associated conditions

There is increasing evidence connecting Snoring to associated medical conditions that are traditionally thought to be more severe.

In addition there are many published studies that highlight the connection between OSA and wider medical problems such as High Blood Pressure, Fatigue, Diabetes and Heart Disease.

This section is a resource bank for published studies that have highlighted the wider healthcare issues for snorers.

Is snoring dangerous? It really depends on whether you are suffering from simple noisy snoring or whether you have progressed to a more serious condition. This is best explained by understanding what is happening when you snore.

Individuals snore because their “upper airways” (the breathing passages between the nose and lips extending down to the start of the windpipe) become narrow during sleep. Whilst awake small muscles keep the upper airway open, but once asleep, if you have a narrow airway already, these muscles relax and the breathing passage narrows. At a critical point the airway becomes so narrow that the airflow becomes turbulent. Turbulence causes things to rattle, and that’s what snoring is. The soft floppy bits in your airway rattling. If you live by yourself or have a deaf bed-partner this isn’t a problem. However, if it is disturbing your partner (and you are getting the elbow in the side) it can lead to serious disharmony. If you are sleeping separately this problem may be partly resolved but holidays are always difficult.

A more serious situation arises if the airway narrows more, to a point where significant effort is required to drag air into the lungs. This is known as Upper Airways Resistance Syndrome (UARS). The problem arises when you enter the really deep bit of sleep that makes you feel refreshed the next day. This is when the airway really narrows and as a result you have to work hard to breathe. Unfortunately this effort disturbs sleep and causes an arousal. This means that you come up out of the deep restorative sleep to a lighter plane of sleep. As a result you miss out on some of the refreshing sleep and you may start to feel tired during the day. There is also an impact on your heart rate and blood pressure during sleep, causing both to rise.1-3

The next stage is more serious still. Obstructive Sleep Apnoea (apnoea is the medical term for stopping breathing). Now when you are in the really deep sleep the airway blocks off altogether. Your chest still moves trying desperately to suck air in. The pressure in your chest become so negative that you may get heartburn as acid is sucked up the gullet from the stomach. Because no air is getting into the lungs the oxygen levels in your blood starts to fall. Thankfully the brain is constantly monitoring what is happening to your body, recognises the problem and wakes you up but probably not to full consciousness. However, in someone with OSA this blocking of the airway can be happening 50-60 times per hour. As a result you never stay in the deep restorative sleep and you wake up feeling as if you have had no sleep at all. OSA sufferers may also wake up several times during the night and often think it is because they need to empty their bladder.

Excessive daytime sleepiness is bad enough in itself. You are unable to concentrate, fall asleep at times when you don’t want to be asleep, and it makes you at least twice as likely to have a motor accident if you are driving4-6. It is for this reason that the DVLA require OSA sufferers to stop driving until they are treated. However, this is not the worst news. Research into OSA has demonstrated that the repeated falls in oxygen levels are linked to the development of high blood pressure, heart disease, strokes7 and diabetes8-10 Untreated OSA is a killer and needs to be taken seriously.

Reference List

(1) Exar EN, Collop NA. The upper airway resistance syndrome. Chest 1999; 115(4):1127-1139.
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(2) Silverberg DS, Oksenberg A. Essential and secondary hypertension and sleep-disordered breathing: a unifying hypothesis. J Hum Hypertens 1996; 10(6):353-363.
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(3) Guilleminault C, Stoohs R, Shiomi T, Kushida C, Schnittger I. Upper airway resistance syndrome, nocturnal blood pressure monitoring, and borderline hypertension. Chest 1996; 109(4):901-908.
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(4) Barbe F, Pericas J. Automobile Accidents in Patients with Sleep Apnoea Syndrome. Am J Respir Crit Care Med 1998; 158:18-22.

(5) Masa JF. Habitually Sleepy Drivers Have a High Frequency of Automobile Crashes Associated with Respiratory Disorders during Sleep. Am J Respir Crit Care Med 2000; 162:1407-1412.
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(6) Stoohs RA, Guilleminault C, Itoi A, Dement WC. Traffic accidents in commercial long-haul truck drivers: the influence of sleep-disordered breathing and obesity. Sleep 17 (7), 619-623. 1994.
Ref Type: Generic
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(7) Parish JM, Somers VK. Obstructive sleep apnea and cardiovascular disease. Mayo Clin Proc 2004; 79(8):1036-1046.
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(8) Ip MS, Lam B, Ng MM, Lam WK, Tsang KW, Lam KS. Obstructive sleep apnea is independently associated with insulin resistance. Am J Respir Crit Care Med 2002; 165(5):670-676.
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(9) Punjabi NM, Sorkin JD, Katzel LI, Goldberg AP, Schwartz AR, Smith PL. Sleep-disordered breathing and insulin resistance in middle-aged and overweight men. Am J Respir Crit Care Med 2002; 165(5):677-682.
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(10) Meslier N, Gagnadoux F, Giraud P, Person C, Ouksel H, Urban T et al. Impaired glucose-insulin metabolism in males with obstructive sleep apnoea syndrome. Eur Respir J 2003; 22(1):156-160.
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