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PubMed2003

Prevalence and correlates of habitual snoring in high school students.

STUDY OBJECTIVES: To examine the prevalence and correlates of habitual snoring in senior high school students in Korea. DESIGN: A cross-sectional survey. SETTING: Ten high schools in the southern part of Seoul, Korea. PARTICIPANTS: A total of 3,871 high school students (2,703 male students and 1,168 female students; age range, 15 to 18 years; mean age: male students, 16.8 years; female students, 16.9 years) who were attending the 11th grade. MEASUREMENTS AND RESULTS: Data were collected on sociodemographic characteristics, school performance, and patterns of sleep and sleep-related disturbances. The overall prevalence of habitual snoring was 11.2% (boys, 12.4%; girls, 8.5%). The mean total sleep time was similar in habitual snorers vs nonsnorers (6.4 and 6.3 h per day, respectively). Frequency of snoring increased significantly with body mass index (BMI) [p < 0.001], cigarette smoking (p < 0.01), prevalence of witnessed apnea (p < 0.001), and Epworth sleepiness scale score (p < 0.001). The frequency of snoring increased with a decline in school performance (p < 0.001). For those whose school performance was low, there was a 35% excess in the odds of habitual snoring vs those whose school performance was high (odds ratio, 1.35; 95% confidence interval, 1.01 to 1.78). CONCLUSIONS: These findings suggest that chronic habitual snoring is associated with multiple factors in adolescents. Whether interventions to modify BMI and smoking can alter snoring habits and related clinical problems warrants further study, particularly as it also may improve academic performance in high school students.

Adolescent↗

PubMed2004

Risk factors and natural history of habitual snoring.

STUDY OBJECTIVE: It has been suggested that habitual snoring (HS) has adverse health outcomes in children. We aimed to identify risk factors for HS and determine its natural history in primary school children. DESIGN: Cross-sectional, population-based cohort study. SETTING: Twenty-seven primary schools located within the city limits of Hannover, Germany. PARTICIPANTS: Third-grade primary school children. MEASUREMENTS AND RESULTS: Snoring frequency and potential risk factors were investigated using parental questionnaires. Unadjusted and adjusted odds ratios (ORs) for HS and their 95% confidence intervals (CIs) were calculated. One year after the initial contact, snoring status was re-evaluated in habitual snorers. In total, 1,760 children were contacted, and 1,144 parents and their children (49% were girls) agreed to participate and returned a completed questionnaire. A body mass index >/= 90th percentile (OR, 3.5; 95% CI, 1.8 to 7.1), low maternal education (OR, 2.3; 95% CI, 1.1 to 4.7), regular daytime mouth breathing (OR, 7.4; 95% CI, 3.5 to 15.6), and a higher frequency of sore throats (OR, 17.6; 95% CI, 6.4 to 48.8) were independent risk factors for HS. Parental smoking and frequent infections were significantly but not independently associated with HS. The association of low maternal education and HS was higher in boys (OR, 4.4; 95% CI, 1.5 to 13.6; vs OR, 1.2; 95% CI, 0.4 to 3.6), while that of sore throats and HS was higher in girls (OR, 52.7; 95% CI, 6.0 to 460.2; vs OR, 13.3; 95% CI, 3.0 to 58.5). At follow-up, 39 of 80 eligible habitual snorers (48.8%) still snored regularly. Children who continued to snore differed significantly in maternal education, household smoking, snoring loudness, and prior ear, nose, throat surgery from those who had ceased to snore habitually. CONCLUSIONS: Socioeconomic status, obesity, signs of nasal obstruction, and pharyngeal problems were independent risk factors for HS in these primary school children. The expression of HS varied considerably over time.

Body Mass Index↗

PubMed2006

Longitudinal study of risk factors for habitual snoring in a general adult population: the Busselton Health Study.

BACKGROUND: The aim of this longitudinal study was to identify body size, behavioral, and respiratory risk factors for the development of habitual snoring in a general adult population. METHODS: The sample for this study comprised 967 adults aged 25 to 74 years who reported not snoring in the 1981 Busselton Health Survey and who also attended the 1994-1995 follow-up survey. Logistic regression was used to identify and quantify the effect of baseline and change risk factors for the development of habitual snoring. RESULTS: A total of 13% had become habitual snorers by 1994-1995. Male gender (odds ratio [OR], 3.5) and baseline body mass index (OR, 1.4 per 3.4 kg/m(2)) were significant predictors of habitual snoring; after accounting for these variables, no other baseline body size, behavioral, or respiratory/allergy variables were significantly related to the development of habitual snoring. However, change in body mass index over the 14-year follow-up period (OR, 1.55 per 2.3 kg/m(2)), development of asthma (OR, 2.8), and commencement of smoking (OR, 2.2) were additional significant independent risk factors for development of habitual snoring. CONCLUSIONS: This study has confirmed male gender, obesity, and weight gain as key determinants of habitual snoring, and has indicated that development of asthma and taking up smoking also play a role. Maintaining a healthy weight and not smoking are recommended lifestyle preventive strategies to reduce the risk of sleep-disordered breathing and its sequelae.

Adult↗

PubMed2001

Snoring during early childhood and academic performance at ages thirteen to fourteen years.

OBJECTIVES: Obstructive sleep apnea syndrome in young children is associated with an adverse effect on learning. However, the long-term impact of sleep-disordered breathing (SDB) during early childhood on learning remains unknown. METHODS: Questionnaires were mailed to seventh and eighth graders attending public schools whose class ranking was either in the top 25% (high performance [HP]) or bottom 25% of their class (low performance [LP]), and who were matched for age, gender, race, school, and street of residence. Snoring frequency and loudness at 2 to 6 years of age, tonsillectomy and adenoidectomy (T&A) for snoring or recurrent infection, school grades, and parental smoking and snoring were assessed. RESULTS: The questionnaire response rate was 82.8%. Because of ongoing ring, 13 responders were excluded, such that 1588 questionnaires could be analyzed (797 in LP and 791 in HP group). Frequent and loud snoring during early childhood was reported in 103 LP children (12.9%) compared with 40 HP children (5.1%; odds ratio: 2.79; confidence interval: 1.88-4.15). Furthermore, 24 LP and 7 HP children underwent T&A for snoring (odds ratio: 3.40; confidence interval: 1.47-7.84), while 21 LP and 19 HP children required surgery for recurrent tonsillitis. CONCLUSIONS: Children with lower academic performance in middle school are more likely to have snored during early childhood and to require T&A for snoring compared with better performing schoolmates. These findings support the concept that SDB-associated neurocognitive morbidity may be only partially reversible or that a "learning debt" may develop with SDB during early childhood and hamper subsequent school performance.

Achievement↗

PubMed1989

Uvulopalatopharyngoplasty as a treatment for snoring.

Uvulopalatopharyngoplaty was performed in 18 consecutive patients (15 men and three women; mean +/- standard deviation [SD] age, 46.3 +/- 7.5 years) who presented for the treatment of heavy habitual snoring. No attempt was made to select patients who were ideal anatomically for palatal modification. The loudness of snoring was measured during sleep by integrating the output of a calibrated microphone. An assessment before operation showed that nine patients had obstructive sleep apnoea; four patients had an apnoea index of greater than or equal to 25 apnoeas per hour. The patients were overweight and consumed, on average, 38 g of alcohol per day, but these variables did not change after the operation. The postoperative assessment was performed 138 +/- 44 days after uvulopalatopharyngoplasty. Fourteen patients showed a reduction in the loudness of their snoring, although snoring was abolished in one patient only (average snoring loudness in arbitrary units/min of sleep, 2.8 +/- 2.1 before operation compared with 1.4 +/- 1.5 units/min of sleep after the operation; P less than 0.05. The loudest snore in arbitrary units measured 7.1 +/- 3.3 units compared with 4.8 +/- 3.3 units, respectively; P less than 0.05). The percentage of the sleep time that was spent at an arterial oxygen saturation of less than 90% was reduced after uvulopalatopharyngoplasty (28% +/- 32% of total sleep time compared with 17% +/- 24% of total sleep time, respectively; P less than 0.05). There was no change in the apnoea index. The diastolic blood pressure was lower at the postoperative assessment (94 +/- 11 mmHg compared with 87 +/- 8 mmHg; P less than 0.05); six of 10 subjects whose diastolic blood pressures were greater than or equal to 95 mmHg before the operation had a diastolic blood pressure of less than 95 mmHg after uvulopalatopharyngoplasty (P less than 0.02). Computed tomographic scans showed an increase in the upper airway cross-sectional area at 3 cm and 4 cm above the hyoid bone after uvulopalatopharyngoplasty (P less than 0.05). We conclude that uvulopalatopharyngoplasty is an effective treatment for habitual, heavy snoring in many patients, but it is not the treatment of choice for patients with clinically-significant obstructive sleep apnoea.

Adult↗

PubMed1999

Snoring & sleep apnea: a population study in Italian women.

The aim of this cross-sectional study was to evaluate the prevalence of sleep-disordered breathing by means of a validated portable instrument (MESAM IV) and to investigate the relationship between snoring and sleep apnea in a sample of Italian middle-aged female population. We randomly chose 750 subjects aged 40 to 65 years and 365 agreed to participate to the study. In this group, 19.7% of subjects were every-night snorers according to the questionnaire; when recorded, 54.2% snored for more than 10% of the night, and 7.1% for more than 50% of the night. Sleep apnea was also common: 10.7% of subjects had a respiratory disturbances per hour (RDI) between 5 and 9, 7.7% an RDI between 10 and 19, and 2.2% had an RDI > or =20. Snoring percentage and RDI were significantly correlated. However, 50% of subjects who snored for more than half the night had no evidence of sleep apnea. Snoring amount >50% resulted influenced by body mass index, while RDI>10 was influenced by neck diameter. We concluded that in middle-aged women, both snoring and sleep apnea are very common. A high percentage of snoring is not essential for the occurrence of sleep apnea, nor it necessarily indicates the presence of sleep apnea.

Adult↗

PubMed2002

Assessment and management of the patient presenting with snoring.

BACKGROUND: Snoring is experienced regularly by approximately 30% of male adults, of whom one in seven will have obstructive sleep apnoea syndrome. Women experience snoring and apnoea at a rate of approximately half of that of men. OBJECTIVE: General practitioners have a key role in the management of snoring. Patients whose symptoms of excessive sleepiness and loud habitual snoring more than three times per week, should alert the GP to the presence of apnoeas. DISCUSSION: The co-existence of systemic essential hypertension, especially if more than two drugs are required for its control, or any other cardiovascular disease, would increase suspicion of significant sleep apnoea. Conservative measures such as reduction in weight, alcohol and nasal resistance can be instigated in such patients immediately. Patients who have failed conservative treatment, or have suspected moderate to severe apnoea, need to be referred to a physician trained in sleep disorders for further evaluation and management. Snoring represents a trumpeters introduction to the three spectra of sleep related breathing disorders. These vary from simple snoring to profoundly severe snoring associated with obstructive sleep apnoea syndrome and cardiovascular sequelae, through to orthopnoea, paroxysmal nocturnal dyspnoea and fragmented sleep associated with unstable or decompensated cardiovascular and/or pulmonary disease.

Female↗

PubMed2002

Habitual snoring and sleep bruxism in a paediatric outpatient population in Hong Kong.

OBJECTIVE: To determine the prevalence of habitual snoring and sleep bruxism in children attending the out-patient clinics of a paediatric department. METHODOLOGY: A cross-sectional survey of parents was conducted with questionnaire administered by paediatric nurses. Parents were recruited when they brought their children to the out-patient clinics. Sex and age were recorded. Presence and absence of habitual snoring and sleep bruxism were noted. Types of diseases that brought the children to the out-patient clinics were also noted. RESULTS: Twenty-nine of the 200 recruited children were noted to have habitual snoring (14.5%, 95% C.I. 10%-20%). The mean age of these habitual snorers was 6.2 +/- 3.1 years. For habitual snorers, male to female ratio was 1.4 to 1. Sixteen of these 28 children accepted a sleep polysomnographic examination. Eleven children were found to have snoring during the night of study. Two were found to have obstructive sleep apnoea syndrome. Sleep bruxism was found in 17 children (8.5%, 95% C.I.5%-13%). Sleep bruxism was closely related to habitual snoring as 16 out of the 17 children with sleep bruxism were also habitual snorers (p < 0.0001). CONCLUSION: Habitual snoring and sleep bruxism were commonly found in children attending paediatric clinics. Paediatricians should be aware of these problems and be prepared to deal with them. Habitual snoring and sleep bruxism were closely related. Further studies into this relationship is needed.

Ambulatory Care Facilities↗

PubMed2003

[The beneficial effect of septoplasty on snoring].

OBJECTIVES: This study sought to determine whether septoplasty played a favorable role on snoring complaints as well. PATIENTS AND METHODS: The study included 56 patients (40 males, 16 females; mean age 40 years; range 21 to 60 years) who underwent septoplasty operation for causes other than snoring. The patients' snoring complaints were evaluated and rated before and three months after surgery. RESULTS: Before surgery, 22 patients were found to have complaints of snoring. The snoring complaints improved after septoplasty in 16 patients (72.7%). The decrease in snoring complaints was found statistically significant (p<0.01). CONCLUSION: Improvement in snoring complaints in patients undergoing septoplasty operation emphasizes the need for investigating and treating septum deviations which are a primary cause of upper respiratory tract obstruction.

Adult↗

PubMed2003

[An epidemiologic study for relation between the snore and cerebral infarction].

OBJECTIVE: To explore the relation between cerebral infarction and simple, apneic snore. METHOD: A case control comparative study with the exception of influencing factors such as ages, sex, obesity and so on in 60 patients with cerebral infarction and 60 control subjects. RESULT: The probability of cerebral infarction is a little high in all snorer compared with the no snorer. The Odds ratio is 1.709 (95% confidence limits 0.798-3.705). The probability persist high in apneic snore compared with other kind of snore. The Odds ratio is 3.571 (95% CL 1.295-9.849, P < 0.05). The Odds ratio of cerebral infarction is highest in apneic snore compared with normal subjects (Odd ratio = 4.107, 95% CL 1.407-11.99, P < 0.01). CONCLUSION: Cerebral infarction is not obviously related with common snore. It is related significantly with the apneic snore. It indicated that snore is a possible cause of cerebral infarction. The possibility suffering from cerebral infarction is more in people especially in apneic snorer than no snorer.

Aged↗

PubMed1991

[Increase in blood pressure due to continuous obstructive snoring].

Sleep-related breathing disorders can strain the cardiovascular system. Link-ups with arterial hypertension have been confirmed in obstructive or mixed sleep apnoea which is characterised by discontinuous nocturnal snoring. On the other hand, it is known that arterial hypertension is very frequently seen in snorers. The present study deals with short-term, breathing-related blood pressure patterns and blood pressure changes during the snoring phase. 18 obstructive snoring phases were identified in 4 male patients aged 50 years (42-65), Broca index 136 (119-171). Polysomnographic measurements were carried out in the sleep laboratory and the blood pressure was continuously recorded via the a. brachialis. The short-term breathing-dependent blood pressure changes were systolic 10.8 (10-30) mmHg at the beginning and 17.5 (10-30) mmHg at the end of the snoring phase (P less than 0.01). Diastolically there was a difference of 9.4 (5-15) mmHg versus 13.9 (5-25) mmHg (P less than 0.01). During the snoring phases the systolic blood pressure increased from 140.3 (120-190) mmHg to 170.0 (145-235) mmHg and the diastolic pressure from 69.7 (50-110) mmHg to 93.1 (70-120) mmHg. The study proves that blood pressure increases occur not only in apnoeic snoring but also in continuous obstructive snoring. It is suspected that these changes are responsible for the high frequency of arterial hypertension among continuous snorers.

Adult↗

PubMed1995

Epidemiology of snoring and its consequences.

Much has been written about snoring and its affects on health, in particular its possible influence on cardiovascular disease. However, there are many assumptions made when linking the report of snoring to any consequences such as hypertension, heart disease or stroke. In particular it is not clear how snoring might influence the cardiovascular system, whether subjective reports of snoring are accurate, and snoring might only be acting as a marker for some common risk factor such as upper body obesity; a particular risk factor for cardiovascular disease, and through neck circumference, snoring. There is much better evidence that snoring is an important cause of sleepiness, even in the absence of conventional sleep apnoea.

Cardiovascular Diseases↗

PubMed1994

Fiberoptic evaluation of the nasal and nasopharyngeal anatomy in children with snoring.

In this prospective study, fiberoptic examinations of the nasal cavity and nasopharynx were performed in 162 children with snoring and compared with similar examinations performed in 211 children without snoring. Our study aimed to determine a correlation between snoring and measured parameters of nasal and nasopharyngeal anatomy including the size of the adenoid tissue. Results have confirmed significant evidence that adenoid hyperplasia is the commonest etiologic factor in children with snoring (p < .001). In addition, an important statistical relevance of mouth breathing in snoring was demonstrated (p < .001). It seemed that mouth breathing is a basic condition in children's snoring. It is essential to both confirm that mouth breathing occurs, and then, to institute an appropriate treatment as a therapeutic approach for children with snoring. The introduction of the flexible fiberscope in the fields of pediatric examination of the nasal cavity and nasopharynx has proved to be of great clinical value.

Adenoids↗

PubMed1997

[Nasal strips without effect on obstructive sleep apnea and snoring].

Recently a nose plaster (NP, Breathe-Right) has been increasingly used in the treatment of obstructive sleep apnoea (OSA) and snoring. Hence, we examined the use of the NP as a treatment of both OSA and snoring without OSA. The NP has a elastic spine that increases the diameter of the nostril and is thought to reduce the degree of OSA and snoring. According to the polysomnographic data two groups were differentiated: Group A (30 patients with OSA, apnoea index > 10/h, 26 men) and Group B (20 snorers, without OSA, 13 men). After the diagnostic polysomnography the efficacy of the NP was measured with a cardiorespiratory polygraph on the 2 following nights. In the group A the polygraphic data (apnoea index, time of apneas, desaturation index, time of desaturations, mean and nadir SaO2) were studied; in group B the snoring index (snoring events/hour) was measured. A questionnaire scored quality of sleeping, daytime condition and the quality of nose breathing. In neither group were the recorded polygraphic findings different with the NP although with the NP an improved nose breathing was scored in both groups. In group A 90% of the patients scored the daytime sleepiness unchanged and 10 of 30 patients described an improved quality of sleep. In group B there was no change in the frequency of snoring events with the NP. Neither the degree of OSA nor of snoring without OSA were changed by the NP, which can therefore not be considered a treatment of these conditions. However, the majority of the study population were impressed by the symptomatic improvement in nose breathing.

Dilatation↗

PubMed1997

[Changes in the time spent awake in obstructive sleep apnea and snoring--results of a pilot study].

Continuous positive airway pressure (CPAP) therapy reduces sleeping time per day and daytime sleepiness in obstructive sleep apnoea (OSA) and heavy snoring. Due to sleep fragmentation the OSA and heavy snoring are associated with a daytime sleepiness and increased necessity of sleep. In this pilot study the effect of CPAP-therapy on daytime sleepiness and sleep time during 24 hours were assessed in patients with OSA or heavy snoring (daytime sleepiness, none or slight apnoea with AHI < 10/h and benefit of CPAP). We studies 42 patients with OSA (AHI: 34.5 +/- 23.6) and 15 patients with heavy snoring: inclusion criteria: Patients with OSA (AHI > 10/h, ESS-Score > 8) and heavy snoring (AHI < 10/h, ESS-Score > 8) who were treated with nCPAP. Before and 2 months after initiation the CPAP-therapy all patients completed diary cards recording the sleeping time/day for 1 month; additionally they scored sleepiness using the Epworth sleepiness scale (ESS-score ranged from 0 to 24, the higher the score the worse the sleepiness) before and 2 months after initiation the CPAP-therapy. In the whole study population nCPAP-therapy reduced the sleeping time significantly by a mean period of 46 minutes per 24 hours (from 8.3 +/- 1.3 to 7.5 +/- 1.2 hours, p < 0.001) and improved the ESS score from 13.7 +/- 4.6 to 6.1 +/- 3.6 (p < 0.0001). In respect of the change of sleeping time/day and of the sleepiness score there was no significant difference between the OSA and heavy snoring group. With CPAP the AHI in OSA patients was reduced from 34.5 +/- 23.6/h to 3.2 +/- 3.2/h. Due to the improvement of sleep-related breathing disorders CPAP therapy reduced the mean sleeping time/day by approximately 10% and the daytime sleepiness score both in patients with OSA and heavy snoring compared to the pretreatment period.

Airway Obstruction↗

PubMed1993

Sleep, snoring and smoking in high school students.

The relationship between snoring, sleep and smoking was investigated in young students from a survey by self-administered questionnaire on sleep habits, conducted in high schools in the educational district of Lyons (France). Our sample consisted of 11,417 boys and 13,265 girls between 15 and 20 years of age. We found that 28.4% of girls and 38.8% of boys reported that they snored. In both sexes, snoring was associated with short (<7 h) and long (>10 h) sleep length, nocturnal awakenings and daytime sleepiness. Smoking was a risk factor for snoring. Multiple logistic regression showed that the odds-ratio for habitual snoring increased when tobacco consumption increased from a 1.30 (moderate smokers) to 2.26 (heavy smokers) in girls and from 1.38 to 2.09 in boys. This dose-effect relationship between smoking and snoring suggests that a substantial proportion of snoring cases is attributable to tobacco consumption in young students.

Journal Article↗

PubMed1990

Snoring in a Hispanic-American population. Risk factors and association with hypertension and other morbidity.

Snoring was investigated in a survey of respiratory disease in Hispanic-Americans of a New Mexico community. A population-based sample of 1222 adults was studied with questionnaires and measurements of height, weight, and blood pressure. The age-adjusted prevalence of regular loud snoring was 27.8% in men and 15.3% in women. Snoring prevalence increased with age and obesity in both men and women. Cigarette smoking was also associated with snoring, but chronic obstructive lung disease and alcohol consumption were not. Snorers more frequently had hypertension, ischemic heart disease, and excessive daytime sleepiness. In contrast to other studies, after adjustment for confounding factors, there was no effect of snoring on hypertension (odds ratio, 1.0; 95% confidence interval, 0.7 to 1.5), but an effect on myocardial infarction was still demonstrable (odds ratio, 1.8; 95% confidence interval, 0.9 to 3.6). The association of snoring with sleepiness suggests that respiratory disturbance of sleep related to upper airway obstruction, such as sleep apnea, occurs more frequently in snorers in this population.

Adult↗

PubMed2004

The effect on snoring of structural nasal valve dilatation with a butterfly graft.

OBJECTIVE: To evaluate the effect on snoring of structural nasal valve dilatation with butterfly spreader grafts in patients with nasal valve insufficiency. DESIGN: Retrospective medical chart review and telephone follow-up; mean +/- SD follow-up time, 20.7 +/- 11.34 months (range, 3-48 months). SETTINGS: Tertiary care referral center. SUBJECTS: A total of 37 snoring patients with nasal valve insufficiency who underwent nasal valve dilatation with a butterfly spreader graft. INTERVENTIONS: The conchal cartilage butterfly graft technique was performed during rhinoplasty through either an external or endonasal approach. MAIN OUTCOME MEASURE: To establish through a retrospective review that butterfly graft conchal cartilage nasal reconstruction is effective in reducing snoring. RESULTS: After surgery, 30 patients (81%) had significant improvement in breathing, 5 (14%) had slight improvement, and 2 (5%) had no benefit in breathing. Snoring stopped completely in 11 (30%) of the patients after surgery. The improvement in snoring was significant in 13 patients (35%) and slight in 3 (8%). Twenty-six patients (70%) reported tiredness and grogginess on awakening before the surgery. Surgery significantly improved patients' tiredness and grogginess on awakening in 15 cases (58%), slightly improved them in 5 (19%), and did not change the patients' tiredness and grogginess in 6 cases (23%). CONCLUSION: The conchal cartilage butterfly graft yields successful results not only in breathing but also in snoring symptoms in patients with nasal valve insufficiency.

Adult↗