Chin Strap May Help with Snoring

There is a relatively simple (and cheap) device that may help some people who snore called a chin strap. This lowly, humble, and low-tech device may benefit patients who typically snore when:

1) Lays on back, but not on side
2) Mouth-breathes when sleeping (but suffers no nasal obstruction)
3) Does not suffer from severe obstructive sleep apnea
4) Appears to be "slack-jawed" when sleeping (chin pushed back relative to upper jaw creating a pseudo-overjet dental appearance)

How (or more importantly why) does this device work?

When a person sleeps who also mouth-breathes AND has a chin that falls backwards, it also causes the tongue to fall back against the back wall of the throat causing a partial narrowing. It also causes the overall throat diameter to decrease causing the throat mucosa to loosen creating the perfect environment for snore production: a partially narrow airway resulting in negative pressure due to increased respiratory effort which triggers any loose mucosa to vibrate causing a snore sound.

A chin strap can be used to force the mouth closed into a more normal position (chin in normal forward position with teeth in normal occlusion). By preventing the chin from falling backward, it would prevent the tongue from falling backward. By preventing the tongue from falling backward, the partial airway narrowing could be avoided. By preventing the airway from narrowing, the throat mucosa would be more taught and less prone to vibrate as well as prevent increased respiratory effort and a "negative" pressure environment.

Where can you get one? There's a whole bunch that can be purchased on Amazon.com.

So there you have it... Of course, keep in mind that the chin-strap will NOT work for everybody as the snore production could be due to other factors unrelated to the chin, tongue, mouth position.

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OSA is a Risk for Sudden Cardiac Death

Mayo Clinic researchers have determined that not only does OSA (obstructive sleep apnea) lead to increased risk of stroke, cardiac arrest, hypertension, vascular disease, etc but it can also increase the risk of sudden cardiac death, usually due to a fatal cardiac arrhythmia. This conclusion was reached after tracking thousands of men and women with sleep apnea for up to 15 years of whom 142 had sudden cardiac deaths or arrests who were resuscitated.

These sudden cardiac arrests occurred mainly at night, 60 years of age or older, with AHI scores of 20 or greater, and having low blood levels of oxygen. When oxygen saturation was 78% or less, the risk of sudden cardiac arrest increased by 80%. Normal oxygen saturation is 95-100%.

Unfortunately, the study failed to address whether those who used a CPAP machine (continuous positive airway pressure) or underwent surgical intervention to correct the OSA had a reduced risk of sudden cardiac death.

Such surgical intervention to treat OSA include UPPP and base of tongue reduction. Sedated endoscopy may be required to determine where the obstruction occurs anatomically before deciding on a surgical course of action.

Source:
Sleep Apnea May Boost Risk of Sudden Cardiac Death. WebMD 6/11/13

Reference:
Obstructive Sleep Apnea and the Risk of Sudden Cardiac Death: A Longitudinal Study of 10,701 Adults. J Am Coll Cardiol. 2013;():. doi:10.1016/j.jacc.2013.04.080

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Snoring is Bad for the Heart? Not so fast...

This past week, media has both aired and published a story regarding new research that suggests snoring WITHOUT obstructive sleep apnea may lead to potential increased risk of heart disease as well as stroke.

Apparently, researchers in Michigan examined the data of 913 patients between the ages of 18 and 50 who had undergone a sleep study between 2006 and 2012. None had been diagnosed with sleep apnea, but did have significant snoring. These patients underwent an ultrasound that measured the thickness of the carotid artery inner lining. The thicker the inner lining of the carotid artery, the higher the risk for carotid artery disease and stroke.

The researchers found that in their patient population, the carotid arteries were thicker in snorers than in non-snorers. In fact, these abnormal changes were comparable to smokers, diabetics, and patients with hypertension.

Unfortunately, their findings have not yet been published (though submitted to the journal Laryngoscope), but was presented at the Combined Sections Meeting of the Triological Society in Scottsdale, Arizona held between January 24-26, 2013.

However, this is not the first study to show a link between snoring and heart disease. Hungarian researchers in 2008 reported that loud snorers were at significantly higher risk for stroke and heart disease in their study population of 12,642 subjects.

Contradictory Research: Snoring is NOT Bad for the Heart

Now, before every snorer goes into a panic regarding the fact that they snore, even if there are no problems with obstructive sleep apnea confirmed on sleep study, consider this...

Australian researchers published findings in 2012 that snoring did NOT increase risk for heart disease and mortality regardless of whether the patient suffered from sleep apnea or not. Their population study group consisted of 380 subjects.

What's Going On?

Admittedly, the burden of epidemiological evidence does suggest a link between snoring alone and potential increased risks for stroke and heart disease. But the very factors that predispose to snoring are also associated with other diseases that confound a conclusive relationship. Such other confounding factors include obesity, hypertension, diet, age, smoking, and alcohol consumption. When ignoring snoring-related health issues, there are numerous other confounding factors including periodontal disease, personality, stress, sedentary lifestyle, etc.

A study I would like to see to help clear the confusion regarding the risk of snoring would be to examine a large population of subjects who snore, but who are all skinny, non-smokers, non-alcohol drinkers, not diabetic, do not have high blood pressure, eat a balanced healthy diet, do not have a type A personality, good teeth, exercise daily, and lead a relatively stress-free life.

Any takers???

Assuming Snoring DOES Lead to Elevated Risk

The simplistic reason this may occur is due to acoustic and vibrational trauma that gets transmitted from the airway to the carotid arteries located nearby in the neck. Such snore-induced vibrational trauma leads to micro-injury to the inner lining of the carotid artery leading to thickening.

With thickening, the carotid arteries in essence become more narrow leading to increased risk of stroke.

Such vascular injury can also lead to increased levels of catecholamines that can lead to similar changes elsewhere in the body including the heart.

Of course, there are more complex variables at play which requires more complex answers, but that's beyond the scope of this blog.

Treatment

Snoring is unfortunately a complex problem to fix and does require some testing to fully evaluate and treat successfully. Such tests include fiberoptic laryngoscopy, sleep study and sedated endoscopy.


Source:
Snoring May Be as Bad as Smoking for Your Heart. Medical Daily 1/24/13

References:
Cardiovascular Disease and Health-Care Utilization in Snorers: a Population Survey. Sleep 2008 Mar;31(3):411-6.

Snoring Is Not Associated With All-Cause Mortality, Incident Cardiovascular Disease, or Stroke in the Busselton Health Study. Sleep. 2012 Sep 1;35(9):1235-40. doi: 10.5665/sleep.2076.

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Cuddly Robot That Cures Snoring!

The robot which is shaped like a polar bear essentially listens for snoring while monitoring oxygen levels of the snorer. The individual sleeps on this robotic bear. When oxygen levels drop coupled with snoring heard through its microphone, the robot lifts its paw and tickles the forehead which induces the snoring individual to shift position resulting in snore cessation all without actually waking the individual. Watch video below.

Of course, there's no studies I'm aware of that actually determines whether this works or not, but the concept is sound.

The robot was developed in Japan in Tokyo's Waseda University and was unveiled during the International Robot Show, but not yet commercially available.

The name of the robotic bear is "Jukusui-Kun".

Read more about this here.

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New Video on "Where" Snoring Comes From and Treatment

Our office has produced a new video describing "where" snoring comes from determined by a simple procedure known as sedated or sleep endoscopy.

At its most basic definition, snoring is noise produced from a vibrating mucosal surface in the upper airway.

Though snoring can be defined simply, the tough question is WHERE are these vibrating mucosal surfaces? Because unless one can define WHERE the snoring is coming from, successful treatment can't be pursued definitively.

An office exam performed while a patient is awake is suboptimal as the patient is awake... and not snoring. As such, it is an educated guess where the snoring problem is stemming from.

To this end, there are three main levels where snoring can be produced and the best way to localize a snore is to perform the exam while the patient is asleep (induced by anesthesia) and snoring!

1) Nose
2) Mouth
3) Throat
4) All of the above

Watch the video to see how each of these areas can contribute to a person's snore as well as treatment options.

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