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Is my snoring really sleep apnea?

While simple snoring is unlikely to be more than a domestic problem, albeit a pesky one, the presence of certain additional symptoms suggest that a patient's snoring is a clue to the presence of obstructive sleep apnea syndrome.

Besides the embarrassing moments of loud snoring and daytime hypersomnia, sleep apnea also has social and clinical implications, including job inefficiency, increased risk of motor vehicle accidents, and, in severe cases, nocturnal cardiac arrhythmias and cardiorespiratory failure.

Signs and symptoms of sleep apnea syndrome include snoring, headache, excessive sleepiness during the day, falling asleep at inappropriate times in inappropriate places, fragmented sleep patterns, frequent nocturnal awakening, and hypertension. The syndrome may, however, be marked by only a few of these symptoms: The person may be observed sleeping in a chair or while at the dinner table, for instance.

Sleep apnea most commonly affects obese men who are 30-60 years old, but may also affect women and children. Risk factors for sleep apnea include obesity, maxillofacial abnormalities, enlarged tonsils, male gender, cigarette smoking, and certain endocrinologic problems such as acromegaly.

Sleep apnea is classified etiologically as obstructive, central, or mixed, and snoring may occur in any of these types. Obstructive sleep apnea, or pickwickian syndrome, is caused by partial obstruction of the airway. The fricative sounds emitted by individuals with this sort of apnea and the relative lack of frequency and consistency of the noise suggest it is produced by high velocity airflow through a very small orifice created by positioning the tongue on the soft palate. (In contrast, innocuous snoring appears to result from oscillations of the soft palate that produce sound by causing abrupt fluctuations in supraglottic pressure.) Apnea ensues when the small opening is completely closed by collapse of the lateral oropharyngeal walls. When the individual wakes in response to the resultant asphyxia, the airway is re-established; loud gasping and snoring accompany the first breaths, but sleeping is soon resumed.

An episode of obstruction may last 10-60 seconds or longer. This cycle may repeat itself every few minutes. The patient is not usually aware of the sleep-wake cycle, but the cumulative effect is the loss of slow-wave and rapid-eye-movement sleep, the factors believed to be responsible for the restorative power of sleep. As the apnea worsens, apneic episodes last much longer and are more frequent, and they result in marked reduction in arterial oxygen saturation.

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