| What is Snoring?
Snoring is generated by the vibrations of the uvula, soft
palate, walls of narrowed upper airway as turbulent air travels past. What
is the magnitude of the problem?
The data
is available from large epidemiological studies from the West, and none exists
from India so far. Approx
44% of middle-aged men and 28% of middle aged women are habitual snorers as reported
from West. When
is snoring significant?
- When
it is unduly loud (i.e. can be heard in the next room/ disturbs the sleep of the
bed partner)
- When
there is snorting
- When
there are pauses and at the end of the pause there is a loud snore, explosive
sound and sometimes movement of all the 4 limbs, the patient may jerk, & even
fall off the bed and wake up.
What
are the Causes of Snoring?
- The
most important one being obesity - particularly as measured by neck circumference.
The fat, which accumulates around rest of the body, also collects around the neck
thus causing a collapse of the airway.
- Secondary
causes
- Tonsillar
hypertrophy
- Airway anomalies
- Mandibular insufficiency
- Endocrine
disorders
- Hypothyroidism / Acromegaly |
What is OSA?
Spectrum of Diseases Associated with Snoring
| Snoring |  | Upper
Airway Resistance Syndrome (UARS) | | | Obstructive
Sleep Apnoea Syndrome (OSAS) | | | | UARS | | Is
when snoring is accompanied with symptoms of
excessive daytime sleepiness. |
| OSAS | | Diagnosed
by overnight sleep study. There is snoring
(v. loud ) with pauses (>10
secs) and excessive daytime sleepiness. | What
is the clinical significance of snoring?
The misconception that this is an indicator of sound health
with good sleep cannot be more misleading.
Current opinion is that this is a harbinger of events and adequate measures need
to be taken to prevent further progression to OSAS.
On comparing snorers vs nonsnorers, there was a much higher prevalence of hypertension,
angina, diabetes, smoking and alcohol intake in snorers.
The risk of hypertension and angina has been found to be independently associated
with snoring. Snoring
when part of OSAS, is accompanied with constant feeling of lethargy, fatigue,
feeling refreshed on waking up, irritability, memory disturbance and marital disharmony.
Excessive daytime
sleepiness, which occurs in OSAO, is a major cause of traffic accidents. This
has prompted USA to screen long haul truck drivers for sleep complaints.
Treatment:
-
Various
modalities are currently available. However one with good efficacy, no harmful
effects is Weight Reduction. Essential thing being weight maintenance
Others are dental appliances, surgery (to increase airway - not recommended, but
in children adeno/ tonsillectomy has good results).
| Laser | - | For
snoring, is a good modality. However exclusion of OSAS is a must
prior to
use of laser for snoring. | | CPAP | - | Continous
Positive Airway Pressure
Is a device which delivers air under pressure thus
keeping the airway open. It has to used every night. The results are v. good,
major limitation being the cost. | Conclusion:
- Obesity
can result is snoring which if unchecked can lead to progression to OSAS. The
latter is a risk factor for cardiovascular and cerebrovascular disease.
Weight
reduction results is 40-50% improvement of symptoms. This is a simple, easy to
follow modality with no side-effects, thus should be first therapeutic measure. | 
