Siamak N. Nabili, MD, MPH
Siamak N. Nabili, MD, MPH
Dr. Nabili received his undergraduate degree from the University of California, San Diego (UCSD), majoring in chemistry and biochemistry. He then completed his graduate degree at the University of California, Los Angeles (UCLA). His graduate training included a specialized fellowship in public health where his research focused on environmental health and health-care delivery and management.
In this Article
What is the clinical importance of snoring?
It is important to determine if snoring is related to an underlying medical condition or is an isolated (primary) problem (not associated with any underlying disease).
More specifically, primary snoring is not associated with obstructive sleep apnea, upper airway resistance, insomnia, or other sleep disorders. This distinction is important because of the associated link between the underlying conditions and other adverse health effects.
For example, obstructive sleep apnea (OSA) is associated with higher risks of cardiovascular disease such as heart attacks and strokes. This association is thought to exist because of higher prevalence of high blood pressure (hypertension) in individuals with obstructive sleep apnea. On the other hand, studies have shown that people with primary snoring did not have higher rates of elevated blood pressure compared to the general public. Despite this, there is increasing evidence of a relationship between snoring and other significant health problems. However, the exact relationship remains unclear.
What are different levels of snoring?
Mild resistance to airflow for any of the above reasons in the upper airways may result in some snoring that is not associated with any sleep disturbance.
If resistance to airflow increases, the efforts to maintain adequate ventilation and breathing may cause transient arousal from sleep that is typically not severe enough to cause the level of oxygen in the blood to decrease (hypoxia). This is called the respiratory effort related arousal (RERA).
When the resistance increases even further, the ventilatory efforts cannot keep up with the degree of resistance to maintain adequate levels of oxygen, and airflow decreases or stops. This often leads to a decrease in the level of oxygen in the blood. As a result, sleep becomes more fragmented and arousals more frequent. The events are referred to as obstructive hypopneas or apneas, and the condition is termed obstructive sleep apnea-hypopnea syndrome.
How should someone with snoring be evaluated?
To thoroughly evaluate someone with a snoring problem, it is important to also talk to that person's bed partner or family members. A complete history and physical examination is often performed.
In addition, more detail about their snoring and sleep problems needs to be obtained. The patients may be asked about their sleep pattern and sleep hygiene, daytime symptoms of sleepiness, daytime napping, and frequency of awakening at night.
A thorough physical examination may also be performed including assessing the patient's body weight and body mass index (BMI), assessment of the neck circumference (area around the neck), and visualization of the throat, nasal, and oral cavities to determine how narrow the oral and nasal passages are.
Medically Reviewed by a Doctor on 2/19/2015
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