The sound ranges from barely audible to an extremely annoying noise that can be so loud that it is heard in another room. Snoring is usually stressful for others (typically a bed partner or roommate trying to sleep) and not for the snorer himself; it is unusual that snorers wake up from their own snoring.
Snoring is a raspy sound that is produced in the nose and throat during sleep. It is quite common and occurs in about 57% of men and 40% of women; the prevalence increases with age. However, the prevalence estimates vary as widely as the perception of a bed partner is very subjective and snoring from night to night fluctuates. The sound ranges from barely audible to an extremely annoying noise that can be so loud that it is heard in another room. Snoring is usually stressful for others (typically a bed partner or roommate trying to sleep) and not for the snorer himself; it is unusual that snorers wake up from their own snoring. Snoring can have significant social Konsquenzen. It can lead to conflict with partners or roommates; snorers rarely were attacked because of their snoring and even murdered. Depending on the severity, the cause and the consequences of snoring and other symptoms may be as frequent waking, wheezing or choking during sleep, excessive daytime sleepiness and morning headaches. Pathophysiology Snoring is caused by ventilation induced flutter of the soft tissues of the nasopharynx, especially the soft palate. As with any physical structure (eg. As a flag), the flutter develops in the nasopharynx as a function of cooperating factors, including the mass, the stiffness and the attachments of fluttering element as well as the speed and the direction of air flow. The fact that people are awake do not snore, suggests that the sleep-induced muscle relaxation, at least forms part of the etiology, because the muscle tone is the only component of flutter, which may change during sleep; Body mass and attachments remain the same. Moreover, if phyaryngeale dilators in response to the negative intraluminal pressure induced by the inspiration, the airway can not be kept open, to narrow the upper respiratory tract, and the local flow velocity of the air is increased (at a given inspiratory volume). The increased flow velocity directly benefits the flutter and reduces the intraluminal pressure, which further reinforces the closure of the airways and thus favors flutter and snoring. Snoring occurs more in airways that are already affected by structural factors, including micrognathia or retrognathia Nasal septal deviation rhinitis, tissue swelling caused obesity etiology Primary Snoring In primary snoring is it’s a snore that neither of awakening or excessive arousals, restriction of ventilation, incomplete oxygen saturation is still accompanied by arrhythmias during sleep and occurs in people who do not suffer from ETS. Arousals are short transitions to lighter sleep or awakenings that last <15 s and usually not noticed werden.Schlafstörungsbezogene breathing snoring is sometimes a manifestation of insomnia-related breathing that covers a spectrum from resistance syndrome of the upper airway to obstructive sleep apnea (OSA obstructive sleep apnea). Each disorder has a similar obstructive pathophysiology of the upper respiratory tract, but differences lie in the degree and the clinical consequences of airway obstruction. The clinical consequences concern v. a. Disorders of sleep and / or ventilation. Patients with OSA have ? 5 episodes of apnea or hypopnea per hour during sleep (apnea-hypopnea index [AHI]) plus ? 1 of the following: daytime sleepiness, unintentional sleep episodes, non-restorative sleep, fatigue or insomnia breath holding, gasping or choking on awakening reports of a bed partner about loud snoring, breathing pauses, or both while the patient is asleep OSA can be divided according to severity levels: easy (5-15 episodes / hour), medium (16 to 30 episodes / hour) or severe (> 30 episodes / hour) , tWiderstandssyndrom upper respiratory tract irritation ETS or any other manifestation, but do not meet all the criteria of a OSA.Komplikationen Although snoring itself has no known adverse physiological effects, OSA can have consequences (eg. as hypertension, stroke, heart disease, diabetes) .Risikofaktoren risk factors for snoring are Advanced age obesity use of alcohol or other sedatives chronic narrowing or blockage of the nose A small or Male backward shifted Kiefer Gender Postmenopausal status Black race pregnancy Abnormal structures that may block the air circulation (eg. as large tonsils, a different nasal septum, nasal polyps) It can also pass a familial risk. Clarification The primary goal is to identify snorers at high risk for OSA. Many snorers have OSA, but most patients with OSA snore (the exact proportion is not known). Since some important manifestations of OSA are mainly noticed by others, bed partner or roommate should also be questioned as possible. History The history should cover the extent of snoring with information on the frequency, duration and volume. In addition, the degree to which the snoring affects the bed partner should be noted. A severity scale for snoring can be used. In reviewing the organ systems symptoms should be sought, suggestive of OSA, such as the presence of sleep disorders, the indicators are: number of awakenings testified apneic or gasping / choking episodes occurrence of non-recuperative sleep or morning headaches Excessive daytime sleepiness The Epworth Sleepiness Scale ( see table: Epworth sleepiness scale) can be used to Quantifiziereung daytime sleepiness. The STOP-BANG score (see Table: STOP-BANG risk score for obstructive sleep apnea) is a useful tool to predict the risk of OSA in patients who snore. STOP-BANG-Riskikoscore for obstructive sleep apnea Assessed characteristic findings Snoring (Snoring) Loud snoring (louder than talking or loud enough to be heard through a closed door) Tired (Fatigue) During the day, often fatigue or sleepiness Observed (observation) is observed, to have pauses in breathing during sleep BP (Bludru ck) High blood pressure or current hypertension treatment BMI (body mass index) (> 35 kg / m2 Age (Age)> 50 Neck circumference (neck circumference)> 40 cm Gender (gender) Male ? 3 findings = high risk for obstructive sleep apnea OSA). <3 findings = low risk for obstructive sleep apnea (OSA). BMI = body mass index; OSA = obstructive sleep apnea. The history should determine the presence of diseases that may be associated with OSA, especially hypertension, coronary ischemia, heart failure, stroke, gastroesophageal reflux disease, atrial fibrillation, depression, obesity (v. A. Morbid obesity) and diabetes. Patients are asked how much alcohol they consume and when this is done in terms of bedtime. The drug history may sedative or muscle relaxant drugs registrieren.Körperliche investigation The investigation should begin by measuring the size and weight incl. Calculation of body mass index (BMI). The remainder of the examination is of limited use and focuses on the inspection of the nose and mouth to detect an obstruction. Warning signs include nasal polyps and swollen turbinates A high vaulted palate enlargement of the tongue, tonsils or suppositories A small or backward shifted mandible A Mallampati score of 3 or 4 (only the base or no part of the uvula is during the examination of the oral cavity to see- Mallampati score.) indicates an increased risk for OSA. Mallampati score. The modified Mallampati score is as follows: Class 1: tonsils, uvula and soft palate can be seen. Class 2: Hard and soft palate and the upper part of the tonsils and uvula are visible. Class 3: Soft and hard palate and base of the uvula are visible. Class 4: Only the hard palate is visible. Warning The following results are of particular importance: testified apnea or choking during sleep Morning headache Epworth sleepiness score ? 10 BMI ? 35 Very loud, constant snoring interpretation of the findings, the clinical evaluation is not completely reliable for the diagnosis of OSA, but it can indicative have character. The warning signs correlate clearly with OSA. However, all these findings kontinierlich into each other, and there is no consensus on the cut-off points and relative weighting. Nevertheless, having the more findings with warning a patient and the more serious they are, the greater the likelihood of OSA.Tests A testing is carried out at a suspected diagnosis; it consists in a polysomnography (PSG tests). However, since snoring is so widespread, PSG should be done only when the clinical suspicion of OSA is significant. A reasonable approach is to test patients who have warning signs (in particular testified apnea), and those which have several elements of warning signs, which reach the point values ??referred to not completely. People without symptoms or signs of sleep about snoring also do not have to be tested; However, they should be clinically observed with regard to the development of such manifestations. Treatment Treatment for snoring, the other causes such as chronic nasal obstruction and OSA (Obstructive Sleep Apnea Therapy) is associated, is discussed elsewhere in the MSD Manual. Overall, treatment includes general measures for handling the risk factors and physical methods to open the airway and / or stiffen the affected structures. General measures Various general measures to be taken against snoring. Their effectiveness is judged not good, mainly because the perception of snoring is very subjective; nevertheless certain patients may benefit from it. The measures include avoiding alcohol and sedative substances for several hours before going to bed sleeping with the head elevated (is best achieved with tools such as wedges for the positioning of the bed or body) weight loss use of earplugs introduction of alternative arrangements during sleep (z. B. separate . bedroom) treating each nasal congestion (for example, with decongestant and / or corticosteroid sprays or with elastic strips that hold the nostrils open) devices in the mouth in the mouth devices are only worn during sleep; they include mandibular and stands for the tongue. These devices need to be adjusted by specially trained dentists. They are helpful for patients with mild to moderate OSA and are generally regarded as very effective in simple snoring, although there are few studies in this area. Adverse effects include discomfort in the temporomandibular joint (TMG), misaligned teeth and excessive salivation, but most patients tolerated the devices well. Mandibular advancement devices are most commonly used. These push the lower jaw and tongue relative to the upper jaw forward and thus reduce the collapse of the airway during sleep. These devices can be fixed or adjustable; in order to achieve optimum results can be phased with adjustable devices of the first matching, as far as the mandible is advanced. Adjustable means are effective as a solid. Holding devices for tongue use the suction to hold the tongue in a forward position. Holding devices for the tongue are unpleasant and probably less effective than Protrusionsschienen.Continuous Positive Airway Pressure (CPAP) CPAP devices maintain a constant positive pressure in the upper airways upright using a small mask placed on the nose or mouth and nose is (Obstructive sleep apnea: CPAP). By CPAP eliminating the need for a negative pressure during inspiration, preventing the narrowing or collapse of the airway during inspiration. thus CPAP provides a very effective relief for OSA and is effective in primary snoring. However, the use is limited in primary snoring, because there is no reimbursement for it and patients are not sufficiently motivated. Although patients are often willing to at night to use a CPAP device to avoid the significant symptoms and long-term consequences of OSA, but this applies to a lesser extent when it comes to dealing with primary snoring, the v. a. social consequences hat.Operative interventions As a restricted nasal patency encourages snoring, surgical correction of specific causes of the disorder of the airways (eg. as nasal polyps, hypertrophic tonsils, deviated septum) seems to be a sensible way to reduce snoring. However, studies have not supported this theory. For OSA different revenge operations have been developed that alter the structure of the palate and the uvula sometimes. Some are also suitable for nichtapnoischem snoring. A Uvulopalatopharyngoplasik can be very effective in snoring, although the effects may last more than a few years. It is a stationary process in general anesthesia; Thus, the sole utility for the snoring is limited. Therefore, a number of outpatient procedures have been developed that can be performed under local anesthesia: The laser-assisted Uvuloplastik is less invasive than Uvulopalatopharyngoplasty. Although some patients report they have benefited, the benefit in the treatment of snoring is not proven. In the injection Snoreplasty sklerotherapeutische a substance is injected into the submucosa of the soft palate to stiffen the latter and the uvula. The sole utility in snoring requires further study. In radiofrequency ablation, a probe is used to introduce thermal energy into the soft palate. Studies have shown the benefits for snoring, but further research is needed. Palatal implants made of polyethylene can be used in the soft palate, to stiffen it. It used three small implants. Their sole benefit in snoring is not proven. Conclusion Only some snorers have OSA, but snoring most patients with OSA. Clinical risk factors such as nocturnal choking episodes of apnea or, daytime sleepiness and a high BMI contribute to the identification of patients at risk for OSA and thus the need for a polysomnographic analysis in. Recommend general measures to reduce snoring (z. B. avoiding alcohol and sedatives, sleeping with the head elevated, weight loss). Consider specific measures such as mandibular advancement devices, Uvulopalatopharyngoplasty, palate-changing procedures and CPAP snoring due to OSA.