Snoring Frequency Research Articles

Early life environment and snoring in adulthood

BackgroundTo our knowledge, no studies of the possible association of early life environment with snoring in adulthood have been published. We aimed to investigate whether early life environment is associated with snoring later in life.MethodsA questionnaire including snoring frequency in adulthood and environmental factors in early life was obtained from 16,190 randomly selected men and women, aged 25–54 years, in Sweden, Norway, Iceland, Denmark and Estonia (response rate 74%).ResultsA total of 15,556 subjects answered the questions on snoring. Habitual snoring, defined as loud and disturbing snoring at least 3 nights a week, was reported by 18%. Being hospitalized for a respiratory infection before the age of two years (adjusted odds ratio (OR) = 1.27; 95% confidence interval (CI) 1.01–1.59), suffering from recurrent otitis as a child (OR = 1.18; 95%CI 1.05–1.33), growing up in a large family (OR = 1.04; 95%CI 1.002–1.07) and being exposed to a dog at home as a newborn (OR = 1.26; 95%CI 1.12–1.42) were independently related to snoring later in life and independent of a number of possible confounders in adulthood. The same childhood environmental factors except household size were also related with snoring and daytime sleepiness combined.ConclusionThe predisposition for adult snoring may be partly established early in life. Having had severe airway infections or recurrent otitis in childhood, being exposed to a dog as a newborn and growing up in a large family are environmental factors associated with snoring in adulthood.

Sleep Duration and Risk of Ischemic Stroke in Postmenopausal Women

Many studies have shown a U-shape association between sleep duration and mortality, but epidemiological evidence linking cardiovascular diseases with habitual sleep patterns is limited and mixed. We conducted a prospective study on 93 175 older women (aged 50 to 79 years) in the Women's Health Initiative Observational study cohort to examine the risk of ischemic stroke in relation to self-reported sleep duration. Cox models were used to investigate the putative associations, adjusting for multiple sociodemographic and lifestyle factors, depression, snoring, sleepiness symptoms, and other cardiovascular disease-related clinical characteristics. At baseline, 8.3% of subjects had reported their sleep duration as <or=5 hours per night and 4.6% reported long duration of sleep (>or=9 hours/night). After an average of 7.5 years of follow-up, 1166 cases of ischemic stroke had occurred. Multivariable-adjusted relative risk (RR) and 95% CI for ischemic stroke (using a sleep time of 7 hours/night as the reference) were 1.14 (0.97, 1.33), 1.24 (1.04, 1.47), and 1.70 (1.32, 2.21) for women reporting <or=6, 8, and >or=9 hours of sleep. A modestly stronger association with sleep duration <or=6 hours per night (RR, 1.22; 1.03, 1.44) was noted among women without prevalent cardiovascular disease at baseline. Our analyses also reveal that the adverse effect of long sleep is likely independent of the increased risk for ischemic stroke associated with frequent snoring and sleepiness (RR, 1.31; 1.00, 1.72). Habitual sleep patterns are important neurobehavioral determinants of risk for ischemic stroke in postmenopausal women. The underlying neurobiology and mechanistic mediators for the putative adverse effect of long sleep (>or=9 hours/night) need further elucidation.

Snoring, Witnessed Sleep Apneas, and Pregnancy-induced Hypertension

Pérez-Chada, D.; Videla, A.J.; O'Flaherty, M.E.; Majul, C.; Catalini, A.M.; Caballer, C.A.; Franklin, K.A. Author Information

All snoring is not adenoids in young children

To determine the prevalence of snoring in young children and to assess age, growth, previous surgery therapy, respiratory problems and sleep-related symptoms in relation to child's snoring, and to evaluate the relationship between child's snoring and parents' snoring and smoking. A cross-sectional study evaluated 2100 children 1-6 years of age in Helsinki, Finland. Child's frequency of snoring on a five-point scale (never to every night) and age, height, weight and body mass index, previous adenotonsillectomies, tympanostomies, allergic rhinitis and respiratory infections were determined as was frequency of parental snoring and smoking. Sleep problems were determined based on Finnish or Swedish modified version of the sleep disturbance scale for Children. Of the 2100 eligible children, 1471 (71%) returned questionnaires. Children always or often snoring numbered 92 (6.3%), sometimes snoring, 183 (12.4%), and never or occasionally snoring, 1196 (81.3%). No difference in age (p=0.06) or gender (p=0.39) existed between snorers and non-snorers. History of previous adenotonsillectomies (p<0.001), allergic rhinitis (p<0.001), recurrent respiratory infections (p<0.001), and otitis media (p<0.001) were more common among snorers than among occasional or never-snorers. Nocturnal symptoms such as breathing problems, sleep hyperhydrosis, sleep-wake transition disorders, and daytime somnolence were associated with children's snoring. Frequency of children's snoring was also associated with parental snoring (p<0.001) and smoking (p<0.001). Snoring is common among young children and is associated with previous adenotonsillectomy, allergic rhinitis, respiratory infections, nocturnal symptoms, and parents' snoring and smoking. The high prevalence of snoring among children with adenotonsillectomy raises the question whether adenotonsillectomy alone is adequate treatment for snoring in young children.

Does tonsillectomy reduce the risk of being a habitual or severe snorer?

We assessed the relationship between tonsillectomy and being a habitual or severe snorer. Volunteers were asked to provide their age and sex, a detailed snoring history covering the frequency and intensity of snoring, and their smoking and alcohol intake habits. After oral and nasal examinations, the tonsil size scores, Mallampati index scores, and nasal obstructions of the volunteers were recorded. Body heights and weights were measured, and body mass indexes were calculated. Being male, aging, an increase in body mass index and tonsillectomy were identified as independent risk factors for being a habitual and severe snorer. Although a nasal obstruction was found to be an independent risk factor for being a habitual snorer, an obstructive tongue base was identified as an independent risk factor for being a severe snorer. Tonsillectomy reduces the risk of being both a habitual and severe snorer. This reduced incidence and intensity of snoring following tonsillectomy could be accepted as a long-term beneficial side effect of the operation.

Long-term outcome of uvulopalatopharyngoplasty on snoring

Objective: to find out the long-term outcome of UPPP on snoring. Method: we retrospectively looked at 200 case notes for those patients who underwent UPPP in the period from 2000-2004 in our department. We have sent a questionnaire for 200 patients early in 2007. This has meant that the minimum time period after surgery was 2 years which was the cut-off point for our definition of “long-term” in this study. We have asked the snorer and partner as well as other family members about the impact of surgery on snoring. Results: The respondents were 42%. As a long-term outcome, 59% reported improvement, 18% have remained the same and 23% have reported to have got worse. Conclusion: we conclude that UPPP is still a viable option for snorers in selected cases. INTRODUCTION & REVIEW OF LITERATURE Snoring represents a fair number of complaints in the outpatient clinic setting. Snoring obviously disturbs the partner's sleep; hence it is a social problem. However, it can be a health issue if it is associated with obstructive sleep apnea. Snoring has been viewed and treated by various means of treatment. None of which has proved 100% efficacy. Clinicians, therefore, vary significantly in their practice in terms of offering different modes of treatment for their patients. One surgical method of treatment is uvulopalatopharyngoplasty (UPPP). The literature is replete with studies which talk about the short-term effectiveness of UPPP. In contrast, the long-term outcome of this surgery has been viewed with suspicion by many ENT surgeons. This is partly related to the fact that there are few published studies which address this issue and even these studies differ in terms of their definition of how long after surgery would mean a “long-term”. This has prompted us to conduct this study. In this study, we have set out our definition of “longterm” outcome of UPPP, which is at least two years after surgery. Iyngkaran et al reported that the long term success of UPPP was 55%. This was through a telephone survey for 168 patients who underwent UPPP with a mean follow-up of 59 months after surgery. 1 Maheshwar et al reported, on 33 patients, over a 4 year of follow up, that 50% of patients reported reduction in frequency of snoring, 51.85% reported reduction in the volume of snoring and 53.7% reported reduction in disturbance of their partners. Overall, 60.8% felt that surgery was beneficial and has reduced snoring to an acceptable Long-term outcome of uvulopalatopharyngoplasty on snoring

Long-term outcome of uvulopalatopharyngoplasty on snoring

Objective: to find out the long-term outcome of UPPP on snoring. Method: we retrospectively looked at 200 case notes for those patients who underwent UPPP in the period from 2000-2004 in our department. We have sent a questionnaire for 200 patients early in 2007. This has meant that the minimum time period after surgery was 2 years which was the cut-off point for our definition of “long-term” in this study. We have asked the snorer and partner as well as other family members about the impact of surgery on snoring. Results: The respondents were 42%. As a long-term outcome, 59% reported improvement, 18% have remained the same and 23% have reported to have got worse. Conclusion: we conclude that UPPP is still a viable option for snorers in selected cases. INTRODUCTION & REVIEW OF LITERATURE Snoring represents a fair number of complaints in the outpatient clinic setting. Snoring obviously disturbs the partner's sleep; hence it is a social problem. However, it can be a health issue if it is associated with obstructive sleep apnea. Snoring has been viewed and treated by various means of treatment. None of which has proved 100% efficacy. Clinicians, therefore, vary significantly in their practice in terms of offering different modes of treatment for their patients. One surgical method of treatment is uvulopalatopharyngoplasty (UPPP). The literature is replete with studies which talk about the short-term effectiveness of UPPP. In contrast, the long-term outcome of this surgery has been viewed with suspicion by many ENT surgeons. This is partly related to the fact that there are few published studies which address this issue and even these studies differ in terms of their definition of how long after surgery would mean a “long-term”. This has prompted us to conduct this study. In this study, we have set out our definition of “longterm” outcome of UPPP, which is at least two years after surgery. Iyngkaran et al reported that the long term success of UPPP was 55%. This was through a telephone survey for 168 patients who underwent UPPP with a mean follow-up of 59 months after surgery. 1 Maheshwar et al reported, on 33 patients, over a 4 year of follow up, that 50% of patients reported reduction in frequency of snoring, 51.85% reported reduction in the volume of snoring and 53.7% reported reduction in disturbance of their partners. Overall, 60.8% felt that surgery was beneficial and has reduced snoring to an acceptable Long-term outcome of uvulopalatopharyngoplasty on snoring

Snoring, Witnessed Sleep Apneas, and Pregnancy-Induced Hypertension

As many as 1 in 4 pregnant women snore habitually in the last week of pregnancy, and a study from Sweden has claimed an increased risk of both pregnancy-induced hypertension and fetal growth retardation in such women. The present study examined the association between self-reported snoring and witnessed sleep apneas on the one hand and pregnancy-induced hypertensive disease on the other in an Argentinian population of 447 women with singleton pregnancies who responded to a questionnaire administered on the day of delivery. Habitual snoring was reported by 7% of respondents, whereas more than one-fourth of those questioned (28%) acknowledged snoring at some time during pregnancy. Women who snored were more obese before pregnancy, gained more weight during gestation, and reported more frequently witnessed apnea than women who did not snore. In addition, snorers more often experienced daytime sleepiness. None of the women had used sedatives while pregnant. Pregnancy-induced hypertensive disease was documented in 42% of women who had snored at some time during pregnancy and in 27% of those who had never snored. The crude odds ratio (OR) for pregnancy-induced hypertensive disease in snorers was 2.01 (95% confidence interval [CI], 1.33–3.06), and increased with the frequency of snoring. The OR was 1.82 (95% CI, 1.16–2.84) when adjusting for prepregnancy body mass index, weight gain, smoking, alcohol use, and age. Witnessed sleep apneas also were associated with pregnancy-induced hypertension (OR, 8.00; 95% CI, 1.72–23.55). No relationship was found between snoring and delivery of a small-for-gestational-age infant. These findings lead the investigators to believe that snoring or sleep apnea could help to explain the development of pregnancy-induced hypertensive disorders in obese women.

Obstructive sleep apnea in pregnancy and fetal outcome

Objective To simultaneously investigate the polysomnography (PSG) and nonstress test (NST) records of pregnant women with obstructive sleep apnea (OSA) to observe NST changes during maternal desaturation and determine maternal and fetal outcomes. Methods A prospective observational study of pregnant women assessed by questionnaire for symptoms of OSA. Women with self-reported frequent snoring or apnea were offered PSG and NST. Result OSA was diagnosed in 4 (11.4%) of the 35 pregnant women who underwent PSG. Three (75%) had fetal heart decelerations accompanying maternal desaturation. The neonates of women diagnosed with OSA had lower mean Apgar scores and birth weights compared with neonates of women without OSA. Three neonates from the women diagnosed with OSA were admitted to the newborn healthcare unit. Conclusion OSA in pregnancy has important maternal and fetal outcomes. Pregnant women should be assessed for symptoms of OSA and suspected cases should be offered PSG.

Findings of a Berlin Questionnaire survey: Comparison between patients seen in an asthma clinic versus internal medicine clinic

Background Obstructive sleep apnea (OSA) and asthma are common and share similar nocturnal symptoms. We hypothesized that the prevalence of OSA symptoms would be greater in asthmatics compared to a general internal medicine population. Methods Patients in the Asthma Clinics ( n = 177) and Internal Medicine Clinics ( n = 328) at MetroHealth Medical Center, an urban academic institution, were surveyed for OSA risk. Patients completed the Berlin Questionnaire, a validated questionnaire with a positive predictive value (ppv) of 0.89 for determining the presence of OSA in primary care populations. All asthmatics had spirometry performed. Results The asthma group had more females ( p = 0.01) and a higher mean body mass index (33.2 vs. 31.2 kg/m 2, p = 0.02). However, the percentage with a body mass index >30 kg/m 2 was not different between the groups ( p = 0.19). The internal medicine group had a much higher rate of hypertension ( p = 0.002) and diabetes ( p < 0.001). Asthmatics were more likely to report frequent snoring (18.5% vs. 8.0%, p < 0.001) and chronic sleepiness (46.1% vs. 34.3%, p = 0.01). OSA risk, as determined by the Berlin Questionnaire, was higher in the asthma group than in the internal medicine group (39.5% vs. 27.2%, p = 0.004). In the asthma group, risk for OSA did not correlate with asthma severity ( p = 0.183). Conclusions This study suggests a possible association between asthma and OSA. There is a higher prevalence of OSA symptoms in an asthmatic population when compared to a primary care population, independent of the severity of the asthma.

Prevalence of sleep-related symptoms in a primary care population — their relation to asthma and COPD

The aim of this study was to clarify the association between obstructive sleep apnoea/hypopnoea syndrome (OSAHS)-related symptoms and physician-diagnosed asthma and COPD. 1501 subjects aged 19-90 years completed a structured questionnaire and underwent spirometry and respiratory physician assessment in 10 primary care centres. Frequent snoring was reported in 45.6%, breathing pauses during sleep in 11.0%, and excessive daytime sleepiness in 6.7% of the sample. COPD patients were more likely to report frequent snoring (OR=1.34; 95% CI:1.04-1.71), breathing pauses (OR=1.46; 95% CI:1.01-2.10), and excessive daytime sleepiness (OR=2.04; 95% CI:1.33-3.14). In contrast, there was no significant association between asthma patients and OSAHS-related symptoms. Gender differences were recognised as well. The increased likelihood for OSAHS-related symptoms in COPD patients, in contrast to patients with asthma, designates them as a target group for the screening of OSAHS in primary care.

Risk for sleep-disordered breathing and executive function in preschoolers

Background Pediatric sleep-disordered breathing is known to negatively impact cognitive development. While a theoretical basis has been proposed for the developmental effect of pediatric sleep-disordered breathing on executive function specifically, this had not been directly examined among preschool-age children. This population may be particularly vulnerable if school-readiness is compromised. The purpose of the current study was to use a multi-dimensional approach to assessing executive function among preschool-age children at risk for sleep-disordered breathing. Methods Thirty-nine preschool children were administered executive function tasks assessing the dimensions of inhibition, working memory, and planning as part of a larger study. A parent or guardian completed a validated questionnaire concerning the child’s snoring and other behaviors indicating risk for sleep-disordered breathing. Results After controlling for age in a series of regressions, higher parent-reported risk for sleep-disordered breathing was associated with substantially lower performance on each executive function dimension. In comparing the group means of children at high and low risk for sleep-disordered breathing, the single snoring frequency item also showed that children who snored frequently or almost always had lower performance on each executive function dimension. Conclusions The results suggest that sleep-disordered breathing may be associated with impaired executive function in preschoolers, with its strongest impact on the inhibition dimension, further emphasizing the importance of early intervention for sleep-disordered breathing in this early age group.

The development of snoring and sleep related breathing distress from 4 to 6 years in a cohort of Swedish children

Snoring is common among both children and adults and a sign of sleep disordered breathing (SDB). Adenotonsillectomy is often the solution offered, although the effect is uncertain. There are also some who say that young children who snore will outgrow it even without treatment. The present investigation compares snoring and co-founding symptoms in parental reports for a cohort of children at age 4 and at age 6 years. A cohort of 4 year old chidren (615) was investigated with respect to SDB [B. Löfstrand-Tideström, B. Thilander, J. Ahlqvist-Rastad, O. Jakobsson, E. Hultcrantz, Breathing obstruction in relation to craniofacial and dental arch morphology in 4 year old children, Eur. J. Orthod. 21 (1999) 323-332]. Each child was given a questionnaire. Those reporting significant symptoms also received a clinical and an orthodontic examination. Forty-eight children were diagnosed with SDB; of these 28 were operated with adenoidectomy and/or tonsillectomy. After 2 years, the same questionnaire was administered and the same children as before were further examined as well as those newly reporting significant symptoms. The results from the two occasions were compared. Eighty-three percent (509) of the original cohort participated. The frequency of snoring had changed from 53 to 46% for the group as a whole (p<0.05). Significant gender differences in co-founding symptoms were seen. Severity of snoring had changed on an individual basis in half of the cases; some recovered, others got worse. Of the children with SDB at 4 years who were operated, 14/28, did not snore at all, compared to 3/18 of the non-operated (p<0.05). Children who snore at the age 4 seldom "grow out of it" by age 6 and still show other signs of sleep related distress as well. Surgery does not always cure the snoring, thus postoperative follow-up is important. Since new cases develop during this age period, early intervention is not enough.

Le ronflement habituel. Prévalence et facteurs de risque dans un échantillon de la population masculine française

As there are important differences in the prevalence of snoring in the literature we have studied this prevalence and the risk factors in a sample of the active male population of Lorraine. 850 men, aged 22 to 66 tears, volunteered for the study and completed a questionnaire on the frequency of snoring, their lifestyle and their personal and family histories. The usual anthropomorphic measurements were made together with a non-invasive examination of the upper airways. The prevalence of habitual snoring was 34.6%, increasing with age, weight and the derived indices. We identified, by logistic regression, the factors independently associated with habitual snoring in univariate analysis. These were age, weight, nocturnal nasal obstruction, a medical diagnosis of obstructive sleep apnoea, and hypertrophy of the soft palate and uvula. There was evidence that height had a protective effect but exercise activity did not appear to be significant. The 35% prevalence of habitual snoring in our sample of middle aged men is similar to other studies in the literature using the same methods. The present study confirmed that age, weight, girth, nasal obstruction and nasopharyngeal abnormalities are risk factors. The protective effect of height was a new finding not identified in previous studies.

Sleep Duration and Snoring in Relation to Biomarkers of Cardiovascular Disease Risk Among Women With Type 2 Diabetes

Sleep habits have been associated with risk of cardiovascular disease (CVD) and metabolic disturbances, but the mechanisms underlying these associations have yet to be fully elucidated. We aim to determine whether sleep duration and/or snoring are associated with biomarkers of CVD in women with type 2 diabetes. We studied 935 women aged 43-69 years enrolled in the Nurses' Health Study cohort with type 2 diabetes who had no history of documented coronary heart disease or stroke in 1990. Information on sleep duration and snoring frequency was collected in 1986 from mailed questionnaires, and biomarkers of CVD were measured from blood samples taken in 1989-1990. Longer sleep duration was associated with increased levels of C-reactive protein after adjusting for age, BMI, lifestyle factors, family history of diabetes, glycemic control, and medication use (P = 0.05). HDL was decreased with short and long sleep duration among normotensive (P = 0.02) but not hypertensive women. More frequent snoring was directly associated with triglycerides (P = 0.02) and inversely associated with HDL cholesterol (0.03) and adiponectin (P = 0.03) in multivariate-adjusted analyses. The associations of sleep duration and snoring with lipid profile, hormone measures, and/or inflammatory markers may partially explain the previously reported relationship between sleep habits and cardiovascular and metabolic disorders.

Sleep problems and daytime somnolence in a German population‐based sample of snoring school‐aged children

Habitual snoring is associated with daytime symptoms like tiredness and behavioral problems. Its association with sleep problems is unclear. We aimed to assess associations between habitual snoring and sleep problems in primary school children. The design was a population-based cross-sectional study with a nested cohort study. The setting was twenty-seven primary schools in the city of Hannover, Germany. Habitual snoring and sleep problems were assessed in primary school children using an extended version of Gozal's sleep-disordered breathing questionnaire (n = 1144). Approximately 1 year later, parents of children reported to snore habitually (n = 114) and an equal number of children who snored never or occasionally were given the Sleep Disturbance Scale for Children, a validated questionnaire for the assessment of pediatric sleep problems. Snoring status was re-assessed using the initial questionnaire and children were then classified as long-term habitual snorers or ex-habitual snorers. An increasing prevalence of sleep problems was found with increasing snoring frequency for sleep-onset delay, night awakenings, and nightmares. Long-term habitual snorers were at significantly increased risk for sleep-wake transition disorders (e.g. rhythmic movements, hypnic jerks, sleeptalking, bruxism; odds ratio, 95% confidence interval: 12.0, 3.8-37.3), sleep hyperhidrosis (3.6, 1.2-10.8), disorders of arousal/nightmares (e.g. sleepwalking, sleep terrors, nightmares; 4.6, 1.3-15.6), and excessive somnolence (i.e. difficulty waking up, morning tiredness, daytime somnolence; 6.3, 2.2-17.8). Ex-habitual snorers were at increased risk for sleep-wake transition disorders (4.4, 1.4-14.2). Habitual snoring was associated with several sleep problems in our study. Long-term habitual snorers were more likely to have sleep problems than children who had stopped snoring spontaneously.

Reduced language abilities in adolescents who snore

Polysomnographic assessment of 20 adolescents who were referred to hospital for loud and frequent snoring showed they suffered from obstructive sleep apnea syndrome (OSAS). Their apneas and desaturation rates (SaO 2) were abnormal in comparison with the non-snoring adolescents, who served as their controls. The snoring group obtained lower scores on phonemic and semantic tests and had lower marks in the Greek language subject at school than the non-snoring group. These findings could be explained by the fact that OSAS causes certain physiological disturbances which may lead to dysfunction of the prefrontal cortex which plays an active role in language and verbal skills.

Habitual snoring is associated with elevated hemoglobin A1c levels in non‐obese middle‐aged adults

Hemoglobin A(1c) (HbA(1c)) is an indicator of long-term glycemic control. The purpose of this study was to determine whether habitual snoring is associated with increased HbA(1c) levels in non-obese and normoglycemic middle-aged men and women. A total of 6981 subjects (3362 men and 3619 women) aged 40-69 years from the Korean Health and Genome Study were examined for the study. Each participant received a comprehensive physical examination as well as a set of questions pertaining to demographic characteristics and snoring frequency. Habitual snoring was defined as a snoring frequency of > or = 4 days week(-1). After adjusting for age, abdominal obesity, and other confounding covariates, male habitual snorers showed a 1.69-fold excess [95% confidence interval (CI) 1.30-2.19] odds of having a high HbA(1c) level. Similarly, premenopausal women with habitual snoring had a 2.31 times (95% CI 1.22-4.39) significantly higher odds of having elevated HbA(1c)levels compared with non-snorers. This association was not found in postmenopausal women. Multivariate analysis revealed that male habitual snorers aged 40-50 had a 2.08-fold excess (95% CI 1.40-3.09) risk of having an elevated HbA(1c) level. In male habitual snores over 50, the strength of association was attenuated. Our findings based on cross-sectional data support a hypothesis that habitual snoring is associated with impaired glucose tolerance even in non-obese and normoglycemic men and premenopausal women. However, as waist circumference as an index of abdominal obesity (visceral adiposity) in the present study may only partially represent the effect of visceral fat, there may be a residual confounding from visceral obesity in our result. Longitudinal follow-up studies are necessary to confirm the association between sleep-disordered breathing and impaired glucose tolerance and to examine the causal relationship in a healthy population without obesity and diabetes.

Snoring noise pollution—the need for objective quantification of annoyance, regulatory guidelines and mandatory therapy for snoring

Habitual snoring without episodes of apnea or hypoventilation and without respiratory related arousals is considered to be annoying and without any need for treatment. However, studies seem to suggest an enormous psychosocial impact of annoyance for the bed partner. Apart from subjective questionnaires there still exists no generally accepted mode of measurement that can describe snoring objectively. We therefore adapted methods developed for environmental medicine and established a new snore score using psycho-acoustic parameters. For quantification of snoring noise we conducted nocturnal measurements in 19 habitual snorers. Free-field snore sounds were acquired with two low-cost non-contact microphones and transferred to a PC (sampling frequency 11 kHz). The data were recorded, analysed and stored automatically using a MATLAB script. Following the analysis of sound characteristics and levels, the score was computed from relevant parameters containing the rating level (LR), maximum level, two percentile levels for frequent maxima (L5S; L1) and snoring time. The determined values substantially exceeded the prescribed limits defined by WHO noise guidelines, and mainly affected the equivalent continuous sound exposure level, rating level and the immission standard values of brief noise peaks, whose maximum was exceeded by up to 32 dB(A). The Berlin snore score illustrated the objective acoustic annoyance on a scale from 0 to 100. It allows inter-individual comparison and objectifies the need for therapy. The clinical applicability of evaluating the reduction of snoring after surgical therapy is discussed exemplarily. The presented measuring method was found to be suitable for quantifying snoring noise and can be easily integrated into existing polysomnographic applications. In the case of habitual snoring with objective evidence of psychosocially disturbing acoustic annoyance, health fund providers should assume the costs of mandatory medical therapy.

Snoring and Vascular Risk Factors and Disease in a Low-Risk Chinese Population: The Guangzhou Biobank Cohort Study

Snoring is a common condition, but data describing the relationship between snoring and vascular disease is very limited in Asian populations. We therefore describe the association between snoring and vascular disease and associated risk factors. Cross-sectional study of baseline data from the Guangzhou Biobank Cohort Study. Community-based elderly association from Guangzhou, China. 10413 Chinese subjects (50-85 years of age). Self-reported snoring status and frequency and frequency of daytime tiredness were collected by questionnaire, as were demographic and socioeconomic data, disease histories, and potential confounders, such as smoking and alcohol consumption. Anthropometry, blood pressure, and fasting glucose and lipid profile were also measured. Self-reported snoring frequency was identified in 8325 (80.0%) subjects, with 51.6% reporting that they snored, of whom 15.5% were daily snorers. Increasing prevalence of snoring showed a clear positive relationship with cardiovascular risk factors, including age, obesity, blood pressure, and lipid levels (p < .001 for all). The prevalence of self-reported vascular-disease history was low but significantly associated with increasing snoring frequency. Logistic regression showed that snoring frequency was an independent predictor of vascular-disease history (odds ratios [95% confidence intervals] 1.68 [1.32-2.13] for daily snorers compared with the never-snorer reference group), of the metabolic syndrome (2.16 [1.88-2.49]) and each of its components (hypertension [1.37 (1.20-1.56)], and of dyslipidemia [1.22 (1.07-1.40)], central obesity [2.39 (2.08-2.76)], and diabetes [1.30 (1.09-1.56)]) after adjustment for potential confounders. Increasing snoring frequency was associated with an increasing prevalence of risk factors and self-reported vascular disease. Snoring may a useful marker for increased risk of vascular disease.