Snoring can be a sign of diabetes, sleep apnoea, heart disease, hypertension and other conditions

Many a times snoring can be a warning sign of a disease or a disorder.

Snoring is a loud, respiratory sound produced by the vibration of the soft tissue because of obstructed breathing while you sleep. The tissues involved could be the nasal passages, soft palate, base of the tongue, the uvula (cone shaped tissue hanging from the soft palate at the back of the tongue) and the tonsils. When you breathe in, air passes through the nose or mouth, past the back of the throat, to the lungs. The reverse happens when you breathe out - air passes from the lungs, through the throat, and out from the nose or mouth. In people who snore, the airway becomes narrow because the muscles that keep the airways open become too relaxed, blocking the passage of air and the person stops breathing. The period of not breathing is usually few seconds to sometimes up to a minute. After this period, the brain wakes up, and breathing is resumed. But the airways remain narrow. The tissues surrounding the airways vibrate, producing the sound of snoring.

This stoppage of breathing for more than a few seconds is dangerous because the brain does not get the required amount of oxygen, the oxygen levels in the blood decrease and carbon dioxide levels increase. This is called hypoxia. Snoring affects the quality of life not only for you but also for your bed partner who does not snore! And many a times snoring can be a warning sign of a disease or a disorder. Here are top 6 reasons men (and women) snore.

Obstructive sleep apnoea (OSA)

Snoring is characteristic of a sleeping disorder known as obstructive sleep apnoea. This disorder causes excessive daytime sleepiness that can lead to serious driving accidents or workplace accidents. Further, OSA increases the risk of heart disease and many other health consequences that lead to reduced quality of life. Sleep apnea occurs when the airway collapses repeatedly when you are sleeping. This obstruction can be partial or complete. Scientists have found that steady snoring can highly limit the airflow, but if you are a periodic snorer, the risk is not so much, but only if the periodic snoring percentage is less than 15. You can easily find out the percentage by recording your snoring at home. [1]

Metabolic Syndrome

Snoring is not always about OSA. It can be a warning sign for a serious adverse health condition called metabolic syndrome. Metabolic syndrome is a group of conditions, such as increased blood pressure, high blood sugar, abnormal cholesterol levels, and excessive abdominal fat, that increase your risk of diabetes, stroke, and heart disease.

You are classified as having metabolic syndrome if three or more of the following is present:

• triglycerides 150 mg/dl (1.7 mmol/liter)
• high-density lipoprotein (HDL) cholesterol <40 mg/dl (1.0 mmol/l) if you are a man or <50 mg/dl (1.3 mmol/l) if you are a woman
• blood pressure 130/85 mm Hg
• fasting glucose 100 mg/dl
• waist circumference 90 cm (men) or 80 cm (women)

Researchers have found that snoring is highly associated with metabolic syndrome, especially with high diabetes risk. For example, a study done in Chennai showed that 65 percent of the snorers had IDRS scores (measure for diabetes risk) of higher than 60, while the percentage was 46 in case of the non-snorers. People who snored had significantly higher chance of having metabolic syndrome than those who did not snore, even if they did not have abdominal obesity. [2]

Similarly, another study found that snoring is associated with an increased incidence of diabetes within 10 years, in men aged 30-69 years. Researchers believe that though obesity is the main risk factor for developing diabetes, if you are a habitual snorer, it may add to this hazard. [3] Read more about 7 reasons you should take snoring seriously

Diabetes

There is a strong association between snoring and diabetes. Scientists have found that the snoring-diabetes link is stronger in women, more so, in premenopausal women with polycystic ovary syndrome (PCOS). Although researchers are not yet absolutely sure how snoring is associated with diabetes, they believe the periodic pauses in breathing cause hypoxia (low blood oxygen levels), which leads to oxidative stress and, finally, to insulin resistance. [4]

Dyslipidemia, Heart Disease, Hypertension

Dyslipidemia is a disease characterized by high cholesterol levels and, if uncontrolled, can lead to the development of atherosclerosis (plaque build-up inside your arteries), cirrhosis (liver disease in which there is irreversible scarring of liver), and cardiovascular disease. Various studies have confirmed that there is a strong connection between snoring and dyslipidemia, and that BMI more than 25, diabetes, and hypertension, have a crucial role in the snoring-dyslipidemia link. The interesting point is that strong intensity snoring, rather than low intensity snoring, is associated with dyslipidemia. And this could be because of oxidative stress causing OSA, metabolic syndrome, or inflammation. [5]

Similarly, there is an association between increased blood pressure and snoring, and the prevalence of hypertension increased with increased severity of snoring. Snoring, age, BMI and alcohol consumption are all risk factors for hypertension. [6]

Many researchers, however, believe that snoring is not a risk factor for cardiovascular disease, regardless of whether or not the person has sleep apnea. [7]

Carotid artery atherosclerosis

All of the above mentioned diseases are in one way or another associated with snoring, but there is one medical condition that is caused by snoring, and that is - carotid artery atherosclerosis. Carotid arteries are blood vessels that supply oxygen rich blood to the head, brain, and face. When plaque, which is made up of fat, cholesterol, calcium, and other substances, develops inside the carotid arteries, it hardens the arteries, consequently limiting the flow of oxygen-rich blood to the parts of your body. Atherosclerosis of any artery can lead to serious problems, including heart attack and stroke. And now, a study published in the journal Laryngoscope revealed that since carotid arteries and the pharyngeal wall are situated very close to each other, the vibrations of heavy snoring subject the carotid arteries to vibration. This can change the thickness of the inner layers of the carotid arteries and cause atherosclerosis due to the trauma and subsequent inflammation. [8] How?

The inner layer of the arterial wall is lined with endothelial cells which provide a semi-permeable barrier to regulate the exchange of fluid, nutrients, gases, and waste between the blood and tissues. In addition, endothelial cells allow blood to flow without adhering to the vessel lining unless something perturbs these cells. When perturbation occurs, endothelial cells secrete cytokines that trigger and maintain an inflammatory response. The endothelial cells also change shape due to vibrations, allowing leukocytes and low-density lipoprotein (LDL) to enter the arterial wall and undergo oxidation. A series of chemical processes occur, ultimately resulting in lipid accumulating in the inner arterial wall called intima, and causing atherosclerosis. Snoring is more than a bedtime annoyance and it shouldn't be ignored, says Dr Robert Deeb, with the Department of Otolaryngology-Head & Neck Surgery at Henry Ford. Seek treatment in the same way you would if you had any other medical condition, he adds. Read here 6 yoga asanas to help you deal with your snoring

Reference

1. Alakuijala A, Salmi T. Predicting Obstructive Sleep Apnea with Periodic Snoring Sound Recorded at Home. Journal of Clinical Sleep Medicine : JCSM : Official Publication of the American Academy of Sleep Medicine. 2016;12(7):953-958. doi:10.5664/jcsm.5922.

2. Roopa M, Deepa M, Indulekha K, Mohan V. Prevalence of Sleep Abnormalities and Their Association with Metabolic Syndrome among Asian Indians: Chennai Urban Rural Epidemiology Study (CURES 67). Journal of Diabetes Science and Technology. 2010;4(6):1524-1531.

3. Elmasry, A., Janson, C., Lindberg, E., Gislason, T., Tageldin, M. A. and Boman, G. The role of habitual snoring and obesity in the development of diabetes: a 10-year follow-up study in a male population. Journal of Internal Medicine. 2000. 248: 13 20. doi:10.1046/j.1365-2796.2000.00683.x.

4. Xiong X, Zhong A, Xu H, Wang C. Association between Self-Reported Habitual Snoring and Diabetes Mellitus: A Systemic Review and Meta-Analysis. Journal of Diabetes Research. 2016;2016:1958981. doi:10.1155/2016/1958981.

5. Zhang N, Chen Y, Chen S, et al. Self-Reported Snoring Is Associated with Dyslipidemia, High Total Cholesterol, and High Low-Density Lipoprotein Cholesterol in Obesity: A Cross-Sectional Study from a Rural Area of China. Clifton P, ed. International Journal of Environmental Research and Public Health. 2017;14(1):86. doi:10.3390/ijerph14010086.

6. Liu Jianhong, Liang Dahua, Wei Cai Zhou, et al. Analysis of blood pressure in snoring population in Guangxi [J]. Chinese Journal of Tuberculosis and Respiratory Diseases. 2007,30 (5): 347-351.

7. Nordqvist, Christian. Snoring Can Affect The Carotid Artery. Medical News Today. MediLexicon, Intl., 27 Jan. 2013. Web.
8. Deeb, R., Judge, P., Peterson, E., Lin, J. C. and Yaremchuk, K. Snoring and carotid artery intima-media thickness. The Laryngoscope. 2014; 124: 1486 1491. doi: 10.1002/lary.24527.

Image source: Shutterstock