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Factors which contribute to snoring FACTORS WHICH CONTRIBUTE TO SNORING
We have been concerned thus far with a picture of the normal upper airway, discussing its susceptibility to collapse given the compliant nature of the pharynx and the destabilizing effect of sleep. In fact, most people's airways remain open during sleep and they experience neither the audible evidence of partial collapse nor a disastrous total collapse. So what makes snorers different?
The shape of the upper airway
In many instances the cause of snoring is plainly visible on a simple examination of the throat. Looking through the mouth into the oropharynx, one is often confronted with a pendulous and swollen soft palate and uvula which quite plainly has the effect of narrowing the entrance to the upper airway. Inflammation or reddening of this tissue is further evidence of upper airway trauma caused by snoring. Some patients present with a good history of snoring but with no remarkable physical features to account for the symptoms, and it is these patients who impress on us the fact that snoring can be brought about by very subtle changes in the shape of the upper airway.
Using a technique known as acoustic reflection (in principle, not unlike a sonar) several studies have demonstrated that the cross sectional area of the pharynx in heavy snorers is less than that of non snorers. In other words snorers tend to have a narrower pharynx in the awake state even before other factors come into play such as the loss of muscle tone during sleep. Not surprisingly, the soft tissue around the narrowed airway vibrates under the added strain of each inspiratory manoeuvre. Careful analysis of the size and position of facial bones, particularly the jaw, has shown that heavy snorers often have slight changes in the alignment of these structures which again favours collapse of the upper airway.
Although most snorers will have a narrow pharynx or some degree of mal-alignment of the jaw there are sometimes more conspicuous findings which tip the scales dramatically in favour of the repetitive airway obstruction which is often associated with heavy snoring. Any condition, and there are many, which effectively restricts the flow of air through the upper airway by narrowing the pharynx will promote snoring.
Obesity
Obesity certainly contributes to the incidence and severity of snoring. The relationship between excessive weight and sleep disorders is under active investigation and there is evidence to suggest that fat deposits in the tissue surrounding the pharynx play a role. Weight loss, even for the mildly overweight, has been shown to be effective in reducing the severity of snoring.
Other impediments
There are several structural anomalies of the upper airway which can interfere with the normal flow of air such as enlarged adenoids and tonsils, a large tongue, malformations of the jaw or an abnormally long or fleshy soft palate. The list is incomplete but serves to show that some changes to the anatomy of this critical part of the airway will favour snoring.
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