Snoring.(WOMEN'S HEALTH ADVISER)

Primary snoring is more a social than a medical concern. But about 10% of snorers also have sleep apnea, which can be a serious health problem in its own right, and it can exacerbate other problems such as cardiac disorders and high blood pressure.

Among people aged 30-40 years, 15% of women snore, compared with 45% of men, but by 60 years and older, about 50%-60% of both men and women snore. The rapid increase in snoring among older women is probably related to postmenopausal tissue laxity. Muscular tone in the tongue and throat decreases; these tissues are then prone to collapse during sleep, narrowing the oropharyngeal passage and vibrating on inspiration.

A landmark 1993 study indicated that women with sleep apnea are significantly underdiagnosed. The study of 602 people aged 30-60 years found that men with sleep apnea outnumbered women 2:1 based on clinical symptoms, but they outnumbered women 10:1 in undergoing a sleep study (N. Engl. J. Med. 1993;328:1230-5).

Diagnosis

Women are often unaware of any cessation in breathing during their sleep, and male bed partners are notoriously poor in describing their partners' apnea, snoring, or any other sleep disturbance. Women therefore are unlikely to associate the symptoms of sleep apnea with a sleep problem.

Women with snoring and sleep apnea usually present with complaints that might prompt thyroid function tests: a headache upon awakening, day-time sleepiness, lack of energy, and depression. These are symptoms of transient hypoxemia, which occurs during the apneic periods. These periods can last anywhere from 10 to 45 seconds. Combined with a history of snoring, these symptoms should prompt the physician to recommend a sleep study.

An exam may reveal a deviated septum, nasal polyps, allergic rhinitis, or sinusitis. The patient may have large tonsils, excess tissue in the soft palate, or a particularly long and floppy uvula.