Benign Snoring… How Benign is it?
Snoring is very prevalent in our society, and is considered by most to be simply a cosmetic nuisance. The position health coverage takes in denying claims to treat snoring lends further support to this common consensus; at least for our patients. Unfortunately, in light of the mounting literature data which suggests that this is not the case, we have to ask ourselves, “Benign snoring … How Benign is it?
Literature data suggests that Obstructive Sleep Apnea seems to progress from snoring. The vibration associated with snoring has been shown to lead to “nervous lesions”; muscle tissue atrophy and denervation. The degree of these changes has been shown to increase with increasing snore severity. Sensory neurons have also been shown to be affected by these vibrations. Studies have shown us that increasing severity of OSA is related to increase in “vibration & cold detection thresholds”; suggesting an impairment in the sensory neurons necessary to maintain airway patency.
When muscle tissue is altered by vibrations associated with snoring, the airway narrows making it more susceptible to collapse. When the pharyngeal sensory nerves become impaired from these same vibrations, the dilation reflex intended to prevent airway collapse also becomes impaired. It is particularly interesting that these “vibration caused lesions” become more prevalent in individuals that have increasing levels of disease from snoring to OSA.
Literature data also suggests that snoring and OSA may be important risk factors for Carotid Atherosclerosis and Stroke. A study of One hundred and ten volunteers that underwent full polysomnography, snoring quantification, and femoral and carotid artery ultrasound demonstrated this relationship. These subjects were categorized as mild, moderate or heavy snorers. The results showed that prevalence of carotid atherosclerosis increased with increase in snoring severity. This was not the case for femoral atherosclerosis.
It was concluded that heavy snoring significantly increases the risk of carotid atherosclerosis and that this risk is independent of other risk factors including measures of nocturnal hypoxia and OSA severity. These findings have substantial public health implications for the management of carotid atherosclerosis and the prevention of stroke.
Literature data clearly suggests that snoring is a precursor to OSA and that increasing severity levels of snoring is associated with increasing risk of Carotid Atherosclerosis and Stroke. Yet, snoring is commonly considered by many to be of cosmetic importance only.
In summary, increasing severity of snoring has been associated with changes in airway tissues, which impair upper airway function and to arterial changes which increase susceptibility to Stroke. The next time we are dealing with “Benign Snoring …” we need to ask ourselves; “How Benign is it?”
John Viviano DDS
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