • Sam Morris,
  • Qunhua Nie,
  • Alfred Pozarickij,
  • Paul Ryder,
  • Saredo Said,
  • Dan Schmidt,
  • Paul Sherliker,
  • Becky Stevens,
  • Iain Turnbull,
  • Robin Walters,
  • Lin Wang,
  • Neil Wright,
  • Ling Yang,
  • Xiaoming Yang,
  • Pang Yao,
  • Yu Guo,
  • Xiao Han,
  • Can Hou,
  • Jun Lv,
  • Pei Pei,
  • Chao Liu,
  • Canqing Yu,
  • Qingmei Xia,
  • Zengchang Pang,
  • Ruqin Gao,
  • Shanpeng Li,
  • Haiping Duan,
  • Shaojie Wang,
  • Yongmei Liu,
  • Ranran Du,
  • Yajing Zang,
  • Liang Cheng,
  • Xiaocao Tian,
  • Hua Zhang,
  • Yaoming Zhai,
  • Feng Ning,
  • Xiaohui Sun,
  • Feifei Li,
  • Silu Lv,
  • Junzheng Wang,
  • Wei Hou,
  • Wei Sun,
  • Shichun Yan,
  • Xiaoming Cui,
  • Chi Wang,
  • Zhenyuan Wu,
  • Yanjie Li,
  • Quan Kang,
  • Huiming Luo,
  • Tingting Ou,
  • Xiangyang Zheng,
  • Zhendong Guo,
  • Shukuan Wu,
  • Yilei Li,
  • Huimei Li,
  • Ming Wu,
  • Yonglin Zhou,
  • Jinyi Zhou,
  • Ran Tao,
  • Jie Yang,
  • Jian Su,
  • Fang Liu,
  • Jun Zhang,
  • Yihe Hu,
  • Yan Lu,
  • Liangcai Ma,
  • Aiyu Tang,
  • Shuo Zhang,
  • Jianrong Jin,
  • Jingchao Liu,
  • Mei Lin,
  • Zhenzhen Lu,
  • Lifang Zhou,
  • Changping Xie,
  • Jian Lan,
  • Tingping Zhu,
  • Yun Liu,
  • Liuping Wei,
  • Liyuan Zhou,
  • Ningyu Chen,
  • Yulu Qin,
  • Sisi Wang,
  • Xianping Wu,
  • Ningmei Zhang,
  • Xiaofang Chen,
  • Xiaoyu Chang,
  • Mingqiang Yuan,
  • Xia Wu,
  • Xiaofang Chen,
  • Wei Jiang,
  • Jiaqiu Liu,
  • Qiang Sun,
  • Faqing Chen,
  • Xiaolan Ren,
  • Caixia Dong,
  • Hui Zhang,
  • Enke Mao,
  • Xiaoping Wang,
  • Tao Wang,
  • Xi zhang,
  • Kai Kang,
  • Shixian Feng,
  • Huizi Tian,
  • Lei Fan,
  • XiaoLin Li,
  • Huarong Sun,
  • Pan He,
  • Xukui Zhang,
  • Min Yu,
  • Ruying Hu,
  • Hao Wang,
  • Xiaoyi Zhang,
  • Yuan Cao,
  • Kaixu Xie,
  • Lingli Chen,
  • Dun Shen,
  • Xiaojun Li,
  • Donghui Jin,
  • Li Yin,
  • Huilin Liu,
  • Zhongxi Fu,
  • Xin Xu,
  • Hao Zhang,
  • Jianwei Chen,
  • Yuan Peng,
  • Libo Zhang,
  • Chan Qu

Journal volume & issue
Vol. 44
p. 101001

Abstract

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Summary: Background: Previous observational studies established a positive relationship between snoring and stroke. We aimed to investigate the causal effect of snoring on stroke. Methods: Based on 82,339 unrelated individuals with qualified genotyping data of Asian descent from the China Kadoorie Biobank (CKB), we conducted a Mendelian randomization (MR) analysis of snoring and stroke. Genetic variants identified in the genome-wide association analysis (GWAS) of snoring in CKB and UK Biobank (UKB) were selected for constructing genetic risk scores (GRS). A two-stage method was applied to estimate the associations of the genetically predicted snoring with stroke and its subtypes. Besides, MR analysis among the non-obese group (body mass index, BMI <24.0 kg/m2), as well as multivariable MR (MVMR), were performed to control for potential pleiotropy from BMI. In addition, the inverse-variance weighted (IVW) method was applied to estimate the causal association with genetic variants identified in CKB GWAS. Findings: Positive associations were found between snoring and total stroke, hemorrhagic stroke (HS), and ischemic stroke (IS). With GRS of CKB, the corresponding HRs (95% CIs) were 1.56 (1.15, 2.12), 1.50 (0.84, 2.69), 2.02 (1.36, 3.01), and the corresponding HRs (95% CIs) using GRS of UKB were 1.78 (1.30, 2.43), 1.94 (1.07, 3.52), and 1.74 (1.16, 2.61). The associations remained stable in the MR among the non-obese group, MVMR analysis, and MR analysis using the IVW method. Interpretation: This study suggests that, among Chinese adults, genetically predicted snoring could increase the risk of total stroke, IS, and HS, and the causal effect was independent of BMI. Funding: National Natural Science Foundation of China, Kadoorie Charitable Foundation Hong Kong, UK Wellcome Trust, National Key R&D Program of China, Chinese Ministry of Science and Technology.

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