Study shows an independent relationship between the intensity of snoring sounds and sleepiness

December 15, 2008

Westchester, Ill. -A study in the Dec. 15 issue of the Journal of Clinical Sleep Medicine shows that objectively measured snoring intensity is correlated with subjective sleepiness independent of the apnea-hypopnea index (AHI) in patients with moderate to severe obstructive sleep apnea (OSA).

Results indicate that the sound intensity of objectively measured snoring in patients with OSA is independently correlated with subjective sleepiness as measured by the Epworth Sleepiness Scale (ESS), and subjective sleepiness is better explained by snoring intensity than by AHI. Independent variables such as snoring intensity, desaturation severity, daily sleep time, subjective snoring frequency and nasal obstruction symptoms accounted for 22 percent of the variance in ESS scores. Snoring intensity and AHI together, however, could explain only 15 percent of the variance in ESS scores.

Principal investigator Hiroshi Nakano, MD, PhD, of the department of pulmonology at the Fukuoka National Hospital in Fukuoka, Japan, says that the results of the study indicate that daytime sleepiness is affected not only by the severity of OSA, but also by the loudness of snoring.

"The results were not so surprising, because previous studies in general population have shown an independent relationship between the degree of snoring, by a questionnaire, and sleepiness," said Nakano.

Records of 507 patients who were referred to Fukuoka National Hospital for suspected OSA and who underwent diagnostic polysomnography (PSG) between September 2002 and January 2005 were retrospectively reviewed. Subjective sleepiness was assessed using the ESS, and snoring intensity was assessed using the highest one percentile ambient sound-pressure level attained while asleep during PSG.

Patients were placed into groups of non-to-mild OSA (AHI less than 15) and moderate-to-severe OSA (AHI greater than 15) in order to clarify the effect of OSA severity on the relationship between snoring intensity and sleepiness in subsequent analyses.

Findings suggest that snoring intensity is significantly correlated with age, body mass index (BMI) and AHI. Insufficient sleep in daily life was taken into consideration as a possible cofounder, as it may enhance snoring intensity and sleepiness. Although sleepiness is one of the most important symptoms of OSA, the authors report that the correlation between the degree of sleepiness and the severity of OSA has been found to be relatively weak in many studies.

Because objectively measured snoring is related to sleepiness independent of OSA, the authors conclude that quantitative measurements of snoring are desirable in ordinary sleep studies.
The Journal of Clinical Sleep Medicine (JCSM) contains published papers related to the clinical practice of sleep medicine, including original manuscripts such as clinical trials, clinical reviews, clinical commentary and debate, medical economic/practice perspectives, case series and novel/interesting case reports. In addition, the JCSM publishes proceedings from conferences, workshops and symposia sponsored by the American Academy of Sleep Medicine or other organizations related to improving the practice of sleep medicine

For a copy of the study, "Relationship between Snoring Sound Intensity and Sleeplessness in Patients with Obstructive Sleep Apnea," or to arrange an interview with an AASM spokesperson, please contact Kelly Wagner, AASM public relations coordinator, at (708) 492-0930, ext. 9331, or

AASM is a professional membership organization dedicated to the advancement of sleep medicine and sleep-related research. As the national accrediting body for sleep disorders centers and laboratories for sleep related breathing disorders, the AASM promotes the highest standards of patient care. The organization serves its members and advances the field of sleep health care by setting the clinical standards for the field of sleep medicine, advocating for recognition, diagnosis and treatment of sleep disorders, educating professionals dedicated to providing optimal sleep health care and fostering the development and application of scientific knowledge.

American Academy of Sleep Medicine

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