neurologic disorders
Snoring
Etiology of Snoring
Primary snoring is snoring that is not accompanied by awakening or excessive arousals, limitation of airflow, oxygen desaturation, or arrhythmias during sleep and that occurs in people who do not have excessive daytime sleepiness. Arousals are brief transitions to lighter sleep or awakenings that last < 15 seconds and are usually not noticed. Snoring is usually a symptom of sleep-disordered breathing, which covers a spectrum ranging from upper airway resistance syndrome to Obstructive Sleep Apnea (OSA) (OSA). Each has similar upper airway obstructive pathophysiology but differs in degree and clinical consequences of the airway obstruction. The clinical consequences involve mainly disturbances of sleep and/or airflow. Patients withobstructive sleep apneahave ≥ 5 episodes of apnea or hypopnea (with each episode lasting at least 10 seconds) per hour during sleep (apnea/hypopnea index [AHI]) plus ≥ 1 of the following: Daytime sleepiness, unintentional sleep episodes, unrefreshing sleep, fatigue, or insomnia Awakening with breath holding, gasping, or choking Reports by a bed partner of loud snoring, breathing interruptions, or both during the patient's sleep Obstructive sleep apnea can be categorized by severity: Mild: 5 to 15 episodes/hour Moderate: 16 to 30 episodes/hour Severe: > 30 episodes/hour Upper airway resistance syndrome(airflow limitation secondary to increased upper airway resistance or respiratory effort–related arousals [RERAs]) can cause excessive daytime sleepiness or other manifestations suggesting obstructive sleep apnea but with few episodes of apnea/hypopnea or oxygen desaturation and thus does not meet full criteria for obstructive sleep apnea. Although snoring itself has no known adverse physiologic effects, obstructive sleep apnea may have consequences (eg, hypertension, stroke, heart disorders, diabetes). Risk factors for snoring include Older age Obesity Use of alcohol or other sedatives Chronic nasal congestion or blockage A small or posteriorly displaced jaw Male sex Postmenopausal status Pregnancy Abnormal structures that can block airflow (eg, large tonsils, a deviated nasal septum, nasal polyps, macroglossia, an enlarged soft palate, lateral pharyngeal narrowing) There may also be familial risk. 