Snoring

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Snoring
Sound sample of snoring
ICD-10 R06.5
ICD-9 786.09
DiseasesDB 12260
MedlinePlus 003207
MeSH D012913
Snoring sound production is most often from the soft palate (indicated by the black arrow) and uvula (the gray).
Snoring. Note that the snoring sound is most often caused by the vibration of the soft palate and the uvula.

Snoring is the vibration of respiratory structures and the resulting sound, due to obstructed air movement during breathing while sleeping. In some cases the sound may be soft, but in other cases, it can be loud and unpleasant. Snoring during sleep may be a sign, or first alarm, of obstructive sleep apnea (OSA). Researchers say that snoring is a factor of sleep deprivation.

Causes[edit]

Generally speaking the structures involved are the uvula and soft palate. The irregular airflow is caused by a passageway blockage and is usually due to one of the following:

  • Throat weakness, causing the throat to close during sleep.
  • Mispositioned jaw, often caused by tension in the muscles.
  • Fat gathering in and around the throat.
  • Obstruction in the nasal passageway.
  • Obstructive sleep apnea.
  • The tissues at the top of airways touching each other, causing vibrations.
  • Relaxants such as alcohol or other drugs relaxing throat muscles.
  • Sleeping on one's back, which may result in the tongue dropping to the back of the mouth.

Impact[edit]

Snoring is known to cause sleep deprivation to snorers and those around them, as well as daytime drowsiness, irritability, lack of focus and decreased libido.[1] It has also been suggested that it can cause significant psychological and social damage to sufferers.[2] Multiple studies reveal a positive correlation between loud snoring and risk of heart attack (about +34% chance) and stroke (about +67% chance).[3]

Though snoring is often considered a minor affliction, snorers can sometimes suffer severe impairment of lifestyle. The between-subjects trial by Armstrong et al. discovered a statistically significant improvement in marital relations after snoring was surgically corrected. This was confirmed by evidence from Gall et al.,[4] Cartwright and Knight[5] and Fitzpatrick et al.[6]

New studies associate loud "snoring" with the development of carotid artery atherosclerosis,.[7] Researchers hypothesize that loud snoring creates turbulence in carotid artery blood flow closest to the airway. Generally speaking, increased turbulence irritates blood cells and has previously been implicated as a cause of atherosclerosis.

A U.S. study estimates that roughly one in every 15 Americans is affected by at least a moderate degree of sleep apnea.[citation needed]

Prevalence[edit]

Statistics on snoring are often contradictory, but at least 30% of adults and perhaps as many as 50% of people in some demographics snore.[8] One survey of 5,713 American residents identified habitual snoring in 24% of men and 13.8% of women, rising to 60% of men and 40% of women aged 60 to 65 years; this suggests an increased susceptibility to snoring as age increases.[9]

Treatment[edit]

Almost all treatments for snoring revolve around clearing the blockage in the breathing passage. This is the reason snorers are advised to lose weight (to stop fat from pressing on the throat), stop smoking (smoking weakens and clogs the throat) and sleep on their side (to prevent the tongue from blocking the throat).[10] A number of other treatment options are also available, ranging from over-the-counter aids such as nasal sprays, nasal strips or nose clips, lubricating sprays, oral appliances and "anti-snore" clothing and pillows, to such unusual activities as playing the didgeridoo.[11] Specially designed laser treatments can also be used to reduce the inflammation and elevate the soft palate and uvula.[12]

Dental appliances[edit]

One style of mandibular advancement splint

Specially made dental appliances called mandibular advancement splints, which advance the lower jaw slightly and thereby pull the tongue forward, are a common mode of treatment for snoring. Such appliances have been proven to be effective in reducing snoring and sleep apnea in cases where the apnea is mild to moderate.[13] Mandibular advancement splints are often tolerated much better than CPAP machines.[14]

Positive airway pressure[edit]

A continuous positive airway pressure (CPAP) machine is often used to control sleep apnea and the snoring associated with it. To keep the airway open, a device pumps a controlled stream of air through a flexible hose to a mask worn over the nose, mouth, or both.[15]

Surgery[edit]

Surgery is also available as a method of correcting social snoring. Some procedures, such as uvulopalatopharyngoplasty, attempt to widen the airway by removing tissues in the back of the throat, including the uvula and pharynx. These surgeries are quite invasive, however, and there are risks of adverse side effects. The most dangerous risk is that enough scar tissue could form within the throat as a result of the incisions to make the airway more narrow than it was prior to surgery, diminishing the airspace in the velopharynx. Scarring is an individual trait, so it is difficult for a surgeon to predict how much a person might be predisposed to scarring. Currently, the American Medical Association does not approve of the use of lasers to perform operations on the pharynx or uvula.

Radiofrequency ablation (RFA) is a relatively new surgical treatment for snoring. This treatment applies radiofrequency energy and heat (between 77 °C and 85 °C) to the soft tissue at the back of the throat, such as the soft palate and uvula, causing scarring of the tissue beneath the skin. After healing, this results in stiffening of the treated area. The procedure takes less than one hour, is usually performed on an outpatient basis, and usually requires several treatment sessions. Radiofrequency ablation is frequently effective in reducing the severity of snoring, but, often does not completely eliminate snoring.[16][17]

Bipolar radiofrequency ablation, a technique used for coblation tonsillectomy, is also used for the treatment of snoring.

The Pillar Procedure[edit]

The Pillar Procedure is a minimally invasive treatment for snoring and obstructive sleep apnea. This procedure was FDA indicated in 2004. During this procedure, three to six+ dacron (the material used in permanent sutures) strips are inserted into the soft palate, using a modified syringe and local anesthetic. While the procedure was initially approved for the insertion of three "pillars" into the soft palate, it was found that there was a significant dosage response to more pillars, with appropriate candidates.[citation needed] As a result of this outpatient operation, which typically lasts no more than 30 minutes, the soft palate is more rigid, possibly reducing instances of sleep apnea and snoring. This procedure addresses one of the most common causes of snoring and sleep apnea — vibration or collapse of the soft palate (the soft part of the roof of the mouth). If there are other factors contributing to snoring or sleep apnea, such as conditions of the nasal airway or an enlarged tongue, it will likely need to be combined with other treatments to be more effective.[citation needed]

Pharmacological treatment[edit]

An open label non-randomized study in 30 patients found benefit from pseudoephedrine, domperidone, and the combination in the treatment of severe snoring.[18]

Proposed alternative remedies[edit]

There are occasions wherein snoring is the result of a wrong sleeping position. Sleeping with too many pillows can stretch and narrow the air passage. Use one pillow to avoid it. Also, lying on the back can cause snoring. So, a change in sleeping position can be a help.[citation needed]

Among the 'natural' remedies are exercises to increase the muscle tone of the upper airway,[19] and one medical practitioner noting anecdotally that professional singers seldom snore,[20] but sufficient study of this area remains to be undertaken.[21]

See also[edit]

References[edit]

  1. ^ Luboshitzky, Rafael; Ariel Aviv, Aya Hefetz, Paula Herer, Zila Shen-Orr, Lena Lavie and Peretz Lavie (March 23, 2002). "Decreased Pituitary-Gonadal Secreti". Journal of Clinical Endocrinology & Metabolism 87 (7): 3394–3398. doi:10.1210/jc.87.7.3394. PMID 12107256. Retrieved 2007-07-03. Decreased libido is frequently reported in male patients with obstructive sleep apnea (OSA). 
  2. ^ "The effect of surgery upon the quality of life in snoring patients and their partners: a between-subjects case-controlled trial". M.W.J. Armstrong, C.L. Wallace & J. Marais, Clinical Otolaryngology & Allied Sciences 24 6 Page 510. 1999-01-12. 
  3. ^ "Snoring 'linked to heart disease'". BBC News. 2008-03-01. Retrieved 2010-05-23. 
  4. ^ "Quality of life in mild obstructive sleep apnea". Gall, R., Isaac, L., Kryger, M. (1993) Sleep, 16, S59 S61. 1993. 
  5. ^ "Silent partners: the wives of sleep apneic patients". Cartwright, R.D. & Knight, S. (1987) Sleep, 10, 244 248. 1987. 
  6. ^ "Snoring, asthma and sleep disturbance in Britain: a community-based survey". Fitzpatrick, M.F., Martin, K., Fossey, E et al. (1993) Eur. Respir. J. 69, 531 535. 1993. 
  7. ^ Lee, SA; TC Amis; K Byth; G Larcos; K Kairaitis; TD Robinson; JR Wheatley (September 2008). "Heavy snoring as a cause of carotid artery atherosclerosis". Sleep (Asoociated Professional Sleep Societies) 31 (9): 1207–1213. ISSN 0161-8105. PMC 2542975. PMID 18788645. Retrieved 2009-02-01. 
  8. ^ "New Vaccine Could Cure Snoring (statistics insert)". BBC News. 2001-09-19. 
  9. ^ "Some epidemiological data on snoring and cardiocirculatory disturbances". Lugaresi E., Cirignotta F., Coccoagna G. et al. (1980), Sleep 3, 221–224. 
  10. ^ "BBC Health website: snoring". 
  11. ^ "Didgeridoo playing as alternative treatment for obstructive sleep apnea syndrome". British Medical Journal. 2005-12-23. 
  12. ^ Miracki, Krysztof; Vizintin, Zdenko. "Nonsurgical Minimally Invasive Er:YAG Laser Snoring Treatment". LA&HA - Journal of the Laser and Health Academy: 36–41. 
  13. ^ [1], Henke,Frantz AM J RESPIR CRIT CARE MED 2000;161:420–425.
  14. ^ "Comparative Study of Oral Devices for Snoring" [2], Journal of the California Assoc. Aug. 1998
  15. ^ "Continuous Positive Airway Pressure (CPAP)". American Academy of Otolaryngology−Head and Neck Surgery. Retrieved 2007-07-02. 
  16. ^ Snoring subdued with new treatment: 5/20/98
  17. ^ Radiofrequency ablation of the soft palate for snoring
  18. ^ "Treatment of Severe Snoring with a Combination of Pseudoephedrine Sulfate and Domperidone.". Retrieved 2012-05-01. 
  19. ^ Pai, Irumee; Lo, Stephen; Wolf, Dennis; ajieker, Azgher (2008). "The effect of singing on snoring and daytime somnolence". Sleep and Breathing 12 (3): 265–268. doi:10.1007/s11325-007-0159-1. PMID 18183444. Retrieved 9 January 2011 
  20. ^ Scott, Elizabeth (1995). The Natural Way to Stop Snoring. London: Orion Books. ISBN 0-7528-0067-1 
  21. ^ Valbuza, J.S; de Oliveira, M.M; Conti, C.F; Prado, L.B.F; de Carvalho, L.B.C; do Prado, G.F (2008). "Methods to increase muscle tonus of upper airway to treat snoring: Systematic review". Arq Neuropsiquiatr 66 (3-B): 773–776. doi:10.1590/s0004-282x2008000500037. Retrieved 9 January 2011