Current Management of Primary Snoring

While snoring has primarily been considered a social problem for the approximately 40% of adults who snore—and their bed partners—snoring is no laughing matter. Sleep is disrupted, relationships strained. And, while it has primarily been considered a social problem, some recent evidence suggests that snoring may carry cardiovascular health risks, even in the absence of sleep apnea.

“There’s some evidence that the vibrations of snoring can affect the surrounding blood vessels of the head and neck and may even accelerate atherosclerosis,” said M. Boyd Gillespie, MD, MSc, professor and chairman of otolaryngology–head and neck surgery at the University of Tennessee in Memphis and member of the ENTtoday Editorial Advisory Board. A 2014 study comparing snorers to non-snorers found that snorers have a significantly greater carotid intima-media thickness (Laryngoscope. 2014;124:1486–1491). This finding suggests a possible physiological link between snoring and cerebrovascular events.

“It may not be the apneas that are contributing to an increased risk of cerebrovascular events in patients with sleep apnea, but the vibrations of snoring,” said Kathleen Yaremchuk, MD, an author of the 2014 study and chair of the department of otolaryngology–head and neck surgery at Henry Ford Hospital in Detroit. “The vibrations may disrupt the endothelial lining, and then cholesterol is more likely to be laid down because it’s an injured spot.”

While there’s no consensus on the belief that primary snoring is an independent cardiovascular risk factor, plenty of evidence does show that snoring interferes with the health and well-being of the snorer. A 2015 study of more than eight million Americans found that snorers get less sleep per night (approximately 11 minutes, or more than an hour less per week) than non-snorers and experience 11.5 days of insufficient sleep per month, compared with 7.6 days for non-snorers. The study also found “significant associations between the presence of snoring and coronary artery disease” that persisted after adjusting for age, sex, smoking status, marital status, and body mass index (Laryngoscope. 2015;125:2413–2416).

Still, most individuals who turn to otolaryngologists for snoring treatment are seeking help because their snoring annoys a bed partner. It’s incumbent on otolaryngologists to educate snorers about the possible health implications of snoring even as they work with the patient to find possible solutions.

“There’s still no cure for snoring, but if we attack snoring from multiple angles, it can be managed to the point that most people find it satisfactory,” Dr. Gillespie said.

Otolaryngologists should educate snorers about possible health implications as they work to find solutions

Careful Assessment Is Key to Appropriate Treatment

Because at least 50% of snorers have obstructive sleep apnea (OSA), most otolaryngologists recommend an overnight sleep study for all patients who complain of snoring. If the study confirms the presence of sleep apnea, the patient is treated for sleep apnea. If OSA is ruled out, a careful history and physical exam are conducted to identify the anatomical sites that may be contributing to snoring.