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Behavior and neurocognitive performance in children aged 5-10 years who snore compared to controls.

Sleep disordered breathing in children is a common but largely underdiagnosed problem. It ranges in severity from primary snoring to obstructive sleep apnea syndrome (OSAS). Preliminary evidence suggests that children with severe OSAS show reduced neurocognitive performance, however, less is known about children who snore but do not have severe upper airway obstruction. Participants included 16 children referred to the Ear, Nose and Throat/Respiratory departments of a Children's Hospital for evaluation of snoring and 16 non-snoring controls aged 5-10 years. Overnight polysomnography (PSG) was carried out in 13 children who snored and 13 controls. The PSG confirmed the presence of primary snoring in seven and very mild OSAS (as evidenced by chest wall paradox) in eight children referred for snoring while controls showed a normal sleep pattern. To test for group differences in neurocognitive functioning and behavior, children underwent one day of testing during which measures of intelligence, memory, attention, social competency, and problematic behavior were collected. Compared to controls, children who snored showed significantly impaired attention and, although within the normal range, lower memory and intelligence scores. No significant group differences were observed for social competency and problematic behavior. These findings suggest that neurocognitive performance is reduced in children who snore but are otherwise healthy and who do not have severe OSAS. They further imply that the impact of mild sleep disordered breathing on daytime functioning may be more significant than previously realized with subsequent implications for successful academic and developmental progress.

Analysis of Variance↗

Automatic detection, segmentation and assessment of snoring from ambient acoustic data.

Snoring is a prevalent condition with a variety of negative social effects and associated health problems. Treatments, both surgical and therapeutic, have been developed, but the objective non-invasive monitoring of their success remains problematic. We present a method which allows the automatic monitoring of snoring characteristics, such as intensity and frequency, from audio data captured via a freestanding microphone. This represents a simple and portable diagnostic alternative to polysomnography. Our system is based on methods that have proved effective in the field of speech recognition. Hidden Markov models (HMMs) were employed as basic elements with which to model different types of sound by means of spectrally based features. This allows periods of snoring to be identified, while rejecting silence, breathing and other sounds. Training and test data were gathered from six subjects, and annotated appropriately. The system was tested by requiring it to automatically classify snoring sounds in new audio recordings and then comparing the result with manually obtained annotations. We found that our system was able to correctly identify snores with 82-89% accuracy, despite the small size of the training set. We could further demonstrate how this segmentation can be used to measure the snoring intensity, snoring frequency and snoring index. We conclude that a system based on hidden Markov models and spectrally based features is effective in the automatic detection and monitoring of snoring from audio data.

Acoustics↗

Snoring as a risk factor for type II diabetes mellitus: a prospective study.

To examine the association between snoring and risk of developing type II diabetes mellitus, the authors analyzed data from the Nurses' Health Study cohort. This analysis included 69,852 US female nurses aged 40-65 years without diagnosed diabetes, cardiovascular disease, or cancer at baseline in 1986. Snoring patterns were ascertained by questionnaire. During 10 years of follow-up, 1,957 women were diagnosed with type II diabetes. In analyses adjusted for age and body mass index, snoring was associated with risk of diabetes (for occasional snoring vs. nonsnoring, relative risk (RR) = 1.48 (95% confidence interval (CI): 1.29, 1.70); for regular snoring vs. nonsnoring, RR = 2.25 (95% CI: 1.91, 2.66); p for trend < 0.0001). Further adjustment for other diabetes risk factors and sleeping-related covariates only slightly attenuated the risk (for occasional snoring, RR = 1.41 (95% CI: 1.22, 1.63); for regular snoring, RR = 2.03 (95% CI: 1.71, 2.40); p for trend < 0.0001). Analyses stratified by body mass index, smoking history, or parental history of diabetes showed a consistent association between snoring and diabetes within the categories of these variables. These results suggest that snoring is independently associated with elevated risk of type II diabetes.

Adult↗

Pattern of snoring in obstructive sleep apnea patients and in heavy snorers.

We measured respiratory mechanical characteristics during sleep in five heavy, nonapneic snorers (HS) and in five obstructive sleep apnea (OSA) patients. In two HS and in two OSA patients we obtained lateral pharyngeal cineradiographic images during sleep while snoring. Flow limitation preceded all snores in both HS and OSA. Pattern of snoring, hysteresis and temporal relationship between supraglottic pressure (Psg) and flow rate were different in HS and OSA. Maximal flow during snoring was less (p less than 0.05) in OSA (0.18 +/- 0.07 liter/second) than in HS (0.36 +/- 0.06 liter/second). Linear supraglottic resistance during inspiratory snoring was higher, though not significantly, in OSA patients (7.11 +/- 3.01 cm H2O/liter/second) than in HS (4.80 +/- 2.83 cm H2O/liter/second). We conclude that: 1) Snoring is characterized by high frequency oscillations of the soft palate, pharyngeal walls, epiglottis and tongue. 2) Flow limitation appears to be a sine qua non for snoring during sleep. 3) The pattern of snoring is different in OSA and HS. 4) Pharyngeal size during snoring is probably larger in HS than in OSA patients.

Adult↗

Effect of nasal dilation on snoring and apneas during different stages of sleep.

This study was designed to test the hypothesis that nasal dilation reduces snoring. To achieve this we performed nocturnal polysomnography, including measurement of snoring, in 15 patients without nasal pathology before and after insertion of a nasal dilator (NOZOVENT). Snoring was quantified for each sleep stage by recording the number of snores per minute of sleep, number of snores per minute of snoring time and nocturnal sound intensities (maximum, average and minimum). We found that nasal dilation had no effect on the number of apneas, hypopneas or oxygen saturation. Snoring parameters were unaffected by NOZOVENT during stages I, II and REM sleep, but were all significantly reduced during slow wave sleep. We conclude that dilation of the anterior nares in patients without nasal pathology has a relatively weak effect on snoring, and routine use of nasal dilating appliances is not recommended for treatment of snoring.

Adult↗

Radiofrequency volumetric tissue reduction of the soft palate: a new treatment for snoring.

OBJECTIVE/HYPOTHESIS: Current options for the treatment of snoring have limited acceptance because of intolerance, expense, pain, or need for general anesthesia. A clinical trial using a new application of a previously known technology-radiofrequency energy-was investigated to determine its efficacy in the treatment of snoring. Effects of treatment on speech, swallowing, pain, snoring, and degree of sleepiness were evaluated. These effects were evaluated by post-treatment questionnaires. METHODS: Prospective nonrandomized study. All included subjects snored at a level considered bothersome to their bed partner. A total of 43 patients were enrolled at the University of Maryland (UM) and the Georgia Ear Institute (GEI). Polysomnography was performed before treatment to eliminate patients with significant sleep apnea who had respiratory disturbance indices (RDIs) greater than 15 or nadir desaturations less than 80%. The mean pretreatment RDI for all patients who entered the protocol at UM was 6.7 +/- 4.7. Nine patients completed the study in this group in all other aspects, but did not return for their scheduled post-treatment polysomnogram. At GEI, pretreatment polysomnograms revealed a mean RDI of 8.9 +/- 3.8. Eleven patients at GEI completed the study in all other aspects but did not return for their scheduled post-treatment polysomnogram. Radiofrequency energy was delivered to the soft palate either in the midline (19 patients) at a mean of 698 +/- 52 J per treatment at UM or in the midline and lateral soft palate (24 patients) at a mean of 1,254 +/- 191 J per treatment at GEI. At UM the mean age was 44.3 +/- 8.4 years, with a range from 29 to 59 years. Eighty-four percent of the patients were men. The mean body mass index (BMI) was 28.5 +/- 3.2. Twenty-four patients were enrolled at GEI. The mean age was 44.0 +/- 10.9 years, with a range from 23 to 63 years. Seventy-four percent of patients were men. The mean BMI was 27.7 +/- 3.8. Snoring, pain, swallowing, and speech were assessed after each treatment at post-treatment day 1, 2, or 3; week 1; week 4; and week 7. Daytime sleepiness was assessed by the Epworth Sleepiness Scores (ESS) obtained at the same intervals. RESULTS: Snoring was improved in 77% of patients after three treatments or less. Seventy-nine percent of patients treated with the midline technique at UM and 96% of patients treated with the midline and left and right lateral palate technique at GEI achieved an improvement in their snoring to a level that was no longer bothersome to their bed partner. No persistent negative impact was noted concerning speech or swallowing. Improvements in degree of sleepiness were observed by comparing pretreatment and post-treatment ESS. ESS was significantly reduced (P < .005) after treatment from 10.2 +/- 6.1 to 6.1 +/- 4.7 at UM, and at the GEI, from 8.75 +/- 4.4 to 5.3 +/- 3.2. After a treatment, 27% of the patients at UM and 29% at GEI required analgesics. CONCLUSIONS: This clinical trial demonstrates the efficacy, safety, and lack of pain encountered when using radiofrequency energy delivered to the palate for the treatment of snoring. The tolerability, lack of pain, and ability to perform the procedure with the patient under local anesthesia in the office make the use of this technology an excellent option for the treatment of snoring.

Adult↗

Can snoring relief after nasal septal surgery be predicted?

Patients with nasal obstruction often have associated snoring. This study aims to find out if there are reliable predictors for the success or failure of septal surgery in relieving snoring in patients with symptomatic nasal obstruction secondary to a deviated nasal septum and who have associated snoring. Thirty patients were studied pre-operatively and at 4-12 months (mean 6 months) post-operatively. The intensity of snoring was measured on a visual analogue scale. Nasal patency was measured with a peak nasal inspiratory flow meter. The collapsibility of the soft palate was gauged by the degree of velopharyngeal closure on the Muller manoeuvre. Fifteen patients (50%) achieved snoring relief after septal surgery. The severity of nasal obstruction and intensity of snoring pre-operatively, the magnitude of nasal obstruction relief post-operatively and the degree of collapsibility of the soft palate were found not to influence the outcome of septal surgery on snoring. The relationship between nasal obstruction and snoring is complex and the alteration of airflow patterns after septal surgery is postulated to be important in influencing snoring relief.

Adult↗

Natural history of snoring and related behaviour problems between the ages of 4 and 7 years.

In 1989-90 a survey was carried out of the prevalence of snoring and related symptoms in 782 4 to 5 year old children. Two years later, in 1992, the same group of children was studied to gather information on the natural history of snoring and the related behaviour problems. A total of 507/782 (64.8%) completed questionnaires were received. Comparison of the responses with the 1989-90 survey showed that those who did not reply to the questionnaire were no different from the respondents in terms of the prevalence of snoring, daytime sleepiness, hyperactivity, and restless sleep. The overall prevalence of habitual snoring did not change between the two surveys (12.1% in 1989-90 v 11.4% in 1992), though more than half of the children who snored habitually in the original survey no longer did so. There was little change in the prevalence of hyperactivity (24.2% in 1989-90 v 20.7% in 1992) or restless sleep (both 39%) among the 507 who responded to the present survey. The prevalence of daytime sleepiness, however, did decrease substantially (20.7% in 1989-90 v 10.2% in 1992). There was moderate agreement between the individual questionnaire responses for the 1989-90 and 1992 surveys for snoring (weighted kappa 0.52), but poor agreement for the other symptoms (daytime sleepiness 0.37, hyperactivity 0.35, and restless sleep 0.38). Trend analysis showed that the increasing prevalence of sleepiness, hyperactivity, and restless sleep across the snoring categories was highly significant. Daytime sleepiness, hyperactivity, and restless sleep were all significantly more common in the habitual snorers than in those who never snored. Relative risks (95% confidence interval) were as follows: daytime sleepiness 6.13 (2.5 to 14.9), hyperactivity 2.78 (1.6 to 4.7), and restless sleep 2.3 (1.6 to 3.2). Though habitual snoring and the associated behaviour problems resolved spontaneously over two years in about half of the children with these symptoms, there is still the same overall percentage with these problems due to the emergence of new cases.

Child↗

Snoring and sleep apnea. A population study in Australian men.

Snoring and sleeping apnea are reportedly associated with morbidity. We used home monitoring (MESAM IV) to measure snoring and sleep apnea in 294 men aged 40 to 65 yr from the volunteer register of the Busselton (Australia) Health Survey. In this group, 81% snored for more than 10% of the night and 22% for more than half the night; 26% had a respiratory disturbance index (RDI) > or = 5, and 10% had an RDI > or = 10. There was a relatively low correlation between percentage of night spent snoring and RDI (rho = 0.47, p < 0.005). Subjective daytime sleepiness plus RDI > or = 5 occurred in a minimum of 3%. Obesity was related to snoring, RDI, and minimum SaO2 (all p < 0.0001). There was no relationship between age and either RDI or snoring, but increased age was related to minimum SaO2 < 85% (p < 0.05). Alcohol consumption was not related to sleep-disordered breathing. Smokers snored for a greater percentage of the night than nonsmokers (41 versus 31%, p = 0.01). We conclude that, in middle-aged men, both snoring and sleep apnea are extremely common, and in this age range both are associated with obesity but not with age. However, a high percentage of snoring is not essential for the occurrence of sleep apnea, nor does it necessarily indicate that apnea is present.

Adult↗

Does snoring contribute to presbycusis?

It is well known that hearing acuity decreases with age. The precise mechanism responsible for this phenomenon, called presbycusis, is unknown. One hypothesis advanced to explain this loss of acuity implicates chronic exposure to snoring noise. Consequently, the purpose of this study was to investigate whether snoring is associated with hearing loss. We examined 219 patients (63 women and 156 men) referred to our sleep disorders center. All of the patients underwent nocturnal polysomnography with measurements of snoring, as well as standard audiometry (i.e., measurement of hearing thresholds at 250 Hz, 500 Hz, 1 kHz, 2 kHz, 3 kHz, 4 kHz, 6 kHz, and 8 kHz). Snoring was quantified by measuring three parameters: snoring index (SI = number of snores/h of sleep), average nocturnal sound intensity (dBav), and maximum nocturnal sound intensity (dBmax). We used simple correlation analysis to investigate the relationship between snoring and hearing thresholds; multiple linear regression analysis to determine individual contributions of age, sex, and snoring to the variability in hearing thresholds; and comparison tests to determine whether mild snorers had less hearing impairment than severe snorers. None of these statistical tests demonstrated that snoring was a significant determinant of hearing. We conclude that snoring is not associated with hearing loss and is therefore unlikely to account for presbycusis.

Adolescent↗

Laser-assisted uvulopalatoplasty for snoring: does it meet the expectations?

The high prevalence of habitual snoring (35% of the general population) and the increasing demand for an effective treatment have led, in the last decade, to the generalisation of laser-assisted uvulopalatoplasty (LAUP). However, acceptable studies on its effectiveness are lacking. The present randomised, placebo-controlled study included 25 nonapnoeic and mild obstructive sleep apnoea snorers to evaluate LAUP effectiveness for snoring. Group I received a one-stage LAUP treatment and group II a placebo (simulated snore surgery followed by an oral placebo). Before each treatment and 3 months after, the variables and procedures assessed were: body weight; sleepiness (Epworth sleepiness scale); quality of life (SF-36); subjective snoring intensity (0-10 analogue scale); objective snoring intensity (average decibel intensity); snoring index (number of snores per hour); and apnoea/hypopnea index. No differences were observed in body weight, sleepiness, quality of life, subjective and objective intensity, and frequency of snoring, and apnoea/hypopnea index between the groups before and 3 months after treatment. In conclusion, this study provides evidence of the lack of effectiveness of one-stage laser-assisted uvulopalatoplasty for snoring in nonapnoeic and mild obstructive sleep apnoea patients, with the result that it does not meet the expectations generated by the procedure.

Adult↗

Treatment for snoring. Combined weight loss, sleeping on side, and nasal spray.

OBJECTIVE: We sought to find a combination of noninvasive treatments for snoring by adding weight loss to previously studied treatments, including the combination of sleeping on one's side and using a decongestant nasal spray. STUDY POPULATION: Twenty asymptomatic men who snore heavily were studied previously on a control night and on a night when they slept on their side and used a nasal spray. With these two treatments, minor improvements in apnea/hypopnea index (AHI) were seen, but no improvement occurred in snoring frequency. Nineteen of these subjects subsequently completed a 6-month weight loss program, and 12 lost weight. These 19 subjects comprise the study population of this report. STUDY DESIGN: At the conclusion of the weight loss program, a repeated sleep study was done from which the effect of adding weight loss to the two previously studied treatments could be assessed. RESULTS: Those 12 subjects who lost any amount of weight showed a very mild reduction in snores per hour from 328 using two modalities of treatment to 232 per hour with the addition of weight loss (p = 0.15). The nine subjects who lost > or = 3 kg reduced the number of snores per hour from 320 to 176 (p = 0.0496). Three subjects losing an average of only 7.6 kg showed virtual elimination of snoring after weight loss. Subjects who gained weight had no improvement in snoring. Weight loss added to the other two modalities of treatment had no effect on the AHI. CONCLUSION: In most cases, the combination of weight loss, sleeping on one's side, and the administration of a nasal decongestant significantly reduces the frequency of snoring in asymptomatic men who snore heavily. The major effect appears to be related to weight loss.

Administration, Intranasal↗

Relative occurrence of flow limitation and snoring during continuous positive airway pressure titration.

OBJECTIVES: To examine the relative temporal appearance of flow limitation and snoring during continuous positive airway pressure (CPAP) titration, compare their sensitivity as indicators of airway obstruction, and assess their relative utility as feedback variables for automatic titration of CPAP. DESIGN: Retrospective review of data. SETTING: University teaching hospital. PATIENTS: Fifty-three patients diagnosed as having obstructive sleep apnea or upper airway resistance syndrome undergoing CPAP titration. MEASUREMENTS AND RESULTS: We used a prototype automatic CPAP device that adjusts pressure in response to apnea, snoring, and/or flow limitation. The present study takes advantage of the frequent automatic decreases in pressure from a therapeutic level, as well as any technician-initiated decreases in pressure. We tabulated, for each pressure decrease of >0.4 cm H2O, the occurrences of snoring alone, flow limitation alone, or simultaneous appearance of both. Of 2,177 automatic pressure decreases, 64% resulted in flow limitation alone, 8% in snoring alone, and 22% in the simultaneous occurrence of both. Overall, 86% of decreases resulted in flow limitation alone or were simultaneous with snoring, whereas 30% of decreases resulted in snoring alone or were simultaneous with flow limitation. In 10 of 35 patients, snoring alone occurred in > 10% of the pressure decreases. In all but 5 of 133 manual pressure decreases, flow limitation developed at or above the pressure at which snoring developed. CONCLUSIONS: While detection of snoring occasionally provided additional information, overall flow limitation was the earliest indicator of obstruction during decreases in CPAP.

Adolescent↗

Snoring, pregnancy-induced hypertension, and growth retardation of the fetus.

STUDY OBJECTIVE: Our purpose was to study the relationship between snoring and pregnancy-induced hypertension and growth retardation of the fetus. DESIGN: Retrospective, cross-sectional, consecutive case series. SETTING: The Department of Gynecology and Obstetrics, University Hospital, Umeâ, Sweden. PARTICIPANTS AND MEASUREMENTS: On the day of delivery, 502 women with singleton pregnancies completed a questionnaire about snoring, witnessed sleep apneas, and daytime fatigue. Data concerning medical complications were taken from the women's casebooks. RESULTS: During the last week of pregnancy, 23% of the women reported snoring every night. Only 4% reported snoring before becoming pregnant. Hypertension developed in 14% of snoring women, compared with 6% of nonsnorers (p < 0.01). Preeclampsia occurred in 10% of snorers, compared with 4% of nonsnorers (p < 0.05). An Apgar score < or = 7 was more common in infants born to habitual snorers. Growth retardation of the fetus, defined as small for gestational age at birth, had occurred in 7.1% of the infants of snoring mothers and 2.6% of the remaining infants (p < 0.05). Habitual snoring was independently predictive of hypertension (odds ratio [OR], 2.03; p < 0.05) and growth retardation (OR, 3.45; p < 0.01) in a logistic regression analysis controlling for weight, age, and smoking. CONCLUSIONS: Snoring is common in pregnancy and is a sign of pregnancy-induced hypertension. Snoring indicates a risk of growth retardation of the fetus.

Adult↗

BP and arterial distensibility in children with primary snoring.

STUDY OBJECTIVE: While previous studies have suggested an association between obstructive sleep apnea and cardiovascular complications, the effects of primary snoring in children on daytime systemic BP and arterial distensibility remain unknown. DESIGN AND PATIENTS: To determine the effects of primary snoring on BP and peripheral conduit artery distensibility, 30 children with primary snoring were studied at an age of 9.5 +/- 2.8 years (mean +/- SD). Systemic BP was measured using an automated device, while brachioradial arterial distensibility was assessed by measuring pulse wave velocity (PWV), which is inversely related to the square root of distensibility. The results were compared to those of 30 healthy control subjects matched for age, sex, and body size. RESULTS: As compared to control subjects, children with primary snoring had significantly higher systolic BP (112 +/- 10 mm Hg vs 105 +/- 8 mm Hg, p = 0.001), diastolic BP (60 +/- 7 mm Hg vs 53 +/- 9 mm Hg, p = 0.004), and mean BP (81 +/- 7 mm Hg vs 71 +/- 8 mm Hg, p < 0.001). Likewise, those with primary snoring had significantly higher PWV (9.7 +/- 1.6 m/s vs 7.9 +/- 2.0 m/s, p = 0.001). Multiple regression identified age, body mass index (BMI), and primary snoring as significant determinants of systemic BP; however, primary snoring is the only significant determinant of PWV. Regardless of the BMI, systemic BP and PWV remained significantly higher in children with primary snoring. CONCLUSION: Children with primary snoring have increased daytime systemic BP and reduced arterial distensibility, which may jeopardize long-term cardiovascular health.

Blood Pressure↗

Snoring in preschool children: prevalence and association with nocturnal cough and asthma.

INTRODUCTION: The association between snoring, nocturnal cough, and allergic symptoms in young children is not known. OBJECTIVE: To measure the prevalence of habitual snoring and its association with nocturnal cough, asthma, and hay fever in preschool children. SETTING: A cross-sectional study. SUBJECTS: Preschool children aged 2 to 5 years. METHOD: The data were collected in a cross-sectional study. A total of 974 children were randomly selected from two areas of Lismore and Wagga Wagga in New South Wales, Australia. RESULTS: The prevalence of snoring was 10.5%, with no gender difference (p = 0.99) or trend association with age (p = 0.58). The association between snoring and nocturnal cough was highly significant (odds ratio [OR], 3.68; 95% confidence interval [CI], 2.41 to 5.63; p = 0.001). This association was significant in both the nonasthmatic and asthmatic groups when examined separately. Snoring was also significantly associated with asthma (OR, 2.03; 95% CI, 1.34 to 3.10; p = 0.001). In subjects without hay fever, the association between snoring and asthma was also highly significant (41.2% vs 24.8%; OR, 2.12; 95% CI, 1.34 to 3.37; p = 0.001). CONCLUSION: The prevalence of snoring in preschool children was 10.5% for both genders. Snoring was significantly associated with both nocturnal cough and asthma. Because snoring, asthma, and nocturnal cough may have a common etiology, it is possible that effective treatment of one symptom may lead to reductions in the presence or severity of the other symptoms.

Asthma↗

Prevalence of snoring and symptoms of sleep-disordered breathing in primary school children in istanbul.

STUDY OBJECTIVES: Snoring during sleep is an important manifestation of obstructive sleep apnea syndrome (OSAS). Although clinical history is not sufficiently sensitive and specific to distinguish primary snoring from OSAS, snoring is indicative of upper airway obstruction and may be associated with the presence of diurnal symptoms. Our study aims were to determine the prevalence of snoring in primary school children in Istanbul, and to evaluate the diurnal symptoms and conditions that may be associated with sleep problems. DESIGN, SETTING, AND SUBJECTS: A parental questionnaire was used to assess the sleep and wake behavioral patterns in children. Eight representative schools in each of 9 school districts randomly selected from the 32 school districts in Istanbul were visited. RESULTS: The response rate was 78.1%; 2,147 of 2,746 questionnaires were fully completed, returned, and analyzed. The prevalence of habitual snoring was 7.0%. Habitual snorers had significantly more nighttime symptoms, such as observed apneas (odds ratio [OR], 16.9; 95% confidence interval [CI], 10.0 to 28.8; p < 0.0001), difficulty breathing (OR, 17.8; CI, 10.9 to 29.2; p < 0.0001), restless sleep, parasomnias, and nocturnal enuresis, compared to occasional and nonsnorers. There were also increased prevalence of daytime symptoms, such as falling asleep while watching television (OR, 1.8; CI, 0.9 to 3.7; p = 0.01) and in public places (OR, 2.1; CI, 1.2 to 3.8; p = 0.03), and hyperactivity (OR, 2.7; CI, 1.8 to 3.9; p < 0.0001). Exposure to cigarette smoke and the presence of asthma and hay fever increased the likelihood of habitual snoring. Children with a higher risk for OSAS (habitual snoring, apnea, and difficulty breathing during sleep) were also compared to nonsnorers. Although nighttime symptoms were more likely in the high-risk group, the risk of daytime symptoms increased as well. CONCLUSIONS: Habitual snoring is a significant problem for children and may be associated with diurnal symptoms. Exposure to cigarette smoke at home and the presence of asthma and hay fever increase the likelihood of habitual snoring.

Adolescent↗

Risk factors in a general population for snoring. Importance of cigarette smoking and obesity.

In order to study risk factors associated with snoring in a general adult population, 2,187 subjects in the Tucson Epidemiologic Study of Obstructive Airways Disease were surveyed to determine the prevalence of snoring. Major independent risk factors for snoring were male gender, age between 40 and 64 years, obesity, and current cigarette smoking. Furthermore, greater intensity of cigarette smoking also was associated with higher snoring prevalence rates. Snoring prevalence remained elevated in subjects who recently quit smoking, but declined in ex-smokers to the level of never smokers within four years of smoking cessation. The presence of cough or sputum production was associated with an increase in snoring prevalence especially in ex-smokers. Snoring prevalence was slightly increased in subjects who regularly used alcohol or medications as aids to sleep. We conclude that cigarette smoking, obesity, male gender, age over 40, and use of alcohol or sleep medications are important risk factors for snoring. We propose that the effect of smoking may be related to the production of upper airway inflammation and edema by cigarette smoke, and that smoking cessation may eventually reduce snoring risk.

Adult↗