Korean J Clin Neurophysiol.  2015 Dec;17(2):61-67. 10.14253/kjcn.2015.17.2.61.

Has Snoring Significance for Predicting Obstructive Sleep Apnea Severity?

Affiliations
  • 1Department of Neurology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea. smilepkm@hanmail.net
  • 2Department of Internal Medicine, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea.

Abstract

BACKGROUND
The aim of this study was to investigate the predictive value of snoring frequency in the diagnosis and severity of obstructive sleep apnea.
METHODS
Patients who underwent polysomnography with one or more of the following characteristics were included: 1) sleepiness, non-restorative sleep, fatigue, or insomnia symptoms; 2) arousal due to cessation of breathing or the occurrence of gasping or choking when waking up; and 3) habitual snoring, breathing interruptions, or both, noted by a bed partner or other observer. We analyzed the differences in clinical and polysomnographic variables between patients with and without obstructive sleep apnea and investigated the associations of those variables with obstructive sleep apnea severity.
RESULTS
One hundred ninety-three patients met the inclusion criteria, and 145 of the 193 patients were diagnosed with obstructive sleep apnea. Multiple logistic regression analysis showed that large neck circumference (p = 0.0054) and high snoring index (p = 0.0119) were independent predictors for obstructive sleep apnea. Moreover, between the obstructive sleep apnea severity groups, there was a strong tendency of difference in body mass index (p = 0.0441) and neck circumference (p = 0.0846). However, there was no significant difference in snoring frequency according to obstructive sleep apnea severity (p = 0.4914).
CONCLUSIONS
We confirmed that snoring frequency is a predictor of obstructive sleep apnea. In addition, we showed for the first time that snoring frequency is not associated with obstructive sleep apnea severity, thus it is not a valuable marker for predicting obstructive sleep apnea severity.

Keyword

Snoring; Sleep apnea; Polysomnography

MeSH Terms

Airway Obstruction
Arousal
Body Mass Index
Diagnosis
Fatigue
Humans
Logistic Models
Neck
Polysomnography
Respiration
Sleep Apnea Syndromes
Sleep Apnea, Obstructive*
Sleep Initiation and Maintenance Disorders
Snoring*

Figure

  • Fig. 1. A positive correlation between AHI and BMI (a), and neck circumference (b) was identified, whereas there was no correlation between AHI and snoring index. AHI; apnea-hypopnea index, BMI; body mass index.


Reference

1.Vaessen TJ., Overeem S., Sitskoorn MM. Cognitive complaints in obstructive sleep apnea. Sleep Med Rev. 2015. 19:51–58.
Article
2.Farney RJ., Walker BS., Farney RM., Snow GL., Walker JM. The STOP-Bang equivalent model and prediction of severity of obstructive sleep apnea: relation to polysomnographic measurements of the apnea/hypopnea index. J Clin Sleep Med. 2011. 7:459–465.
Article
3.Epstein LJ., Kristo D., Strollo PJ., Friedman N., Malhotra A., Patil SP, et al. Clinical guideline for the evaluation, management and long-term care of obstructive sleep apnea in adults. J Clin Sleep Med. 2009. 5:263–276.
4.Chung F., Yegneswaran B., Liao P., Chung SA., Vairavanathan S., Islam S, et al. STOP questionnaire: a tool to screen patients for obstructive sleep apnea. Anesthesiology. 2008. 108:812–821.
5.Beck R., Odeh M., Oliven A., Gavriely N. The acoustic properties of snores. Eur Respir J. 1995. 8:2120–2128.
Article
6.Ng AK., Koh TS., Baey E., Lee TH., Abeyratne UR., Puvanendran K. Could formant frequencies of snore signals be an alternative means for the diagnosis of obstructive sleep apnea? Sleep Med. 2008. 9:894–898.
Article
7.Wilson K., Stoohs RA., Mulrooney TF., Johnson LJ., Guilleminault C., Huang Z. The snoring spectrum: acoustic assessment of snoring sound intensity in 1,139 individuals undergoing polysomnography. Chest. 1999. 115:762–770.
8.Ben-Israel N., Tarasiuk A., Zigel Y. Obstructive apnea hypopnea index estimation by analysis of nocturnal snoring signals in adults. Sleep. 2012. 35:1299–1305.
Article
9.Sateia MJ. International classification of sleep disorders-third edition: highlights and modifications. Chest. 2014. 146:1387–1394.
10.Berry RB., Budhiraja R., Gottlieb DJ., Gozal D., Iber C., Kapur VK, et al. Rules for scoring respiratory events in sleep: update of the 2007 AASM Manual for the Scoring of Sleep and Associated Events. Deliberations of the Sleep Apnea Definitions Task Force of the American Academy of Sleep Medicine. J Clin Sleep Med. 2012. 8:597–619.
11.Cho YW., Lee JH., Son HK., Lee SH., Shin C., Johns MW. The reliability and validity of the Korean version of the Epworth sleepiness scale. Sleep Breath. 2011. 15:377–384.
Article
12.Cavusoglu M., Ciloglu T., Serinagaoglu Y., Kamasak M., Erogul O., Akcam T. Investigation of sequential properties of snoring episodes for obstructive sleep apnoea identification. Physiol Meas. 2008. 29:879–898.
Article
13.Perez-Padilla JR., Slawinski E., Difrancesco LM., Feige RR., Remmers JE., Whitelaw WA. Characteristics of the snoring noise in patients with and without occlusive sleep apnea. Am Rev Respir Dis. 1993. 147:635–644.
Article
14.Fiz JA., Jane R., Sola-Soler J., Abad J., Garcia MA., Morera J. Continuous analysis and monitoring of snores and their relation-ship to the apnea-hypopnea index. Laryngoscope. 2010. 120:854–862.
Article
15.Sola-Soler J., Fiz JA., Morera J., Jane R. Multiclass classification of subjects with sleep apnoea-hypopnoea syndrome through snoring analysis. Med Eng Phys. 2012. 34:1213–1220.
16.Maimon N., Hanly PJ. Does snoring intensity correlate with the severity of obstructive sleep apnea? J Clin Sleep Med. 2010. 6:475–478.
Article
17.Li KK., Kushida C., Powell NB., Riley RW., Guilleminault C. Obstructive sleep apnea syndrome: a comparison between Far-East Asian and white men. Laryngoscope. 2000. 110:1689–1693.
Article
18.Wang J., Thornton JC., Russell M., Burastero S., Heymsfield S., Pierson RN Jr. Asians have lower body mass index (BMI) but higher percent body fat than do whites: comparisons of anthropometric measurements. Am J Clin Nutr. 1994. 60:23–28.
Article
19.Sakakibara H., Tong M., Matsushita K., Hirata M., Konishi Y., Suetsugu S. Cephalometric abnormalities in non-obese and obese patients with obstructive sleep apnoea. Eur Respir J. 1999. 13:403–410.
Article
20.Gavriely N., Jensen O. Theory and measurements of snores. J Appl Physiol. 1993. 74:2828–2837.
Article
21.Guilleminault C., Stoohs R., Duncan S. Snoring (I). Daytime sleepiness in regular heavy snorers. Chest. 1991. 99:40–48.
22.Azarbarzin A., Moussavi Z. Snoring sounds variability as a signature of obstructive sleep apnea. Med Eng Phys. 2013. 35:479–485.
Article
23.Sharma SK., Kurian S., Malik V., Mohan A., Banga A., Pandey RM, et al. A stepped approach for prediction of obstructive sleep apnea in overtly asymptomatic obese subjects: a hospital based study. Sleep Med. 2004. 5:351–357.
Article
24.Karakoc O., Akcam T., Gerek M., Genc H., Ozgen F. The upper airway evaluation of habitual snorers and obstructive sleep apnea patients. ORL J Otorhinolaryngol Relat Spec. 2012. 74:136–140.
Article
25.Villaneuva AT., Buchanan PR., Yee BJ., Grunstein RR. Ethnicity and obstructive sleep apnoea. Sleep Med Rev. 2005. 9:419–436.
Article
26.Herzog M., Schmidt A., Bremert T., Herzog B., Hosemann W., Kaftan H. Analysed snoring sounds correlate to obstructive sleep disordered breathing. Eur Arch Otorhinolaryngol. 2008. 265:105–113.
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