DOI: http://dx.doi.org/10.18203/issn.2454-5929.ijohns20175610

Role of polysomnography in patients of snoring

Saurav Sachdeva, Karan Sharma, Nirmal Kajal

Abstract


Background: A useful working definition of snoring is the production of sound by the upper aero digestive tract during sleep. Polysomnography (PSG) is the monitoring of physiological parameters and physiological or pathological events in sleep.

Methods: Fifty patients of either sex, having age >16 years were randomly selected from the ENT OPD based on the pre-determined inclusion and exclusion criteria. Subjective evaluation of snoring was done using Epworth sleepiness Scale. Neck circumference and body mass index were calculated in all patients. Then, complete local ENT examination was done including diagnostic nasal endoscopy. After that, full night polysomnography test of at least 6 hours duration was conducted.  

Results: Normal nasal endoscopy was seen in 64% of patients. DNS, DNS with ITH/MTH, ITH/MTH unilateral, ITH/MTH bilateral and nasal polyps were seen in 14%, 12%, 0%, 8% and 4% of patients respectively. Mean apnoea-hypopnoea index (AHI) was 6.58. 48% of the patients in our study had normal AHI (0-4). Mild, moderate and severe AHI was present in 44%, 6% and 2% of the patients respectively.

Conclusions: All cases of snoring must be subjected to thorough clinical examination and nasal endoscopy and thereafter, be evaluated further for presence of sleep apnoea with polysomnography.


Keywords


Polysomnography, Apnoea-hypopnoea index

Full Text:

PDF

References


The American Heritage dictionary of the English language. 4th ed. Boston: Houghton Mifflin Company; 2000.

Guilleminault C, Stoohs R, Duncan S. Snoring (I). Daytime sleepiness in regular heavy snorers. Chest. 1991;99(1):40–8.

Skatrud JB, Dempsey JA. Airway resistance and respiratory muscle function in snorers during NREM sleep. J Appl Physiol. 1985;59(2):328–35.

Liistro G, Stanescu DC, Veriter C, Rodenstein DO, Aubert Tulkens G. Pattern of snoring in obstructive sleep apnea patients and in heavy snorers. Sleep. 1991;14(6):517–25.

Lugaresi E, Cirignotta F, Montagna P. Pathogenic aspects of snoring and obstructive apnea syndrome. Schweiz Med Wochenschr. 1988;118(38):1333–7.

Lugaresi E, Cirignotta F, Coccagna G, Piana C. Some epidemiological data on snoring and cardiocirculatory disturbances. Sleep. 1980;3(3-4):221–4.

Boulware MH. Snoring among animals. Cornell Vet. 1969;59(3):473–80.

Perez Padilla JR, Slawinski E, Difrancesco LM, Feige RR, Remmers JE, Whitelaw WA. Characteristics of the snoring noise in patients with and without occlusive sleep apnea. Am Rev Respir Dis. 1993;147(3):635–44.

The international classification of sleep disorders. 2nd ed. Westchester: American Academy of Sleep Medicine; 2005.

Counter P, Wilson JA. The management of simple snoring. Sleep Med Rev. 2004;8(6):433–41.

Almendros I, Acerbi I, Puig F, Montserrat JM, Navajas D, Farre R. Upper-airway inflammation triggered by vibration in a rat model of snoring. Sleep. 2007;30(2):225–7.

Woodson BT, Garancis JC, Toohill RJ. Histopathologic changes in snoring and obstructive sleep apnea syndrome. Laryngoscope. 1991;101(12 Pt1):1318–22.

Svanborg E. Upper airway nerve lesions in obstructive sleep apnea. Am J Respir Crit Care Med. 2001;164(2):187–9.

Howitt L, Kairaitis K, Kirkness JP, Garlick SR, Wheatley JR, Byth K, et al. Oscillatory pressure wave transmission from the upper airway to the carotid artery. J Appl Physiol. 2007;103(5):1622–7.

Lee SA, Amis TC, Byth K, Larcos G, Kairaitis K, Robinson TD, et al. Heavy snoring as a cause of carotid artery atherosclerosis. Sleep. 2008;31(9):1207–13.

Stoohs R, Guilleminault C. Snoring during NREM sleep: respiratory timing, esophageal pressure and EEG arousal. Respir Physiol. 1991;85(2):151–67.

Berg S, Hybbinette JC, Gislasson T, Ovesen J. Intrathoracic pressure varia-tions in obese habitual snorers. J Otolaryngol. 1995;24(4):238–41.

Javaheri S, Wexler L. Prevalence and treatment of breathing disorders during sleep in patients with heart failure. Curr Treat Options Cardiovasc Med. 2005;7(4):295–306.

Berg S, Hoffstein V, Gislason T. Acidification of distal esophagus and sleep- related breathing disturbances. Chest. 2004;125(6):2101–6.

B Woodson BT, Franco R. Physiology of sleep disordered breathing. Otolaryngologic Clin North Am. 2007;40(4):691-711.

Isono S, Remmers J, Tanaka A, Sho Y, Sato J, Nishino T. Anatomy of pharynx in patients with obstructive sleep apnea and in normal subjects. J Applied Physiol. 1997;82:1319–26.

Berger H. Ueber das Elektroenkephalogramm des Menschen. J Psychol Neurol. 1930;40:160-79.

Loomis AL, Harvey N, Hobart GA. Cerebral states during sleep, as studied by human brain potentials. J Exp Psychol. 1937;21:127-44.

Aserinsky E, Kleitman N. Regularly occurring periods of eye motility, and concomitant phenomena, during sleep. Science. 1953;118: 273-4.

Dement WC, Kleitman N. Cyclic variations in EEG during sleep and their relation to eye movements, body motility and dreaming. Electroencephalogr Clin Neurophysiol. 1957;9:673-90.

Jouvet M, Michel M. Correlations electromyographiques du sommeil chez le chat decortique et mesencephalique chronique. CR Soc Biol (Paris). 1959;153:422-5.

Hori T, Sugita Y, Koga E, Shirakawa S, Inoue K, Uchida S, et al. Proposed supplements and amendments to ‘A Manual of Standardized Terminology, Techniques and Scoring System for Sleep Stages of Human Subjects’, the Rechtschaffen & Kales (1968) standard. Psychiatry Clin Neurosci. 2001;55:305–10.

Davey MJ. Epidemiological study of snoring from a random survey of 1075 participants. British Snoring & Sleep Apnoea Association. Available at: http://www.britishsnoring.co.uk/pdf/epidem.pdf.

Joaquin D, Santiago E, Ramón R, Ángeles I. Obstructive Sleep Apnea–Hypopnea and Related Clinical Features in a Population-based Sample of Subjects Aged 30 to 70 Yr. Am J Respiratory Critical Care Med. 2001;163(3):685-9.

Zonato AI, Bittencourt LR, Martinho FL, Júnior JF, Gregório LC, Tufik S. Association of systematic head and neck physical examination with severity of obstructive sleep apnea-hypopnea syndrome. Laryngoscope. 2003;113(6):973-80.

Liu J, Wei C, Huang L, Wang W, Liang D, Lei Z, et al. Prevalence of signs and symptoms suggestive of obstructive sleep apnea syndrome in Guangxi, China. Sleep and Breathing. 2014;18(2):375-82.

Chen R, Xiong KP, Lian YX, Huang JY, Zhao MY, Li JX, et al. Daytime sleepiness and its determining factors in Chinese obstructive sleep apnea patients. Sleep Breath. 2011;15(1):129-35.

Resta O, Foschino-Barbaro MP, Legari G, Talamo S, Bonfitto P, Palumbo A. Sleep-related breathing disorders, loud snoring and excessive daytime sleepiness in obese subjects. Int J Obest. 2001;25(5):669-5.

Mary SM, Bing Lam IP, Matthew MT, Wah Kit Lam NT, Kenneth W, Tsang T et al. Obstructive Sleep Apnea Is Independently Associated with Insulin Resistance. Am J Respiratory Critical Care Med. 2002;165(5):670-6.

Osen KD. Sleep and breathing disturbance secondary to nasal obstruction. Otolaryngol Head Neck Sur. 1981;89: 804.

McNicholas WT. Obstructive apnoeas during sleep in patients with seasonal allergic rhinitis. Am Rev Respir Dis. 1982;126:625.

Terry Y, Larel F, Hyon K. Nasal obstruction as a risk factor for sleep-disordered breathing. J Allergy Clin Immunol. 1997;99(2):757–62

Nuckton TJ, Glidden DV, Browner WS, Claman DM. Physical examination: Mallampati score as an independent predictor of obstructive sleep apnea. Sleep. 2006;29(7):903-8.