J Rhinol.  2016 Nov;23(2):75-80. 10.18787/jr.2016.23.2.75.

Clinical Implications of Snoring

Affiliations
  • 1Department of Otorhinolaryngology, College of Medicine, Hanyang University, Seoul, Korea. shcho@hanyang.ac.kr

Abstract

Snoring is the most common symptom, along with increased daytime sleepiness, in patients with obstructive sleep apnea (OSA). However, doctors often neglect snoring in clinical practice, and snoring is not addressed in the treatment guidelines of OSA. Therefore, study about snoring and its clinical implications in sleep medicine are needed. The natural history of snoring shows that snoring can evolve into OSA, and the most important risk factors for this continuum are obesity and male sex. Snoring can be a social problem causing annoyance and family difficulties. Animal and human studies have shown that snoring involves the four injury mechanisms of upper airway inflammation, peripheral neuropathy, parasympathetic hypofunction, and endothelial injury. Previous studies have reported that systemic diseases such as atherosclerosis, metabolic syndrome, hypertension, and cardiac diseases were comorbid with snoring. However, most of these studies enrolled patients characterized by survey or questionnaire; therefore, data were biased with effects of OSA. Thus, consensus on the definition and detection of snoring is lacking. Additional studies are required to determine the exact clinical implications of snoring.

Keyword

Snoring; Pathogenesis; Injury; Clinical; Comorbidity

MeSH Terms

Animals
Atherosclerosis
Bias (Epidemiology)
Comorbidity
Consensus
Heart Diseases
Humans
Hypertension
Inflammation
Male
Natural History
Obesity
Peripheral Nervous System Diseases
Risk Factors
Sleep Apnea, Obstructive
Snoring*
Social Problems

Figure

  • Fig. 1. Snoring events and index in nocturnal polysomnography (Allis 5).

  • Fig. 2. Snoring-related injury mechanisms, pathogenesis, and disease manifestations.


Cited by  1 articles

Clinical Review of Commercially-Available Anti-Snoring Devices
Ki-Il Lee, Ji Ho Choi
Korean J Otorhinolaryngol-Head Neck Surg. 2023;66(6):367-374.    doi: 10.3342/kjorl-hns.2022.01186.


Reference

References

1). Deary V, Ellis JG, Wilson JA, Coulter C, Barclay NL. Simple snoring: not quite so simple after all? Sleep Med Rev. 2014; 18:453–62.
Article
2). Koren A, Groselj LD, Fajdiga I. CT comparison of primary snoring and obstructive sleep apnea syndrome: role of pharyngeal narrowing ratio and soft palate-tongue contact in awake patient. Eur Arch Otorhinolaryngol. 2009; 266:727–34.
Article
3). Lee JG. Pathophysiology of snoring. Korean J Rhinol. 1995; 2:3–7.
4). Berry RB, Budhiraja R, Gottlieb DJ, Gozal D, Iber C, Kapur VK, et al. Rules for scoring respiratory events in sleep: update of the 2007 AASM Manual for the Scoring of Sleep and Associated Events. J Clin Sleep Med. 2012; 8(5):597–619.
Article
5). Cathcart RA, Hamilton DW, Drinnan MJ, Gibson GJ, Wilson JA. Night-to-night variation in snoring sound severity: one night studies are not reliable. Clin Otolaryngol. 2010; 35:198–203.
Article
6). Blumen MB, Quera Salva MA, Vaugier I, Leroux K, d'Ortho MP, Barbot F, et al. Is snoring intensity responsible for the sleep partner's poor quality of sleep? Sleep Breath. 2012 Sep; 16(3):903–7.
Article
7). Chan CH, Wong BM, Tang JL, Ng DK. Gender difference in snoring and how it changes with age: systematic review and meta-regression. Sleep Breath. 2012; 16:977–86.
Article
8). Ng DK, Chan CH, Ng EP. Natural history of snoring in Hong Kong adolescents. J Paediatr Child Health. 2014; 50:596–604.
Article
9). Li AM, Zhu Y, Au CT, Lee DL, Ho C, Wing YK. Natural history of primary snoring in school-aged children: a 4-year follow-up study. Chest. 2013; 143:729–35.
10). Berger G, Berger R, Oksenberg A. Progression of snoring and obstructive sleep apnoea: the role of increasing weight and time. Eur Respir J. 2009; 33:338–45.
Article
11). Dreher A, Rader T, Patscheider M, Klemens C, Schmidt M, Baker F, et al. The annoyance of snoring. Eur Arch Otorhinolaryngol. 2009; 266(2):293–6.
Article
12). Zarhin D. Sleep as a Gendered Family Affair: Snoring and the “Dark Side” of Relationships. Qual Health Res. In press.
13). Boynton G, Vahabzadeh A, Hammoud S, Ruzicka DL, Chervin RD. Validation of the STOP-BANG Questionnaire among Patients Referred for Suspected Obstructive Sleep Apnea. J Sleep Disord Treat Care. 2013; 23(2):1–20.
14). Kang K, Park KS, Kim JE, Kim SW, Kim YT, Kim JS, et al. Usefulness of the Berlin Questionnaire to identify patients at high risk for obstructive sleep apnea: a population-based door-to-door study. Sleep Breath. 2013; 17:803–10.
Article
15). Thornton AT, Singh P, Ruehland WR, Rochford PD. AASM criteria for scoring respiratory events: interaction between apnea sensor and hypopnea definition. Sleep. 2012; 35:425–32.
Article
16). Park CY, Hong JH, Lee JH, Lee KE, Cho HS, Lim SJ, et al. Clinical usefulness of watch-PAT for assessing the surgical results of obstructive sleep apnea syndrome. J Clin Sleep Med. 2014; 10(1):43–7.
Article
17). Almendros I, Acerbi I, Puig F, Montserrat JM, Navajas D, Farré R. Upper-airway inflammation triggered by vibration in a rat model of snoring. Sleep. 2007; 30:225–7.
Article
18). Hagander L, Harlid R, Svanborg E. Quantitative sensory testing in the oropharynx: a means of showing nervous lesions in patients with obstructive sleep apnea and snoring. Chest. 2009; 136:481–9.
19). Schöbel C, Fietze I, Glos M, Schary I, Blau A, Baumann G, et al. Nocturnal snoring decreases daytime baroreceptor sensitivity. Respir Med. 2014; 108:1049–55.
Article
20). Cho JG, Witting PK, Verma M, Wu BJ, Shanu A, Kairaitis K, Amis TC, Wheatley JR. Tissue vibration induces carotid artery endothelial dysfunction: a mechanism linking snoring and carotid atherosclerosis? Sleep. 2011; 34:751–7.
Article
21). Lee YH, Kweon SS, Choi BY, Kim MK, Chun BY, Shin DH, et al. Self-reported snoring and carotid atherosclerosis in middle-aged and older adults: the Korean Multi-Rural Communities Cohort Study. J Epidemiol. 2014; 24:281–6.
Article
22). Leineweber C, Kecklund G, Akerstedt T, Janszky I, Orth-Gomér K. Snoring and the metabolic syndrome in women. Sleep Med. 2003; 4:531–6.
Article
23). Shin C, Kim J, Kim J, Lee S, Shim J, In K, et al. Association of habitual snoring with glucose and insulin metabolism in nonobese Korean adult men. Am J Respir Crit Care Med. 2005; 171:287–91.
Article
24). Kim J, Yi H, Shin KR, Kim JH, Jung KH, Shin C. Snoring as an independent risk factor for hypertension in the nonobese population: the Korean Health and Genome Study. Am J Hypertens. 2007; 20:819–24.
Article
25). Endeshaw Y, Rice TB, Schwartz AV, Stone KL, Manini TM, Satter-field S, et al. Snoring, daytime sleepiness, and incident cardiovascular disease in the health, aging, and body composition study. Sleep. 2013; 36:1737–45.
Article
26). Li D, Liu D, Wang X, He D. Self-reported habitual snoring and risk of cardiovascular disease and all-cause mortality. Atherosclerosis. 2014; 235:189–95.
Article
27). Li M, Li K, Zhang XW, Hou WS, Tang ZY. Habitual snoring and risk of stroke: A metaanalysis of prospective studies. Int J Cardiol. 2015; 185:46–9.
Article
28). Yeboah J, Redline S, Johnson C, Tracy R, Ouyang P, Blumenthal RS, et al. Association between sleep apnea, snoring, incident cardiovascular events and all-cause mortality in an adult population: MESA. Atherosclerosis. 2011; 219:963–8.
Article
29). Marshall NS, Wong KK, Cullen SR, Knuiman MW, Grunstein RR. Snoring is not associated with all-cause mortality, incident cardiovascular disease, or stroke in the Busselton Health Study. Sleep. 2012; 35:1235–40.
Article
Full Text Links
  • JR
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr