INCREASING EVIDENCE SUGGESTS THAT SNORING IS PART OF THE SPECTRUM OF SLEEP-DISORDERED BREATHING (SDB), FROM SIMPLE SNORING ON ONE end to obstructive sleep apnea/hypopnea syndrome on the other.1,2 Snoring associated with sleep apnea is cyclical, with snoring

411 INCREASING EVIDENCE SUGGESTS THAT SNORING IS PART OF THE SPECTRUM OF SLEEP-DISORDERED BREATHING (SDB), FROM SIMPLE SNORING ON ONE end to obstructive sleep apnea/hypopnea syndrome on the other.1,2 Snoring associated with sleep apnea is cyclical, with snoring noises and/or snorts alternating with quiet periods. It often has a disturbing character and may be associated with breathing pauses. Snoring has been associated with increased risk of hypertension,3,4 ischemic heart disease,5 and stroke6,7; however, some studies do not support this association.8-11 These studies focused primarily on the presence or absence of snoring, and no research assessed the potential significance of different types of snoring. We believe that the lack of such a distinction might explain the conflicting results of previous studies in analyzing the relationship between snoring and cardiovascular disease (CVD). There is some evidence that the cardiovascular effects of sleep apnea and snoring have more impact on younger men,12,4 and, therefore, the age and sex of the sample evaluated may critically influence the results obtained when considering the impact of snoring on cardiovascular illness and health-care utilization. There is considerable interest in the association of sleep problems and health consequences. It is well documented that patients with sleep apnea are heavy users of health-care resources for several years prior to the diagnosis,13,14 and the initiation of treatment results in a significant reduction in healthcare utilization.15,16 In a telephone interview survey of a United Kingdom population sample, the use of health-care resources was significantly greater in subjects reporting breathing pauses during sleep, compared with those without breathing pauses.17 We have reported a higher rate of health-care utilization in people with insomnia.18 In this study, we investigated the prevalence of self-reported snoring in the Hungarian population analyzing data obtained from a large, nationally representative, adult sample. We asked respondents to distinguish loud snoring with breathing pauses from quiet snoring because we wanted to find out whether the different types of snoring are associated with different risks of CVD and increased health-care utilization. We hypothesized that individuals with loud snoring and breathing pauses have a higher risk for hypertension, myocardial infarction, and stroke and that they consume more health-care resources, compared with quiet snorers or with people who do not snore. Snoring and CardiovaSCular diSeaSe