Some snoring is explained by nasal congestion or enlarged tonsils or adnoids. An important condition that may be associated with snoring is Obstructive Sleep Apnea when there is obstruction to airflow due to collapse of the walls of the pharynx (throat) during sleep. Obstructive Sleep Apnea (OSA) may already be present or develop in snorers especially with weight gain. Increasing age, male sex, smoking, hereditary factors, cranial abnormalities and diabetes are some risk factors of OSA. This condition is suspected in snorers who complain of daytime fatigue or poor concentration. OSA may affect as many as 15 million adults. 2-9% of the population may have symptoms attributable to OSA.
When there are episodes of complete cessation of airflow this is termed “apnea” and a partial decrease in ventilation is referred to as “hypopneas”. Sleep studies are used to assess OSA and the frequency of apneas and hypopneas–called the AHI–relates to the severity of an individual’s case. A high AHI correlates with a drop in blood oxygen content and an increase in carbon dioxide. This oxygen desaturation leads to activation of the sympathetic nervous system, a decrease in heart rate variability, the release of vasoactive substances and inflammatory mediators, oxidative stress, and abnormal function of the lining of blood vessels. The cessation of airflow and the body’s attempt to compensate causes substantial swings in pressure inside the chest cavity.
It is no wonder that snoring, if it’s associated with obstructive sleep apnea, is linked with medical problems. A study in 2008 followed middle aged and older men and found that those with severe OSA had substantially higher risks of developing cardiac events including heart attack and heart failure. OSA may worsen outcomes in patients with established coronary artery disease.
OSA is considered a cause of secondary hypertension and should be suspected in patients who have high blood pressure that is difficult to manage despite the use of several drugs. The likelihood of elevated blood pressure correlates with the severity of OSA. Treatment of OSA can improve blood pressure control.
OSA is associated with arrhythmia–abnormalities of cardiac impulse formation or conduction. Excessively slow heart rates including heart block, sick sinus syndrome, as well as fast rates such as atrial fibrillation and ventricular arrhythmia can be seen. In some cases treating the sleep apnea can avoid the need for a permanent pacemaker. Treating OSA may lessen the recurrence of some arrhythmia.
OSA may be a risk factor for the development of congestive heart failure. There may be lower mortality in heart failure patients who have their OSA treated.
In conclusion when snoring is associated with obstructive sleep apnea–as determined by a sleep study– polysomnography– significant effects on the cardiovascular system can be present. These can often be favorably impacted by treatments such as CPAP (continuous positive airway pressure). The best advice for habitual snorers is to consult with your doctor.
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