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Malin Svensson, MD, PhD
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Department of Otorhinolaryngology Institute for Surgical Sciences Uppsala, Sweden

Malin Svensson, MD, PhD, Department of Otorhinolaryngology, Institute for Surgical Sciences, Akademiska sjukhuset, Uppsala, Sweden 78185; e-mail: malin.l.svensson@akademiska.se


The author has reported to the ACCP that no significant conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/site/misc/reprints.xhtml).


© 2009 American College of Chest Physicians


Chest. 2009;136(2):649. doi:10.1378/chest.09-0898
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To the Editor:

We are pleased that our article1 has interested Drs. Carratù and Tedeschi, and Professor Resta. In our study, we found that in women from the general population aged 20 to 70 years, several daytime symptoms of sleep-disordered breathing were associated with the presence of self-reported snoring regardless of the apnea-hypopnea index (AHI). Resta et al2 found that obese patients without sleep apnea experienced more daytime sleepiness than nonobese control subjects. However, nearly 50% of the obese subjects snored loudly.2 Our results showed that the snoring women were significantly more overweight than the nonsnoring women (body mass index [BMI], 26 ± 4 vs 28 ± 5 kg/m2, p < 0.0001), but in our calculations we adjusted for BMI. The AHI did not independently correlate to any daytime symptoms in our study. Some previous studies have reported hypersomnolence in snorers with an AHI < 5,3 and that there was no significant modification by AHI on the relation between snoring and sleepiness.4 The nature of this excessive daytime sleepiness (EDS) in habitual snorers is not known. However, it has been shown in a small number of studies5,6 that the EDS can be reversed by treating the snoring even in nonapnoic subjects.

Several studies79 have pointed to the correlation between sleep-disordered breathing and cardiovascular disease, such as hypertension, but to our knowledge only one study7 found an increased risk of hypertension in snorers without nocturnal apneas. Further, the treatment of patients with sleep apnea can reduce cardiovascular mortality.10,11 However, there is no knowledge whether treatment of snoring without sleep apnea influences morbidity and/or mortality. In conclusion, we find that there is an urgent need for interventional studies where habitual snorers without sleep apnea are treated, and that outcome measures should include both short-term parameters, such as EDS, and potential long-term complications, such as hypertension.

Svensson M, Franklin KA, Theorell-Haglow J, et al. Daytime sleepiness relates to snoring independent of the apnea-hypopnea index in women from the general population. Chest. 2008;134:919-924. [PubMed] [CrossRef]
 
Resta O, Foschino Barbaro MP, Bonfitto P, et al. Low sleep quality and daytime sleepiness in obese patients without obstructive sleep apnoea syndrome. J Intern Med. 2003;253:536-543. [PubMed]
 
Young T, Palta M, Dempsey J, et al. The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med. 1993;328:1230-1235. [PubMed]
 
Gottlieb DJ, Yao Q, Redline S, et al. Does snoring predict sleepiness independently of apnea and hypopnea frequency? Am J Respir Crit Care Med. 2000;162:1512-1517. [PubMed]
 
Guilleminault C, Stoohs R, Duncan S. Snoring: I. Daytime sleepiness in regular heavy snorers. Chest. 1991;99:40-48. [PubMed]
 
Janson C, Hillerdal G, Larsson L, et al. Excessive daytime sleepiness and fatigue in nonapnoeic snorers: improvement after UPPP. Eur Respir J. 1994;7:845-849. [PubMed]
 
Bixler EO, Vgontzas AN, Lin HM, et al. Association of hypertension and sleep-disordered breathing. Arch Intern Med. 2000;160:2289-2295. [PubMed]
 
Grote L, Ploch T, Heitmann J, et al. Sleep-related breathing disorder is an independent risk factor for systemic hypertension. Am J Respir Crit Care Med. 1999;160:1875-1882. [PubMed]
 
Cui R, Tanigawa T, Sakurai S, et al. Associations of sleep-disordered breathing with excessive daytime sleepiness and blood pressure in Japanese women. Hypertens Res. 2008;31:501-506. [PubMed]
 
Marin JM, Carrizo SJ, Vicente E, et al. Long-term cardiovascular outcomes in men with obstructive sleep apnoea-hypopnoea with or without treatment with continuous positive airway pressure: an observational study. Lancet. 2005;365:1046-1053. [PubMed]
 
Young T, Finn L, Peppard PE, et al. Sleep disordered breathing and mortality: eighteen-year follow-up of the Wisconsin sleep cohort. Sleep. 2008;31:1071-1078. [PubMed]
 

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References

Svensson M, Franklin KA, Theorell-Haglow J, et al. Daytime sleepiness relates to snoring independent of the apnea-hypopnea index in women from the general population. Chest. 2008;134:919-924. [PubMed] [CrossRef]
 
Resta O, Foschino Barbaro MP, Bonfitto P, et al. Low sleep quality and daytime sleepiness in obese patients without obstructive sleep apnoea syndrome. J Intern Med. 2003;253:536-543. [PubMed]
 
Young T, Palta M, Dempsey J, et al. The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med. 1993;328:1230-1235. [PubMed]
 
Gottlieb DJ, Yao Q, Redline S, et al. Does snoring predict sleepiness independently of apnea and hypopnea frequency? Am J Respir Crit Care Med. 2000;162:1512-1517. [PubMed]
 
Guilleminault C, Stoohs R, Duncan S. Snoring: I. Daytime sleepiness in regular heavy snorers. Chest. 1991;99:40-48. [PubMed]
 
Janson C, Hillerdal G, Larsson L, et al. Excessive daytime sleepiness and fatigue in nonapnoeic snorers: improvement after UPPP. Eur Respir J. 1994;7:845-849. [PubMed]
 
Bixler EO, Vgontzas AN, Lin HM, et al. Association of hypertension and sleep-disordered breathing. Arch Intern Med. 2000;160:2289-2295. [PubMed]
 
Grote L, Ploch T, Heitmann J, et al. Sleep-related breathing disorder is an independent risk factor for systemic hypertension. Am J Respir Crit Care Med. 1999;160:1875-1882. [PubMed]
 
Cui R, Tanigawa T, Sakurai S, et al. Associations of sleep-disordered breathing with excessive daytime sleepiness and blood pressure in Japanese women. Hypertens Res. 2008;31:501-506. [PubMed]
 
Marin JM, Carrizo SJ, Vicente E, et al. Long-term cardiovascular outcomes in men with obstructive sleep apnoea-hypopnoea with or without treatment with continuous positive airway pressure: an observational study. Lancet. 2005;365:1046-1053. [PubMed]
 
Young T, Finn L, Peppard PE, et al. Sleep disordered breathing and mortality: eighteen-year follow-up of the Wisconsin sleep cohort. Sleep. 2008;31:1071-1078. [PubMed]
 
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