Chapter 17 : Sleep - related breathing disorders

The sleep apnoea syndromes are a common cause of excessive daytime sleepiness and may lead to pulmonary hypertension, systemic hypertension, cardiac arrhythmias, mental dysfunction, heart failure and sudden death. The otolaryngologist is increasingly involved in the multidisciplinary approach to assessment and treatment of the obstructive and mixed forms of sleep apnoea; it is important for the modern otolaryngologist to be familiar with the diagnosis and treatment of sleep apnoea syndromes. Snoring is no longer to be considered a rather humorous, frivolous sign of no clinical significance (Robin, 1968), a status accorded for many years. Snoring is a common feature of sleep apnoea syndromes and recent literature has concentrated on it as a possible symptom or sign of a more sinister disorder (Guilleminault and Dement, 1978; Morton, 1986). Incidence figures for snoring state that 53% of an adult male population will snore intermittently and 31% will snore regularly; for women the figures given are 38% snoring intermittently and 19% regularly (Lugaresi, Coccagna and Cirignotta, 1978). Snoring increases with age and up to 60% of men and 40% of women between the ages of 60 and 65 will snore; in the 30-35 year age group the percentages are only 20% for men and 5% for women (Lugaresi et al, 1982). Most people in this large population will be subjectively undisturbed by their snoring yet current work at The Royal National Throat, Nose and Ear Hospital in London, and Stanford Medical Center, California, supports the view that patients with 'heroic' snoring (snoring that occurs in any body position and can be heard in the next room through a closed door), even without daytime sleepiness, may have an occult form of sleep apnoea syndrome and require treatment for medical as well as social reasons.