Is Snoring Dangerous?

Dr Kenny Pang
When snoring is a sleep disorder and points to something more serious.

Believe it or not, “My husband’s snoring is killing me” is the top autocompletion suggested  by Google when one types “My husband’s snoring” in the search bar. A patient told me about this – adding that his snoring doesn’t bother him as much as his partner. It was also said partner who nudged him to seek help for his loud snoring.

Often, one of the first questions I am asked during consultations is this: Is snoring dangerous?

The answer, of course, depends on several factors. Occasional snoring is usually not a problem. Habitual snoring is more concerning, especially if it is accompanied by other symptoms. 

An American research showed that among 30 to 35-year-olds, 20% of men and 5% of women snore. By the age of 60, 60% of men and 40% of women will snore habitually. 

Caused by the vibration of soft tissues in the oral cavity, snoring is an alarm that alerts one to the possibility of a sleep disorder.

Snoring is a manifestation of sleep-disordered breathing. Sleep-disordered breathing is a spectrum of diseases related to reduced airflow through the upper airway during sleep. This is due to a complete or partial upper airway obstruction or increased upper airway resistance. Some people, such as those with allergies and nose congestion, may be more prone to snoring than others.

Sleep-disordered breathing encompasses: 

  • Snoring – in people who snore without experiencing excessive daytime somnolence (sleepiness) and without any breathing cessation (stoppages) at night; 
  • Upper airway resistance syndrome (UARS) – in people with excessive daytime somnolence, but who don’t suffer breathing cessation at night;
  • Obstructive sleep apnea (OSA) – in people who snore and are afflicted by both excessive daytime somnolence and breathing cessation at night.

Obstructive sleep apnea (also spelt as apnoea) is a common sleep disorder and is estimated to occur in 24% of men and 9% of women in the USA. Many authorities believe that up to 93% of females and 82% of males with moderate to severe obstructive sleep apnea (OSA), remain undiagnosed. In Singapore, it is estimated that over one-third of the population suffer from obstructive sleep apnea (OSA); and one-third of these cases are moderate to severe.  

The most common clinical symptom for obstructive sleep apnea (OSA) is snoring. 

Frequently, one’s sleep partner prompts the snorer to see a physician because of concerns over repeated apneas (stoppages in breathing). Many bed partners have witnessed their sleep-apnea-suffering partners choke and hold their breath during sleep. The snorer may complain of frequent awakenings, with choking and gasping sensations, nocturia (waking up frequently during the night due to the need to urinate), or nightmares. 

A person with severe obstructive sleep apnea (OSA) may be unable to sleep supine (horizontally with face and torso facing up), as this causes the tongue to fall backwards, resulting in obstruction of the airway. Common patient complaints include early morning tiredness and morning headaches, which may be attributed to the recurrence of low-oxygen intake during sleep. Morning dry mouth and throat are caused by mouth-breathing and snoring. Other symptoms include forgetfulness, mood changes, irritability, and, less commonly, impotence. 

Excessive daytime sleepiness is very common in patients with obstructive sleep apnea (OSA). This is caused by a combination of frequent nocturnal arousals, fragmented sleep, recurring occurrences of oxygen desaturation, and a decrease in delta and rapid eye movement (REM) sleep. Excessive daytime sleepiness can be measured by a simple questionnaire known as the Epworth’s Sleepiness Score

Snoring is disruptive and often affects the sleep quality of both the snorer and the bed partner. It may not go away on its own. Children snoring should definitely be monitored.

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