Release: Embargoed until September 24, 2000 Contact: Kenneth Satterfield202-371-4517 (9/23-27)703-519-1563[email protected]
SNORING IS JUST NOT UNWELCOME NOISE -- IT MAY INDICATE SERIOUS SLEEPING DISORDERED BREATHING
Washington, DC -- Snoring and sleepiness are cardinal symptoms of sleep-disordered breathing (SDB). However, many health care providers consider sleepiness the primary symptom and snoring a cosmetic nonmedical and nonsymptomatic problem. Consequently, snoring is often excluded from public health outcomes analysis and concern, which can misrepresent clinical outcomes.
Two otolaryngologist--head and neck surgeons who regularly treat sleep disorders challenged that assumption. They examined SDB symptoms using the Epworth Sleepiness Scale (ESS) and patient-reported symptom severity index (SSI) for snoring and sleepiness, to determine the importance and association of snoring to sleep disordered breathing.
The results of their research indicates that snoring is a direct consequence of sleep disordered breathing. Accordingly, patients who seek treatment for snoring should also consider an examination for sleep disordered breathing and the symptoms associated with this potentially dangerous medical problem.
The authors of the study, "Snoring: A Cardinal Symptom of Sleep Disordered Breathing," are B.Tucker Woodson MD and Joseph Han MD, both of the Medical College of Wisconsin. Their findings will be presented Monday, September 25, at the Annual Meeting of the American Academy of Otolaryngology -- Head and Neck Surgery Foundation, being held September 24-27, 2000, at the Washington, DC Convention Center.
Methodology: From February 1997 to July 1999, 770 Otolaryngology sleep clinic intake evaluation forms were reviewed for ESS, snoring SSI, and sleepiness SSI (SSI is defined as the product of self-reported symptom magnitude and symptom importance) The patients were divided into two categories (snoring and sleepiness) based on the mathematical difference of the SSI for snoring and sleepiness (SSI snoring ---- SSI sleepiness). Outcomes measures were divided into quartiles based on their ESS level. Each quartile was evaluated for differences and correlations in the outcomes measures.
Results: In total, 599 had complete data for all measures. Mean SSI for the total group was 32.7 -- 14.8 for snoring and 22.4 -- 14.2 for sleepiness. Snoring was the predominant complaint in 429 patients (72 percent), while sleepiness was the predominant complaint for 125 patients (22%). ESS was elevated for both categories: snoring (10.1) and sleepiness (11.6). When equally controlled for sleepiness by ESS, snoring SSI was greater than sleepiness SSI (P < 0.03) in all quartiles.
Conclusion: Snoring is a principal symptom of sleep disordered breathing. It is also the predominant symptom of importance to most patients on initial evaluation. The majority of patients initially perceive their disease as a snorer's disease despite symptoms of sleepiness.
Evidence-based clinical studies may frequently ignore snoring as an outcomes measure. However, this authors contend that snoring is the predominant symptom of most patients with SDB. This trend persists even in the sleepiest patient group. Additionally, a potentially large group of patients who identify their disease as predominantly snoring are at significant risk for sleepiness and SDB, about which public health must identify and educate patients, providers, and payers.
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