Snoring - the role of the laryngologist in diagnosing and treating its causes

Dzieciolowska-Baran E, Gawlikowska-Sroka A, Czerwinski, Czerwinski F

Description

According to various data, snoring may affect about 2 billion people worldwide, with about 8 million adult people in Poland being estimated to snore. Apart from being disturbing for other people, it brings about a measurable risk for the patient, which results from transient anoxia. As a consequence, it may increase the risk of arterial hypertension, myocardial infarction, cerebral stroke and impotency, as well as mental disturbances like depression or anxiety states. The physician a snoring patient may consult in the first instance is the laryngologist. He determines whether upper airway obturation (in contrast to central sleep apnea) is dealt with, and takes a decision about treatment method, or redirects the patient to another specialist. In this paper, the position of a laryngologist in the diagnosis and treatment of snoring is presented. The material consisted of patients presenting with this problem at the otolaryngology department. The proceedings with patients in the admission office setting were described as well as qualification methods for further medical and operative treatment. A review of the applied procedures was made, in particular allowing for the most recent therapeutic methods.

Sujets

• Diagnosis
• Otolaryngology
• Snoring
• Treatment

Informations

• Publié par: biomed
• Publié le: 01 janvier 2009
• Nombre de lectures: 7
• Langue: English

Extrait

December 7, 2009

Eur J Med Res (2009) 14(Suppl. IV): 67-70

EUROPEAN JOURNAL OF MEDICAL RESEARCH

67

© I. Holzapfel Publishers 2009

S NORING – T HE R OLE OF THE L ARYNGOLOGIST IN D IAGNOSING AND T REATING I TS C AUSES

1, 22 2 E. Dzieciolowska-Baran, A. Gawlikowska-Sroka , F. Czerwinski

1 2 Department ofOtolaryngology, Independent Public Provincial Hospital, Szczecin, Poland;Department ofAnatomy, Pomeranian Medical University, Szczecin, Poland

Abstract According to various data, snoring may affect about 2 billion people worldwide, with about 8 million adult people in Poland being estimated to snore. Apart from being disturbing for other people, it brings about a measurable risk for the patient, which results from transient anoxia. As a consequence, it may increase the risk ofarterial hypertension, myocardial infarction, cerebral stroke and impotency, as well as mental dis- turbances like depression or anxiety states. The physi- cian a snoring patient may consult in the first instance is the laryngologist. He determines whether upper air- way obturation (in contrast to central sleep apnea) is dealt with, and takes a decision about treatment method, or redirects the patient to another specialist. In this paper, the position ofa laryngologist in the di- agnosis and treatment ofsnoring is presented. The material consisted ofpatients presenting with this problem at the otolaryngology department. The pro- ceedings with patients in the admission office setting were described as well as qualification methods for further medical and operative treatment. A review of the applied procedures was made, in particular allow- ing for the most recent therapeutic methods. Key words:diagnosis, otolaryngologist, snoring, treat- ment I NTRODUCTION Snoring is a very common phenomenon. It is estimat- ed that at least 30% ofthe adult population snore. This problem increases with age, and over the age of 60 it affects over 50% ofpeople, including about 60% of malesand 40% offemales [1, 2]. Among them, 30 to 50% suffer from obstructive sleep apnea syndrome or upper airway resistance syndrome, which signifi- cantly increases the risk ofarterial hypertension, my- ocardial infarction, cerebral stroke, depression and anxiety disorders, or impotency disorders [3]. Snoring without apnoea may cause sleepiness during the day- time, morning sore throat and uvular swelling, mouth dryness or choking sensations. No less important is also its social aspect, since snoring disturbs the person sharing a bed, room or compartment with the snorer, frequently leading to a conflict [4]. The snoring prob- lem also affects approximately 6% ofchildren, of which almost 25% manifest coexisting apnea attacks

[1]. As a result, the child can have impaired concentra- tion and memory, and show hyperexcitability or even retarded intellectual development. It may also have an influence on failure in the orthodontic treatment of small patients. The snoring phenomenon is related to disturbances in the movement ofinspired air, which leads to the development ofturbulence and actuates palatouvular vibrations. Difficulties in the flow ofair through air- ways are most frequently induced by a blockage being present within them. The most frequent reasons for its presence there are as follows: airway wall swelling (al- lergy, GERD); adenoid tissue hypertrophy; hypertro- phy, deformations, disorders within osseous membra- nous or muscular structures; adipose tissue pressure on throat (obesity: BMI >27, collar size >35 cm); dis- orders ofmastication apparatus (including genetic de- fects); endocrinological diseases (acromegaly, hypothy- roidism). Sleep abnormalities being related to dis- turbed breathing are classified as: snoring, upper air- way resistance syndrome (UARS), obstructive sleep apnoea, obesity hypoventilation syndrome. The term snoring is used to describe an acoustic phenomenon during sleep, developing as a result of vibrations ofsome structures within the respiratory system. They can thus be treated as a vocalization of the presence ofobstruction within airways. Upper air- way resistance syndrome is characterized by recurring snoring attacks with increasing intensity (crescendo snoring), interrupted by awakenings, during which the flow ofair through the upper airways returns tem- porarily to a normal condition. This syndrome occurs more frequently in women suffering from anxiety states. In anamnesis, patients frequently report an ac- companying sensation ofsleepiness and fatigue dur- ing daytime. Apnea is a term used for recurring sus- pension ofbreathing during sleep, lasting longer than 10 s. The degree ofsleep apnoea is described by the number ofepisodes per hour ofsleep: normal <5; I - mild 5-15; II - moderate 16-30; and III - severe >30. The diagnosis ofsnoring should usually start with a medical interview, during which the patient should be asked about morning discomfort, such as sore throat, headaches, fatigue and sleepiness sensations, as well as acid eructation or heartburn (pyrosis). It is also bene- ficial to ask a person sharing the sleeping-room with the patient some questions. In laryngological exami- nation, a careful evaluation ofthe nasal, nasopharyn-