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Snoring

Definition of Snoring:

Snoring is a noise generated from the upper airway (throat, tongue and roof of the mouth) due to partial upper airway obstruction. Snoring occurs when air flows past relaxed tissues in your throat, causing the tissues to vibrate as you breathe causing the classic snoring noise. The more the airway is blocked, the louder and more persistent the snoring becomes.

Snoring is often associated with sleep apnoea (OSAS), a potentially life threatening condition either directly because of long term cardiac effects or indirectly because of excessive day time sleepiness leading to road traffic accidents and it can disrupt your household. OSAS is a condition that may well not be cured by surgery alone but for which there are successful alternate treatments.

Causes and Mechanism of Snoring

It is not fully understood why people snore or develop upper airway obstruction. Research at MicroCare ENT Hospital and at various ENT hospitals all over world revealed Male sex, increasing age and obesity are well recognized associations. Snoring and OSAS are exacerbated by alcohol and sedative medications.

A variety of factors contribute to snoring, including:

• poor muscle tone (after alcohol or sedative use)
• enlarged tonsils and adenoids
• a long soft palate or uvula
• Nasal problems
• Blocked nasal airways from polyps, a deviated septum, allergies or a cold
• excessive weight causing tissue at the neck to be bulky and flaccid
• Tissue swelling from cigarette smoking
• Hypothyroidism.

Alcohol consumption: Snoring can also be brought on by consuming too much alcohol before bedtime. Alcohol relaxes throat muscles and decreases your natural defences against airway obstruction.

Association with Obesity: Up to 70% of the people having OSAS are obese. Obesity leads to fat deposition around muscles in the neck which in turn causes small airway. The more obese the person the more likely it is that he will have OSAS Sleep apnoea.

Complications of Snoring

Snoring and OSAS may raise your lifetime risk of developing health problems like high blood pressure, heart failure and stroke. In children, obstructive sleep apnoea may increase the risk of attention-deficit/hyperactivity disorder (ADHD).

Effects on Heart:

Heart has to work hard to pump against high negative intrathoracic pressures and increased lung and peripheral arterial resistance. Heart enlarges during an obstructive episode. This excessive workload to continue throughout the night is extremely abnormal and results in most serious consequences of untreated OSAS i.e. heart problems. This is the reason why it is so important to exclude or establish the diagnosis of OSAS.

Social consequences of Snoring and OSAS:

Excessive day time sleepiness can vary from a feeling of being generally tired to actually falling asleep during important activities. Patients are often not good at assessing their degree of daytime sleepiness and talking to the partner may give a more accurate picture of the degree of the problem.

Daytime sleepiness and disturbed sleep are responsible for other psychological and intellectual changes that those with OSAS may exhibit. These include personality change, poor memory and difficulty in concentrating. These complications combines with loud snoring can result in serious social consequences. Example include marital stress, partners sleeping in separate rooms sometimes leading to divorce, interference with the performance of the job possibly leading to loss of employment and unwillingness to stay in hotels often limiting business and leisure pursuits. Even people sleeping nearby rooms can lose excessive amounts of sleep and this often leads to resentment .

Increased incidence of Road Traffic Accidents:

Far more serous is the increased incidence of accidents, especially road traffic accidents because of day time sleepiness and poor concentration.

Tests and diagnosis of Snoring

To assess patients’ general condition:

• Weight
• Height
• Blood pressure
• FBC look for polycythemia/ anemia/ MCV (? Alcohol)
• TFT
• CXR- to detect heart enlargement or lung disorders
• ECG- to detect heart disease
• Blood Gases- arterial Po2 and Pco2
• Lung Function Tests.

To differentiate between simple snoring and OSAS:

1) Polysomnography- the gold standard investigation in the diagnosis of OSAS. It involves spending a night or more in a sleep laboratory connected to a variety of monitors.

2) Overnight pulse oximetry recording- this is much cheaper and simpler than full Polysomnography and is often used as alternative screening test.

To assess site of obstruction in awake patients:

Evaluation by Video Nasal endoscopy and Direct Endo Laryngoscopy

Nasendoscopy while patient is performing Reverse Valsalva (Miller’s Manoeuvre.

Lateral Cephalometry- lateral Head and Neck X- ray

CT scan

Sleeping patients

To assess site of obstruction in Sleeping patients:

Sleep Nasendoscopy

When to seek medical advice

MicroCare ENT Hospital and Research institute strongly advocates:

You may not be aware that you snore, but your bed partner likely is. Seeing your ENT doctor about your snoring can help both you and your partner.

For you, snoring may indicate another health concern, such as obstructive sleep apnoea, nasal obstruction or obesity.

For your partner, your seeking ENT advice about your snoring may result in being able to get a restful sleep.
If your child snores, ask your ENT Doctor about it. Children, too, can have obstructive sleep apnoea, though most don’t. Nose and throat problems, such as enlarged tonsils, and obesity often underlie habitual snoring in children. Treating these conditions could help your child sleep better.

MicroCare ENT Hospital has Top snoring doctors in hyderabad