By: Worthy Bro. Dr. Paul Kwaw Ntodi
ASPH, DRGK (C91, Western North Regional Council)
SNORING is an undesirable sound that occurs during sleep. The intensity of the noise varies from causing a minor disturbance to an annoying social problem. It may lead to Snoring- Spouse Syndrome (SSS), a social disruptive condition which has been known to cause spousal discord and led to divorce in some instances. It may also cause the invitation of unwanted guests (robbers) who have a good signal of confirmation of sleep.
In addition the snorer may have daytime sleepiness and fatigue as well as morning headaches. Memory loss, irritability, depression and decreased libido are common symptomatology of snorers. People who snore have an increased risk of road traffic accidents.
Snoring is commoner in men with a prevalence of 25% in adult males compared with 15% in adult females. The prevalence increases with age affecting 60% of adult males over 60 years.
Anatomy of the Upper Airway
Mechanism of Snoring
Snoring occurs when air flow during breathing causes the relaxed tissues in the throat during sleep to vibrate. Breathing against obstruction causes vibration of the soft palate, tonsillar pillars, base of tongue and the hypo-pharynx (lower part of the throat) producing sounds as loud as 90 decibels. The undesirable sounds created are of different tones and intensities. The loudness may commence like the start of an old diesel corn mill and gain momentum gradually. The noise usually occurs during inspiration (breathing in). It may occur during any stage of sleep. The worst forms of Snoring are usually complicated with Sleep Apnoea.
SLEEP APNOEA
Temporary cessation of breathing for more than 10 seconds during sleep is described as sleep apnoea. The cause may be Central (from disease conditions of the Brain) or Obstructive or a mixture of the two. Obstructive Sleep Apnoea is a serious sleep disorder and is always accompanied by snoring. NB: Not all snoring is caused by Obstructive Sleep Apnoea (OSA). In OSA, there is upper airway obstruction resulting in intermittent cessation of airflow and breathing though there is respiratory effort.
CAUSES OF SNORING
The commonest cause of snoring and OSA in children is the enlargement of the tonsils and adenoids (a lymphoid tissue at the back of the nose and in the throat).
In adults common causes include abnormalities in the nasal passage such as deviation of the nasal septum, nasal polyps and growths, enlargement of the turbinates (folds in the nose) and stuffiness.
Abnormalities in the mouth including elongated soft palate and uvula, enlarged tonsils, big tongue, enlarged base of tongue and growths of the tongue also lead to snoring and OSA. Various abnormalities of the larynx (voice box) and epiglottis may also cause snoring and OSA.
People with short neck and obesity are also prone to Snoring. The use of alcohol, sedatives and anti-depressants also predispose to snoring.
OBSTRUCTIVE SLEEP APNOEA (OSA)
Obstructive Sleep apnoea is a serious sleep disorder. It is a risk factor for Heart Diseases such Heart Failure, Angina and irregular heartbeats. It predisposes to Strokes, Diabetes mellitus and sudden deaths.
During sleep apnoea, the frequent arousals cause breaking up of sleep patterns resulting in daytime sleepiness and all the manifestations that occur in snorers.
MANAGEMENT
Sleep study is required for patients with sleep apnoea; this can be in-lab or home study. Snoring with the following should always be evaluated for OSA:
- Episodes of breath pauses or apnoea
- Daytime sleepiness or fatigue
- High blood pressure
- Heart disease and
- History of Stroke
The patient’s partner or parent should be relied upon in providing information on the degree of snoring, restlessness during sleep, mouth-breathing, gasping, choking, body position during sleep, the use of alcohol and sedatives and other relevant history.
TREATMENT AND PREVENTION
Treatment involves non-surgical methods and surgical methods when the conservative methods are ineffective.
Non-Surgical Methods
The avoidance of alcohol, heavy meals, sedatives and hypnotics especially before bedtime is helpful. Weight reduction and sleeping on the side rather than on the back also help to improve the condition. Other self-help activities include establishing a regular sleep pattern and elevating the head of the bed.
The use of nasal decongestants in cases of nasal congestion is also useful. There are numerous over-the –counter devices designed to improve snoring; they are designed to prevent lying on the back, intra-oral for preventing tongue fallback, for opening the nasal passage and for conditioning.
Surgical Methods
Surgical methods include the removal of obstructions in the mouth, throat, nose and larynx helps to alleviate the condition. In children all that may be required is the removal of the tonsils and adenoids.
Surgical removal of part of the soft palate, uvula and base of the tongue sometimes with thermal or laser or with the assistance of robots can also be done.
CONCLUSION
In conclusion, it should be noted that snoring may not be a trivial noise. Sleep apnoea may be Central, Obstructive or Mixed. Obstructive sleep apnoea is ALWAYS associated with snoring. Persistent Apnoea may result in serious Heart and Brain Complications.
The surgical removal of Tonsils and Adenoids is all that is needed for cure in the majority of children with OSA. Surgical removal of the uvula, part of the soft part of the roof of the mouth and base of the tongue corrects the obstruction in most adults with OSA and snoring. A tracheostomy may be life-saving in some instances.