Snoring: Sleep-related Breathing Disorders?

Sleep-disordered breathing (SDB) is associated with several conditions that result in altered respirations. The most common SDB is sleep apnea.

Two types of sleep apnea:

• Central sleep apnea (not common with unknown etiology)-
  • associated with underlying pathological conditions such as Cheyne-Stokes breathing or environmental causes such as high-altitude periodic breathing.
  • Characterized by a cessation or decrease in ventilatory effort during sleep and is usually associated with oxygen desaturation.
• Obstructive sleep apnea (OSA) syndrome – (much more common)
  • caused by upper airway obstruction
  • Characterized by snoring (loud snoring and labored breathing interrupted by periods of silence soon followed by apnea), disrupted sleep, and excessive daytime sleepiness
  • airflow ceases, but respiratory muscles continue to function
  • Apnea: cessation of airflow through the nose and mouth for 10 seconds or longer.
    • The apneic periods typically last for 15 to 120 seconds, some people may have as many as 300 to 500 apneic periods per night
    • hypopnea: a decrease in arterial oxygen saturation
      • The average number of apnea-hypopnea periods per hour is called the apnea-hypopnea index (AHI)
        • an adult may experience up to five events an hour without symptoms. as the AHI increases, so does the severity of symptoms. An AHI of five or greater in combination with reports of excessive daytime sleepiness is indicative of OSA.
  • Principal mechanism of OSA
    • When the person is awake, the airway is kept open by the activity of the pharyngeal musculature
    • During sleep, this pharyngeal musculature activity decreased, causing airway obstruction, most commonly in the area behind the uvula, soft palate, and posterior tongue
  • Factors predispose: male gender, increasing age, a positive family history, obesity
    • large neck girth – male and female snorers – neck circumferences > 40cm
  • Signs & Symptoms of OSA
    • excessive daytime sleepiness
    • noisy snoring
    • observed apnea
    • insomnia
    • abnormal movements during sleep
    • morning headaches
    • cognitive and personality changes
    • sexual impotence
    • systemic hypertension
    • pulmonary hypertension, cor pulmonale
    • polycythemia
  • Treatment
    • behavioral measures: weight loss, eliminating evening alcohol and sedatives, and proper bed positioning (such as training the person to sleep in lateral position if he or she snoring during supine sleep position)
    • Oral or dental appliance
    • Nasal or naso-oral continuous positive airway pressure (NCPAP)
    • Surgical procedures: nasal septoplasty… uvulopalatopharyngoplasty … (may or may not require tracheostomy placement)
    • facts or myths?
      • researchers believe snoring is caused by the vibration of soft tissues in response to turbulent air flow within the upper airway. Nasal strips, sold in drugstores, are narrow pieces of springy plastic encased in adhesive strips. when fastened to the outside of the nose so that the nostrils are opened up, the strip opens up the constricted passage, reducing the turbulence …
      • It is possible to cure snoring by losing weight… study shows males who snore heavily were placed on a six-month weight loss program. among the men who lost 6 lbs, the amount of snoring dropped 50%. among those who lost 13 obs or more, snoring was virtually eliminated…
      • Chronic poor sleep caused by snoring may disturb blood flow to the penis. A study found that about half of all impotent men also suffered from sleep apnea. whether or not snoring causes impotence is unclear. however, there seems to be a clear association….