Significance and treatment of nonapneic snoring

Snoring has been associated with an increased risk of vascular morbidity and mortality and with the complaint of excessive daytime sleepiness. Much of this risk may be attributable to concomitant sleep apnea or hypopnea. Recent work suggests that in certain individuals, snoring without apnea or hypopnea can lead to sleep disruption. This appears to be due to augmented ventilatory effort in response to an increased "internal" resistive load that results in repetitive arousals from sleep. This condition has been termed the upper airway resistance syndrome (UARS). Identification of load-related arousals in patients with the UARS may require the addition of esophageal pressure monitoring to the diagnostic polysomnogram. Nasal continuous positive airway pressure (CPAP) effectively eliminates snoring, hypopnea and apnea and therefore may be useful in treating this form of sleep-disordered breathing. The diagnostic criteria and indications, if any, for chronic treatment of these nonapneic snorers with nasal CPAP as well as long term compliance remain to be determined.