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Factors contributing to snoring: smoking, incidence, treatment and weight control
FACTORS CONTRIBUTING TO SNORING: SMOKING, INCIDENCE, TREATMENT AND WEIGHT CONTROL
Cigarette smoking is not only a risk factor for lung and cardiovascular disease. Chronic inflammation of the nasal passages and other components of the upper airway are more likely in smokers, having the same effect as other forms of upper respiratory tract obstruction. Smoking should be regarded as a risk factor for snoring.
It wouldn't be difficult to convince the average lay person that snoring is a common occurrence. We all know someone or have heard stories about someone who snores, but accurate estimates of the incidence of snoring are not easily established. Problems arise when we start asking questions about snoring. For a start, how do you get reliable information from people who sleep by themselves, and how do you classify the ones who snore "sometimes"? Despite these methodological problems, some impressive studies have been reported. A study in Italy involving about 6000 subjects showed that 20% of the selected population was habitual snorers with a further 15% being occasional snorers. A study in Toronto, Canada, collected data on 2629 subjects from a wide variety of ethnic and socioeconomic groups resulting in an overall snoring incidence of 42%. Detailed analysis of these and subsequent studies tells us a great deal about snoring in different age groups and the association with other medical complaints such as obesity, hypertension and heart disease. Several important trends emerge, particularly the higher incidence of snoring in males and the fact that we are more likely to snore as we get older.
The demand for a snoring cure is evidenced by a proliferation of commercially available devices which claim to reduce or eliminate the problem. The techniques are various: hypnosis, designer pillows, electronic snore detectors and mouth appliances. Rather than present an evaluation of every one of these devices, it is intended to give an overview of current modes of treatment based on our understanding of the mechanisms of snoring.
For the "uncomplicated" snorer, there are several approaches not requiring medical supervision. Overweight snorers, for example, will always be advised to lose weight regardless of other measures taken. Weight loss seems an absurdly simple way to reduce snoring, to the extent that many snoring patients are disappointed, if not offended, by the suggestion that their weight has anything to do with their nocturnal symptoms. Some recent work suggests that loss of weight is effective not merely because fatty impediments to the airway are removed, but because the function of the muscles supporting and controlling the pharyngeal area is improved.
There may well be both structural and functional reasons why weight loss decreases the likelihood of airway collapse during sleep, but regardless of the mechanisms, the importance of weight loss cannot be overemphasized. Weight loss, like alcohol avoidance, can only be achieved with appropriate education of the patient and a degree of self discipline. Unfortunately there are no diets designed specifically to meet the needs of snorers. Weight loss will follow when fewer calories are ingested, which for most people means a reduction in sweet and fatty foods. Consultation with a dietician is strongly recommended.
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