Self-Reported Snoring in Adults

Using R with NHANES

Author

Cubicle 3253

Introduction

NHANES added a question about snoring in the 2005-2006 survey (1), using the question “In the past 12 months, how often did you snore while you were sleeping?”, with response categories: never, rarely (1-2 nights/week), occasionally (3-4 nights/week), frequently (5 or more nights/week), refused and don’t know.

For the 2007-2008 survey (2), interviewers were instructed to ask respondents, who reported don’t know, if anyone has told them they snore. The question has remained the same since and was asked in the 2015-2016, 2017-2018, and 2019-March 2020 surveys.

This document examines self-reported snoring, in adults, for the available survey periods. The combined 2017-March 2020 data was used as it’s the only public source for the 2019-March 2020 data. The data was examined by survey period. First overall, and then by sex, age group, and marital status. Lastly, modeling of self-reported frequent snoring is included.

Overall

Self-Reported Snoring in Adults by Survey Cycle

By Sex

Self-Reported Snoring in Adults by Sex & Survey Cycle

By Age

Self-Reported Snoring in Adults by Age & Survey Cycle

By Marital Status

Self-Reported Snoring in Adults by Marital Status & Survey Cycle

Modeling

Poisson regression is used to model self-reported frequent snoring.

	Prevalence Ratio (95% CI)
Survey Period
2005-2006	Ref.
2007-2008	1.01 (0.91, 1.12)
2015-2016	0.81 (0.74, 0.89)
2017-March 2020	0.86 (0.80, 0.94)
Sex
Men	Ref.
Women	0.64 (0.60, 0.68)
Age Group
20 to 34	Ref.
35 to 49	1.49 (1.37, 1.61)
50 to 64	1.60 (1.48, 1.73)
65 or more	1.29 (1.18, 1.41)
Marital Status
Never Married	Ref.
Widowed/Divorced/Separated	1.24 (1.11, 1.39)
Married/Living with Partner	1.38 (1.24, 1.54)

	Prevalence Ratio (95% CI)
Survey Period
2005-2006	Ref.
2007-2008	0.98 (0.88, 1.08)
2015-2016	0.77 (0.70, 0.84)
2017-March 2020	0.82 (0.75, 0.89)
Sex
Men	Ref.
Women	0.65 (0.61, 0.69)
Age Group
20 to 34	Ref.
35 to 49	1.50 (1.39, 1.62)
50 to 64	1.64 (1.51, 1.77)
65 or more	1.39 (1.27, 1.51)
Marital Status
Never Married	Ref.
Widowed/Divorced/Separated	1.28 (1.15, 1.43)
Married/Living with Partner	1.26 (1.13, 1.41)

--- title: Self-Reported Snoring in Adults subtitle: Using R with NHANES author: Cubicle 3253 format: html: code-tools: true echo: false embed-resources: true grid: sidebar-width: 150px body-width: 1600px margin-width: 50px linestretch: 1.1 toc: true toc-location: left --- ## Introduction <p> NHANES added a question about snoring in the 2005-2006 survey (<a href="https://wwwn.cdc.gov/nchs/data/nhanes/public/2005/questionnaires/sp_slq_d.pdf">1</a>), using the question *"In the past 12 months, how often did you snore while you were sleeping?"*, with response categories: never, rarely (1-2 nights/week), occasionally (3-4 nights/week), frequently (5 or more nights/week), refused and don't know. </p><p> For the 2007-2008 survey (<a href="https://wwwn.cdc.gov/nchs/data/nhanes/public/2007/questionnaires/slq07_08_eng.pdf">2</a>), interviewers were instructed to ask respondents, who reported don't know, if anyone has told them they snore. The question has remained the same since and was asked in the 2015-2016, 2017-2018, and 2019-March 2020 surveys. </p><p> This document examines self-reported snoring, in adults, for the available survey periods. The combined 2017-March 2020 data was used as it's the only public source for the 2019-March 2020 data. The data was examined by survey period. First overall, and then by sex, age group, and marital status. Lastly, modeling of self-reported frequent snoring is included. </p> ```{r} #| message: false library(apexcharter) library(broom.helpers) library(dplyr) library(gt) library(ggiraph) library(ggplot2) library(haven) library(survey) library(srvyr) library(viridisLite) read_nhanes <- function(xpt_name) { xpt_name <- toupper(xpt_name) if(substr(xpt_name, 1, 2) == "P_") { begin_year = "2017" } else { begin_year = switch(substr(xpt_name, nchar(xpt_name) - 1, nchar(xpt_name)), "_L" = "2021", "_J" = "2017", "_I" = "2015", "_H" = "2013", "_G" = "2011", "_F" = "2009", "_E" = "2007", "_D" = "2005", "_C" = "2003", "_B" = "2001", "1999") } xpt_url <- paste0("https://wwwn.cdc.gov/nchs/data/nhanes/public/", begin_year, "/datafiles/", xpt_name, ".xpt") try(read_xpt(xpt_url), silent = TRUE) } do_apexchart <- function(df, c_height = 600) { df |> apex(aes(x = SDDSRVYR, y = p, fill = SLQ030), type = "bar", height = c_height) |> ax_colors(viridis(5)) |> ax_xaxis(title = list(text = "Percent", style = list(fontSize = "15px")), labels = list(style = list(fontSize = "14px")), min = 0, max = 100, stepSize = 10) |> ax_yaxis(labels = list(style = list(fontSize = "14px"))) |> ax_title(text = "Self-Reported Snoring", style = list(fontSize = "16px")) |> ax_tooltip(y = list(formatter = format_num(".1f", suffix = "%"))) |> ax_chart(stacked = TRUE) |> ax_plotOptions(bar = bar_opts(horizontal = TRUE, barHeight = "85%")) } do_poisson <- function(srv) { svyglm((SLQ030 == "Frequently") ~ SDDSRVYR + RIAGENDR + RIDAGEYR + DMDMARITAL, srv, family = quasipoisson()) |> tidy_and_attach(exponentiate = TRUE) |> tidy_remove_intercept() |> tidy_add_reference_rows() |> tidy_add_term_labels() |> mutate( variable = case_match(variable, "SDDSRVYR" ~ "Survey Period", "RIAGENDR" ~ "Sex", "RIDAGEYR" ~ "Age Group", "DMDMARITAL" ~ "Marital Status"), pr = if_else(!is.na(estimate), sprintf("%.2f (%.2f, %.2f)", estimate, conf.low, conf.high), "Ref.")) |> select(variable, label, pr) |> gt(groupname_col = "variable", rowname_col = "label") |> tab_stubhead(label = "") |> cols_label(pr = "Prevalence Ratio (95% CI)") |> tab_stub_indent(rows = everything(), indent = 3) |> cols_align(columns = 3, align = "center") |> tab_options(table.align = "left", data_row.padding = px(2), row_group.padding = px(2), table.font.size = 16) } ``` ```{r} demo_vars <- c("SEQN", "SDDSRVYR", "RIAGENDR", "RIDAGEYR", "DMDMARTL", "DMDMARTZ", "SDMVSTRA", "SDMVPSU", "WTINT2YR", "WTINTPRP") DEMO_D <- read_nhanes("DEMO_D") |> select(any_of(demo_vars)) DEMO_E <- read_nhanes("DEMO_E") |> select(any_of(demo_vars)) DEMO_I <- read_nhanes("DEMO_I") |> select(any_of(demo_vars)) P_DEMO <- read_nhanes("P_DEMO") |> select(any_of(demo_vars)) DEMO <- bind_rows(DEMO_D, DEMO_E, DEMO_I, P_DEMO) ``` ```{r} SLQ_D <- read_nhanes("SLQ_D") |> select(SEQN, SLQ030) SLQ_E <- read_nhanes("SLQ_E") |> select(SEQN, SLQ030) SLQ_I <- read_nhanes("SLQ_I") |> select(SEQN, SLQ030) P_SLQ <- read_nhanes("P_SLQ") |> select(SEQN, SLQ030) SLQ <- bind_rows(SLQ_D, SLQ_E, SLQ_I, P_SLQ) ``` ```{r} One <- left_join(DEMO, SLQ, by = "SEQN") |> mutate( RIAGENDR = if_else(RIAGENDR == 1, "Men", "Women"), RIDAGEYR = case_match(RIDAGEYR, 20:34 ~ "20 to 34", 35:49 ~ "35 to 49", 50:64 ~ "50 to 64", 65:80 ~ "65 or more"), DMDMARITAL = case_when( SDDSRVYR != 66 & DMDMARTL %in% c(1, 6) ~ "Married/Living with Partner", SDDSRVYR != 66 & DMDMARTL %in% 2:4 ~ "Widowed/Divorced/Separated", SDDSRVYR != 66 & DMDMARTL == 5 ~ "Never Married", DMDMARTZ == 1 ~ "Married/Living with Partner", DMDMARTZ == 2 ~ "Widowed/Divorced/Separated", DMDMARTZ == 3 ~ "Never Married"), DMDMARITAL = factor(DMDMARITAL, levels = c("Never Married", "Widowed/Divorced/Separated", "Married/Living with Partner")), ## See: https://wwwn.cdc.gov/nchs/nhanes/continuousnhanes/overviewbrief.aspx?Cycle=2017-2020 ## survey_wt = if_else(SDDSRVYR != 66, WTINT2YR * 2/9.2, WTINTPRP * 3.2/9.2), SDDSRVYR = case_match(SDDSRVYR, 4 ~ "2005-2006", 5 ~ "2007-2008", 9 ~ "2015-2016", 66 ~ "2017-March 2020"), SLQ030 = case_match(SLQ030, 0 ~ "Never", 1 ~ "Rarely", 2 ~ "Occasionally", 3 ~ "Frequently", 7:9 ~ "Refused/DK"), SLQ030 = factor(SLQ030, levels = c("Never", "Rarely", "Occasionally", "Frequently", "Refused/DK"))) |> select(SDDSRVYR, RIAGENDR, RIDAGEYR, DMDMARITAL, SLQ030, SDMVSTRA, SDMVPSU, survey_wt) ``` ```{r} NHANES1 <- One |> filter(!is.na(RIDAGEYR), !is.na(SLQ030)) |> as_survey_design(id = SDMVPSU, strata = SDMVSTRA, nest = TRUE, weights = survey_wt) NHANES2 <- One |> filter(!is.na(RIDAGEYR), SLQ030 != "Refused/DK") |> as_survey_design(id = SDMVPSU, strata = SDMVSTRA, nest = TRUE, weights = survey_wt) ``` ## Overall <h4>Self-Reported Snoring in Adults by Survey Cycle</h4> ```{r} t1 <- NHANES1 |> group_by(SDDSRVYR, SLQ030) |> summarize(p = survey_prop(proportion = TRUE, vartype = "ci", prop_method = "beta")) |> mutate(across(p:p_upp, ~ .x * 100)) t2 <- NHANES2 |> group_by(SDDSRVYR, SLQ030) |> summarize(p = survey_prop(proportion = TRUE, vartype = "ci", prop_method = "beta")) |> mutate(across(p:p_upp, ~ .x * 100)) ``` ::: {.panel-tabset} ### Including Refused & Don't Know ```{r} #| results: asis do_apexchart(t1) ``` ### Excluding Refused & Don't Know ```{r} #| results: asis do_apexchart(t2) ``` ::: ## By Sex <h4>Self-Reported Snoring in Adults by Sex & Survey Cycle</h4> ```{r} t1 <- NHANES1 |> group_by(RIAGENDR, SDDSRVYR, SLQ030) |> summarize(p = survey_prop(proportion = TRUE, vartype = "ci", prop_method = "beta")) |> mutate(across(p:p_upp, ~ .x * 100)) t2 <- NHANES2 |> group_by(RIAGENDR, SDDSRVYR, SLQ030) |> summarize(p = survey_prop(proportion = TRUE, vartype = "ci", prop_method = "beta")) |> mutate(across(p:p_upp, ~ .x * 100)) ``` ::: {.panel-tabset} ### Including Refused & Don't Know ```{r} #| results: asis do_apexchart(t1, 300) |> ax_facet_wrap(vars(RIAGENDR), ncol = 1) ``` ### Excluding Refused & Don't Know ```{r} #| results: asis do_apexchart(t2, 300) |> ax_facet_wrap(vars(RIAGENDR), ncol = 1) ``` ::: ## By Age <h4>Self-Reported Snoring in Adults by Age & Survey Cycle</h4> ```{r} t1 <- NHANES1 |> group_by(RIDAGEYR, SDDSRVYR, SLQ030) |> summarize(p = survey_prop(proportion = TRUE, vartype = "ci", prop_method = "beta")) |> mutate(across(p:p_upp, ~ .x * 100)) t2 <- NHANES2 |> group_by(RIDAGEYR, SDDSRVYR, SLQ030) |> summarize(p = survey_prop(proportion = TRUE, vartype = "ci", prop_method = "beta")) |> mutate(across(p:p_upp, ~ .x * 100)) ``` ::: {.panel-tabset} ### Including Refused & Don't Know ```{r} #| results: asis do_apexchart(t1, 300) |> ax_facet_wrap(vars(RIDAGEYR), ncol = 2) ``` ### Excluding Refused & Don't Know ```{r} #| results: asis do_apexchart(t2, 300) |> ax_facet_wrap(vars(RIDAGEYR), ncol = 2) ``` ::: ## By Marital Status <h4>Self-Reported Snoring in Adults by Marital Status & Survey Cycle</h4> ```{r} t1 <- NHANES1 |> filter(!is.na(DMDMARITAL)) |> group_by(DMDMARITAL, SDDSRVYR, SLQ030) |> summarize(p = survey_prop(proportion = TRUE, vartype = "ci", prop_method = "beta")) |> mutate(across(p:p_upp, ~ .x * 100)) t2 <- NHANES2 |> filter(!is.na(DMDMARITAL)) |> group_by(DMDMARITAL, SDDSRVYR, SLQ030) |> summarize(p = survey_prop(proportion = TRUE, vartype = "ci", prop_method = "beta")) |> mutate(across(p:p_upp, ~ .x * 100)) ``` ::: {.panel-tabset} ### Including Refused & Don't Know ```{r} #| results: asis do_apexchart(t1, 300) |> ax_facet_wrap(vars(DMDMARITAL), ncol = 2) ``` ### Excluding Refused & Don't Know ```{r} #| results: asis do_apexchart(t2, 300) |> ax_facet_wrap(vars(DMDMARITAL), ncol = 2) ``` ::: ## Modeling <p> Poisson regression is used to model self-reported frequent snoring. </p> ::: {.panel-tabset} ### Including Refused & Don't Know ```{r} do_poisson(NHANES1) ``` ### Excluding Refused & Don't Know ```{r} do_poisson(NHANES2) ``` :::