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Snoring

Snoring is the hoarse or harsh sound that occurs when air flows past relaxed tissues in the upper airway, causing the tissues to vibrate during breathing, typically while sleeping. Snoring is classified as primary snoring, which is usually benign and not associated with sleep apnea, or secondary snoring, which may indicate underlying obstructive sleep apnea.^[1] Although occasional snoring is common and often harmless, chronic snoring affects approximately 40% of men and 20% of women in the general adult population and can disrupt sleep for both the snorer and their bed partner.^[2] It arises primarily from partial obstruction of the upper airway due to factors such as throat muscle relaxation, excess throat tissue, or nasal congestion, and is more prevalent in individuals who are overweight, consume alcohol before bed, or sleep on their back.^[1] Snoring serves as a key symptom of obstructive sleep apnea (OSA), a serious disorder involving repeated pauses in breathing that increases risks for hypertension, cardiovascular disease, and daytime fatigue if untreated.^[1] Management options range from lifestyle modifications like weight loss and positional therapy to medical interventions such as oral appliances or continuous positive airway pressure (CPAP) devices, with surgical procedures reserved for cases unresponsive to conservative approaches.^[3]^[4]

Overview

Definition

Snoring is the audible sound generated by the vibration of respiratory structures in the upper airway, including the soft palate, uvula, and base of the tongue, during sleep as a result of partial obstruction to airflow. This vibration occurs when inhaled air passes through narrowed passages formed by relaxed tissues, creating turbulent flow that produces the characteristic noise. Unlike normal breathing, which generates minimal sound due to unobstructed airflow, snoring specifically arises from this partial blockage without complete cessation of breathing. The typical snoring sound manifests as a low-frequency rumbling or rattling, often described as hoarse, harsh, or snorting, with intensity levels ranging from 40 to 100 decibels. These sounds are predominantly in the frequency range of 40 Hz to 2000 Hz, though lower frequencies dominate the rumbling quality. Snoring tends to worsen in the supine sleeping position, where gravity promotes greater collapse of the airway structures, increasing the amplitude and duration of the vibrations. Snoring is distinct from complete airway blockage, as seen in apnea, where airflow halts entirely, leading to breathing pauses rather than ongoing vibratory noise. It primarily emerges during relaxed non-REM sleep stages, when pharyngeal muscle tone naturally decreases, facilitating partial airway narrowing and tissue flutter. In severe instances, persistent snoring can signal obstructive sleep apnea, a disorder characterized by recurrent full obstructions alongside vibratory sounds.

Classification

Snoring is broadly classified into primary and secondary types based on its association with underlying sleep disorders. Primary snoring, also known as simple or non-apneic snoring, refers to habitual snoring without episodes of apnea, hypopnea, or significant oxygen desaturation, typically defined by an apnea-hypopnea index (AHI) less than 5 events per hour and absence of daytime sleepiness or sleep disruption.^[5]^[6] In contrast, secondary snoring occurs as a symptom of sleep-disordered breathing, most commonly obstructive sleep apnea (OSA), where snoring accompanies respiratory pauses and associated complications like excessive daytime fatigue.^[7]^[8] Severity of snoring is often graded by frequency, intensity, and symptomatic impact. Mild or simple snoring involves occasional episodes without daytime symptoms, typically occurring less than three nights per week and at lower sound levels (40-50 dB). Moderate snoring is more frequent, occurring three or more nights weekly, with intermittent patterns and possible mild fatigue, reaching intensities of 50-60 dB. Severe snoring is characterized by near-nightly occurrences, higher intensities exceeding 60 dB, and frequent apneic episodes indicative of OSA.^[9]^[10] Snoring patterns further delineate its presentation. Positional snoring intensifies when sleeping supine due to gravitational narrowing of the airway, often resolving in lateral positions. Continuous snoring produces steady vibrations throughout sleep, while intermittent snoring aligns with irregular airflow, such as during respiratory events. Diurnal snoring is rare and typically nocturnal in nature.^[1]^[11] By etiology, snoring is categorized as anatomical, involving structural airway narrowing like enlarged tonsils or a deviated septum; neuromuscular, resulting from reduced muscle tone in pharyngeal tissues during sleep; or multifactorial, combining both with lifestyle influences. OSA represents a severe, multifactorial form often requiring clinical intervention.^[12]^[1]

Causes and Risk Factors

Anatomical Factors

Anatomical factors contributing to snoring primarily involve structural abnormalities in the upper airway that narrow the passageway and promote airflow turbulence during sleep. These fixed or congenital variations can predispose individuals to partial obstruction, particularly when throat muscles relax, leading to vibrations in the soft tissues. Common nasal cavity issues include a deviated septum, which displaces the nasal partition and restricts airflow on one side, nasal polyps that form benign growths blocking the nasal passages, and chronic congestion that further diminishes airway diameter.^[13]^[1]^[14] In the oropharynx, enlarged tonsils and adenoids, known as adenotonsillar hypertrophy, protrude into the airway and reduce its cross-sectional area, especially in children but also persisting into adulthood.^[15] An elongated uvula or a thick soft palate can similarly encroach on the space, increasing resistance to airflow and facilitating tissue flutter.^[1]^[16] Jaw and tongue positioning abnormalities, such as retrognathia—a receding lower jaw that positions the tongue posteriorly—or macroglossia, an enlarged tongue that occupies more pharyngeal space, exacerbate narrowing during supine sleep.^[17]^[18] A low hyoid bone position, where this U-shaped structure sits inferiorly in the neck, further destabilizes the airway by altering the tension of supporting muscles.^[19] Laryngeal factors are particularly relevant in pediatric populations, where laryngomalacia—the softening and inward collapse of supraglottic tissues, including the epiglottis—can cause dynamic obstruction and manifest as snoring alongside stridor.^[20]^[21] Epiglottis abnormalities, such as redundancy or abnormal angulation, contribute similarly by impeding glottic opening in affected children.^[22] Prevalence data indicate that anatomical variants like nasal obstruction play a notable role, with nocturnal nasal blockage reported in approximately one-third of adults experiencing sleep-disordered breathing, including habitual snoring.^[23]

Physiological and Lifestyle Factors

Reduced pharyngeal muscle tone during sleep contributes to snoring by allowing the upper airway to collapse more easily, a process exacerbated by aging, with prevalence peaking between ages 40 and 60 years.^[24] This age-related decline in muscle responsiveness is a key physiological factor, as neural drive to dilator muscles diminishes, promoting airway instability.^[25] Sedatives, such as benzodiazepines, further worsen this by suppressing muscle activity and increasing upper airway collapsibility.^[26] Obesity is a major modifiable risk factor for snoring, as excess adipose tissue in the neck compresses the pharynx, particularly when neck circumference exceeds 17 inches in men.^[27] Individuals with a body mass index (BMI) greater than 30 kg/m² face a 2- to 4-fold increased risk compared to those with normal weight, due to fat deposition reducing airway patency.^[28] This effect interacts briefly with anatomical narrowing, amplifying vibration in the soft tissues during respiration. Lifestyle habits significantly influence snoring severity. Alcohol consumption relaxes pharyngeal muscles, elevating risk by approximately 25% per drink through heightened airway collapsibility.^[29] Smoking promotes mucosal inflammation and edema in the upper airway, independently increasing snoring likelihood by thickening tissues and impairing clearance.^[30] Poor sleep posture, especially supine positioning, worsens snoring by gravitational pull on the tongue and soft palate, narrowing the airway more than lateral or prone positions.^[1] Hormonal and developmental changes also play roles. During pregnancy, weight gain and progesterone-induced muscle relaxation lead to snoring in about 30% of cases, particularly in the third trimester.^[31] In menopause, declining estrogen levels contribute to reduced upper airway muscle tone and increased fat deposition, heightening snoring risk among postmenopausal women.^[32] Hereditary factors predispose individuals to snoring through genetic influences on craniofacial development and connective tissue integrity. Familial traits affecting jaw and palate structure can narrow the airway, while collagen disorders like Ehlers-Danlos syndrome elevate risk via hypermobile tissues and associated sleep-disordered breathing.^[33] These genetic elements often manifest alongside modifiable factors, underscoring the multifactorial nature of snoring.

Pathophysiology

Mechanism

Snoring arises from turbulent airflow during inspiration through a narrowed upper airway, which generates negative intraluminal pressure and leads to the partial collapse and vibration of pharyngeal tissues.^[34] This turbulence is initiated when the airway cross-section is constricted, causing air to accelerate and produce unsteady flow patterns that destabilize surrounding soft tissues.^[35] The primary site of vibration is the soft palate, where fluttering occurs as it is drawn inward by suction; secondary contributions come from the tongue base, which experiences suction forces, and the flapping of pharyngeal walls against each other.^[34] According to Bernoulli's principle, the increased velocity of air through the constriction lowers the static pressure, drawing floppy tissues together and promoting their oscillation.^[34] This can be expressed by the simplified Bernoulli equation:

P + \frac{1}{2} \rho v^2 = \text{constant}

where P is the static pressure, \rho is air density, and v is the airflow velocity.^[34] The vibration cycle involves partial airway obstruction that creates eddies and pressure oscillations, typically at frequencies between 20 and 500 Hz, producing the characteristic snoring sound.^[36] These oscillations result from the repetitive opening and closing of the pharyngeal lumen, with tissue tonicity briefly restoring patency before negative pressure recurs.^[34] In the supine position, gravitational pull exacerbates this process by displacing soft tissues posteriorly, increasing the likelihood and intensity of vibrations.^[37]

Relation to Obstructive Sleep Apnea

Snoring serves as a hallmark symptom of obstructive sleep apnea (OSA), occurring in 70% to 95% of affected individuals, where it reflects partial upper airway obstruction that may escalate to complete collapse during sleep events. This partial blockage generates the characteristic vibratory sounds and often precedes more severe respiratory pauses, distinguishing simple snoring from the pathological breathing disruptions in OSA.^[38] The apnea-hypopnea index (AHI), which quantifies the frequency of apneas and hypopneas per hour of sleep, provides a key diagnostic threshold: snoring combined with an AHI exceeding 5 events per hour indicates likely OSA, with higher values correlating to greater severity. Longitudinal studies demonstrate a natural progression from habitual snoring to apneic episodes, particularly over intervals of about 5 years, where initial partial obstructions evolve into full airway closures, exacerbated by factors such as weight gain that further narrow the pharyngeal space.^[39]^[40] Shared pathophysiological mechanisms link snoring to OSA through repetitive tissue vibrations in the upper airway, which induce local inflammation and edema, progressively elevating resistance and promoting recurrent obstructions. Chronic snoring thereby heightens the risk of developing OSA, with simple snoring acting as a precursor that significantly elevates susceptibility. Screening instruments like the STOP-BANG questionnaire incorporate snoring as a primary criterion to identify individuals at elevated OSA risk, facilitating early intervention.^[41]^[42]^[43] Research has uncovered genetic associations, including upregulation of brain-derived neurotrophic factor (BDNF) in the soft palate muscles of snorers and OSA patients, which correlates with neuromuscular injury severity and may influence neuroplastic changes in airway tissues.^[44]

Health Consequences

Immediate and Partner Impacts

Snoring induces frequent micro-arousals in the snorer, leading to sleep fragmentation that diminishes overall sleep quality and contributes to excessive daytime sleepiness. Studies utilizing the Epworth Sleepiness Scale (ESS) demonstrate that primary snorers exhibit higher mean ESS scores compared to non-snorers (mean 8.2 vs. 6.3, difference ~2 points), indicating a moderate elevation in daytime fatigue without the severity seen in obstructive sleep apnea (OSA).^[45] Mouth breathing associated with snoring dries the oral mucosa and irritates the throat tissues due to prolonged exposure to air, resulting in discomfort such as dry mouth and sore throat upon waking. This irritation arises from the vibrations of the soft palate and pharyngeal walls during snoring episodes, exacerbating mucosal dehydration overnight.^[46]^[47] Snoring is linked to sleep bruxism, where involuntary jaw clenching or grinding occurs as a response to upper airway instability, affecting approximately 45% of primary snorers based on polysomnographic assessments. This association stems from heightened muscle activity in the orofacial region during partial airway obstructions, though it does not directly correlate with apnea frequency.^[48]^[49] The snorer may experience immediate psychological strain, including anxiety and embarrassment, particularly when aware of disturbances caused to others, leading to self-consciousness about the condition. This emotional response is compounded by social stigma, as snoring is often perceived as a source of personal and relational discomfort.^[50] For bed partners, snoring noise disrupts sleep continuity, with over two-thirds reporting poor sleep quality and up to 55% experiencing nightly disturbances that prompt separate sleeping arrangements in 23 to 33% of couples. These interruptions foster increased stress and resentment within relationships, as chronic sleep deprivation for the partner heightens irritability and emotional tension.^[51]^[52]^[53] In severe cases, snoring may signal underlying OSA, amplifying these immediate disruptions, though primary snoring alone accounts for most short-term interpersonal and personal effects.^[54]

Long-term Health Risks

Persistent snoring, even without obstructive sleep apnea (OSA), is associated with elevated cardiovascular risks due to intermittent hypoxia and sympathetic nervous system activation during sleep. Habitual snoring independently increases the odds of developing hypertension, with odds ratios ranging from 1.49 to 1.56 after adjusting for confounders such as age and body mass index.^[55] This hypoxia can also heighten stroke risk, with studies reporting odds ratios up to 2.69 for ischemic stroke in genetically predicted snorers.^[56] Additionally, snoring correlates with cardiac arrhythmias, including a prevalence of 4.8% in individuals with simple snoring compared to higher rates in OSA, linked to nocturnal oxygen desaturation.^[57] Neurologically, chronic snoring contributes to morning headaches primarily through carbon dioxide retention during airway obstructions, leading to vascular dilation and cerebral vasodilation upon awakening.^[58] Over time, persistent snoring is tied to cognitive deficits, such as memory impairment and reduced executive function, with sleep-disordered breathing affecting up to 37-48% of cases involving mild cognitive impairment in related populations.^[59] Snoring exacerbates gastroesophageal reflux disease (GERD) via negative intrathoracic pressure generated during airway collapse, which draws stomach acid into the esophagus, with bidirectional associations observed in 40-60% of OSA cases.^[60] Other long-term effects include enamel wear from associated bruxism (teeth grinding), which occurs more frequently in snorers due to sleep fragmentation and jaw muscle tension, leading to progressive tooth damage and sensitivity.^[61] Snoring also links to insulin resistance, independently raising prediabetes risk with odds ratios of 1.8 (95% CI 1.3-2.2), promoting metabolic dysregulation through chronic sleep disruption.^[62] Recent studies from 2023-2025 highlight snoring as an independent risk factor for atrial fibrillation beyond OSA, with higher snoring frequency and duration correlating to same-day arrhythmia episodes due to autonomic imbalance and reduced REM sleep.^[63]

Diagnosis

Clinical Evaluation

The clinical evaluation of snoring begins with a detailed patient history to assess the condition's characteristics and potential underlying causes. Clinicians inquire about the duration and onset of snoring, its frequency (e.g., nightly or intermittent), and severity, including loudness and any witnessed apneas or breathing pauses reported by bed partners. Risk factors such as elevated body mass index (BMI), alcohol consumption, smoking, and family history of sleep disorders are explored, as these contribute to upper airway collapsibility. The Epworth Sleepiness Scale (ESS) is commonly administered to quantify daytime sleepiness, with scores above 10 indicating excessive somnolence that may suggest associated sleep-disordered breathing.^[3]^[64]^[65] Physical examination focuses on anatomical features that may predispose to snoring. The Mallampati score is evaluated to gauge oropharyngeal crowding, where higher scores (III or IV) indicate reduced visibility of the posterior pharynx and increased risk of airway obstruction. Neck circumference is measured, with values exceeding 43 cm in men or 40 cm in women serving as a proxy for central obesity and elevated OSA risk. Nasal patency is assessed through simple bedside tests, such as the Cottle maneuver, to identify nasal valve collapse or obstruction from septal deviation or allergies.^[3]^[66]^[4] Validated questionnaires aid in risk stratification, particularly for distinguishing simple snoring from obstructive sleep apnea (OSA). The Berlin Questionnaire evaluates snoring intensity, witnessed apneas, daytime fatigue, and hypertension, categorizing patients into high or low OSA risk based on affirmative responses in at least two of three symptom categories. Similarly, the STOP-BANG questionnaire screens for snoring, tiredness, observed apneas, high blood pressure, BMI over 35 kg/m², age over 50, neck circumference over 40 cm, and male gender, with scores of 3 or higher indicating intermediate to high OSA probability. These tools facilitate efficient triage in clinical settings.^[3]^[67]^[66] Red flags during evaluation prompt heightened concern for comorbid conditions. Excessive daytime somnolence, often captured by the ESS, alongside symptoms like morning headaches or cognitive impairment, signals potential OSA. Comorbid hypertension is a critical indicator, as snoring-related intermittent hypoxia can exacerbate cardiovascular strain, necessitating urgent consideration for further assessment.^[3]^[68]^[64] Initial evaluation is typically conducted by primary care providers, who perform history and basic exams to identify modifiable risk factors and screen for OSA. Referral to ear, nose, and throat (ENT) specialists occurs for detailed anatomical assessment, particularly if structural abnormalities like adenotonsillar hypertrophy or nasal pathology are suspected. If clinical findings suggest OSA, progression to objective sleep studies may be indicated.^[3]^[69]^[70]

Diagnostic Tests

Polysomnography (PSG) serves as the gold standard diagnostic test for evaluating snoring, particularly when associated with obstructive sleep apnea (OSA), by providing comprehensive overnight monitoring of sleep stages, respiratory events, and related parameters.^[71] Conducted in a sleep laboratory or as a home-based variant, PSG records airflow via nasal pressure transducers or thermistors, snoring vibrations through an ambient microphone, and the apnea-hypopnea index (AHI) to quantify severity, alongside electroencephalography for brain waves and pulse oximetry for oxygen levels.^[72] This multi-channel approach allows precise identification of snoring episodes and their correlation with apneic events, distinguishing primary snoring from pathological conditions.^[73] Home sleep apnea testing (HSAT) offers a convenient, portable alternative for initial diagnosis of snoring linked to OSA in uncomplicated cases, using devices worn overnight at home to measure key respiratory metrics.^[74] These tests typically include sensors for airflow, oxygen desaturation via pulse oximetry, and snoring intensity through acoustic monitoring, often quantifying sound levels in decibels (dB) to assess severity without full laboratory oversight.^[75] While less comprehensive than PSG, HSAT effectively detects moderate to severe snoring and desaturations, with guidelines recommending it for adults with high pretest probability based on clinical history.^[76] Imaging modalities provide structural insights into anatomical contributors to snoring by visualizing upper airway dimensions and abnormalities. Cephalometry, a lateral X-ray of the head and neck, evaluates craniofacial features such as hyoid position and posterior airway space, aiding in the assessment of skeletal factors predisposing to airway collapse during sleep.^[17] Computed tomography (CT) scans offer detailed cross-sectional views of the upper airway, measuring volumes and identifying soft tissue obstructions like palatal hooking, which correlate with snoring risk.^[77] Acoustic pharyngometry complements these by non-invasively estimating pharyngeal cross-sectional area and volume through sound wave reflection, helping quantify collapsible segments without radiation exposure.^[78] Recent advances in 2024-2025 have introduced wearable technologies and smartphone-based applications for accessible snoring monitoring, leveraging built-in microphones and algorithms to track episodes with high accuracy. For instance, apps like SleepWatch utilize smartphone audio to detect snoring sounds, achieving sensitivity and specificity comparable to traditional methods in simulated environments.^[79] Deep learning models integrated into these tools enable real-time analysis of home-recorded audio, reporting accuracies exceeding 90% for distinguishing snoring from other noises, thus facilitating preliminary severity assessment before formal testing.^[80] Nasal endoscopy plays a key role in differential diagnosis by directly visualizing the upper airway to exclude non-apneic causes of snoring, such as allergic rhinitis or nasal obstructions. This procedure, using a flexible endoscope, identifies mucosal inflammation, polyps, or turbinate hypertrophy indicative of allergies, which may mimic or exacerbate snoring symptoms.^[81] By ruling out these pathologies, endoscopy guides appropriate test selection and prevents misattribution of symptoms to primary snoring.^[17]

Management and Treatment

Conservative Approaches

Conservative approaches to managing snoring focus on lifestyle modifications and behavioral strategies that address underlying contributors such as body position, excess weight, substance use, muscle tone, and nasal congestion, without relying on medical devices or interventions. These methods are recommended as first-line options due to their low risk and potential for significant improvement in many cases. Positional therapy involves encouraging non-supine sleeping positions, such as side sleeping, to prevent the tongue and soft tissues from collapsing into the airway during supine sleep. This can be achieved through the use of specially designed pillows that promote lateral positioning or positional alarms that vibrate to alert the sleeper when rolling onto their back. In habitual snorers, avoiding the supine position can reduce snoring in most cases by maintaining better airway patency.^[37] Weight loss is a key strategy for overweight individuals, as excess adipose tissue around the neck and pharynx can narrow the airway and exacerbate snoring. A reduction of 10-15% of body weight through a balanced diet emphasizing whole foods, portion control, and regular aerobic exercise (such as 150 minutes per week of moderate activity) can decrease snoring intensity and related obstructive sleep apnea severity by up to 50% in moderately obese patients by reducing fat deposits in the tongue and improving overall airway stability.^[82] Avoiding sedatives, including alcohol and muscle relaxants, is essential, as these substances relax the pharyngeal muscles, increasing the likelihood of airway obstruction. Ceasing alcohol intake at least 4 hours before bedtime minimizes its impact on muscle tone and reduces snoring frequency, while discontinuing muscle relaxants or sedatives in consultation with a healthcare provider can similarly alleviate symptoms.^[83] Myofunctional therapy consists of targeted oropharyngeal exercises to strengthen the muscles of the tongue, soft palate, and throat, thereby enhancing muscle tone and reducing tissue vibration during sleep. Examples include tongue strengthening exercises, such as pressing the tongue against the roof of the mouth for 30 seconds multiple times daily, and soft palate elevation maneuvers. Performing these exercises consistently over 3 months can reduce snoring frequency by 36% and snoring power by 59%, leading to improved airway patency.^[84] Nasal hygiene practices help alleviate snoring caused by congestion from allergies or infections by promoting clearer nasal airflow. Regular saline nasal rinses using a neti pot or squeeze bottle with isotonic saline solution clear mucus and irritants from the nasal passages, while humidifiers maintain ambient moisture to prevent dryness and reduce inflammation in the sinuses. These methods provide relief for congestion-related snoring by facilitating nasal breathing over mouth breathing.^[85]^[86] If conservative approaches prove insufficient, further evaluation for device-based or medical options may be warranted.

Medical and Surgical Interventions

Medical and surgical interventions for snoring typically target cases where conservative measures, such as lifestyle modifications, have proven insufficient, focusing on maintaining airway patency through devices, pharmacotherapy, or operative techniques. Positive airway pressure (PAP) therapy, including continuous PAP (CPAP) and bilevel PAP (BiPAP), delivers pressurized air via a mask to stent the upper airway open, with typical pressures ranging from 4 to 20 cmH₂O.^[87] CPAP has demonstrated efficacy in reducing snoring intensity, with one study reporting decreases in snoring frequency by 67% at 40 dBA and 85% at 45 dBA.^[88] Overall, PAP therapies achieve 70-80% success in mitigating snoring among users, particularly those with associated obstructive sleep apnea (OSA), though adherence can vary due to mask discomfort.^[87] BiPAP, which alternates pressure levels between inhalation and exhalation, offers similar benefits for snoring reduction but may improve comfort for some patients.^[89] Oral appliances, such as mandibular advancement devices (MADs), reposition the lower jaw forward by 5-10 mm during sleep to enlarge the pharyngeal airway and reduce tissue vibration causing snoring.^[90] These devices come in custom-fitted versions, fabricated by dentists for precise adjustment, or over-the-counter boil-and-bite options that allow home molding but may offer less optimal fit and efficacy.^[91] Clinical evidence supports MADs in significantly lowering perceived snoring and improving sleep quality, with systematic reviews indicating substantial reductions in snoring episodes and associated daytime symptoms.^[92]^[93] Success rates for snoring alleviation range from 50-70%, though side effects like jaw discomfort can limit long-term use in 20-30% of patients.^[94] Daytime neuromuscular stimulation devices, such as eXciteOSA, apply electrical stimulation to the tongue protrusor muscles during short wakeful sessions to improve muscle tone and endurance, reducing snoring and mild obstructive sleep apnea (OSA). FDA-authorized as of 2021 with updates through 2025, clinical studies show significant reductions in snoring time and intensity after 6 weeks of use.^[95]^[96] Pharmacological interventions primarily involve topical nasal corticosteroids to address inflammation contributing to airway narrowing and snoring. Intranasal fluticasone propionate, for instance, reduces nasal congestion and adenoidal hypertrophy, leading to decreased snoring in both pediatric and adult populations with evidence of improved sleep architecture.^[97]^[98] Studies show moderate efficacy, with snoring indices dropping by up to 50% in responsive cases, particularly when allergic rhinitis or nasal obstruction is a factor.^[98] However, evidence for systemic medications, such as sedatives or muscle relaxants, remains limited and inconclusive for snoring treatment, with risks outweighing benefits in most guidelines.^[99] Surgical options aim to restructure or stiffen upper airway tissues to prevent collapse and vibration. Uvulopalatopharyngoplasty (UPPP) involves excision of excess soft palate, uvula, and pharyngeal tissues to widen the oropharynx, achieving success rates of 40-60% in reducing snoring severity based on long-term follow-up data.^[100]^[101] Radiofrequency ablation (RFA) of the soft palate, a less invasive outpatient procedure, uses controlled thermal energy to shrink and stiffen palatal tissues, resulting in subjective snoring improvement in 70-80% of patients at short-term follow-up with minimal complications like transient pain.^[102]^[103] Both techniques carry risks such as postoperative swelling or velopharyngeal insufficiency, and outcomes are more favorable for primary snorers without severe OSA.^[100] As of 2025, emerging implantable therapies like hypoglossal nerve stimulation (HNS) devices represent a targeted option for severe snoring linked to OSA, where an implanted pulse generator stimulates the hypoglossal nerve to protrude the tongue and maintain airway patency during sleep.^[104] Recent FDA approvals, including systems like Nyxoah's Genio, have shown clinically significant reductions in snoring and apnea events, with success rates exceeding 70% in pivotal trials for moderate-to-severe cases unresponsive to other therapies.^[105]^[104] These battery-powered implants require surgical placement but offer adjustable stimulation via external controls, marking a shift toward neurostimulation for refractory snoring.^[106]

Epidemiology

Prevalence and Demographics

Snoring is a widespread phenomenon, with occasional snoring reported in 40-60% of adults worldwide, while habitual snoring affects approximately 25% of the adult population.^[107] Habitual snoring is more prevalent in men, affecting 35-45% compared to 15-28% in women, based on systematic reviews of population studies.^[108] These differences are consistent across multiple meta-analyses, though prevalence varies by diagnostic criteria and self-reporting methods.^[109] Prevalence of snoring increases with age, rising from about 20% in individuals in their 20s to around 50% by their 50s, after which it plateaus and then declines, particularly in older adults.^[110] This pattern is observed in both sexes, though the decline after age 60 is more pronounced in men.^[111] Demographic risk factors further elevate rates; for instance, obesity is associated with a significantly higher prevalence of snoring, while current smokers face roughly twice the risk compared to non-smokers.^[112] Ethnic variations also exist, with higher rates reported among certain groups such as Hispanics and African Americans, potentially linked to differences in body composition.^[113] In children, snoring affects 10-20% overall, with habitual snoring occurring in 3-12% based on parental reports and polysomnographic studies.^[114] A meta-analysis of pediatric populations estimates habitual snoring at 7.45%, often more common in preschool-aged children.^[115] Urban-rural differences show variations, with some studies indicating slightly higher rates in urban settings due to environmental factors, though overall prevalence remains comparable across locales.^[116] Snoring in children frequently overlaps with obstructive sleep apnea (OSA), serving as a primary symptom present in the majority (over 50%) of cases.^[115] Data from recent meta-analyses, such as those in Sleep Medicine Reviews, underscore these patterns across diverse global cohorts.^[117]

Trends and Variations

The prevalence of snoring and associated sleep-disordered breathing (SDB) has risen significantly since the 1990s, largely driven by the obesity epidemic. In the United States, data from national health surveys indicate relative increases of 14% to 55% in SDB prevalence among adults between 1988–1994 and 2007–2010, with milder cases (apnea-hypopnea index ≥5) showing a 14% rise and moderate-to-severe cases (≥15) up to 55%, particularly among men aged 30–49 (53% increase) and women in the same group (42% increase).^[118] This upward trend correlates directly with rising obesity rates, as weight gain exacerbates upper airway obstruction, a primary mechanism of snoring.^[118] Geographically, snoring prevalence exhibits notable variations, with higher rates in Western countries compared to many Asian populations, influenced by dietary patterns and obesity levels. In Western cohorts, habitual snoring affects 35–45% of men and 15–28% of women, reflecting higher caloric intake from processed foods and sedentary lifestyles.^[119] In contrast, rates in Asian studies are often lower, such as 6.8% overall in a multi-ethnic Singapore population, though variability exists (e.g., up to 59% in Taiwan), attributed to traditional diets lower in fats and higher in fiber that mitigate obesity-related risks.^[120] The COVID-19 pandemic amplified these disparities, with global lockdowns leading to widespread weight gain—averaging 0.5–2 kg in adults—and a subsequent surge in snoring and SDB reports, as excess adiposity worsened airway collapse.^[121] Socioeconomic factors also contribute to variations, with snoring more prevalent in lower-income groups due to chronic stress and suboptimal sleep environments. Surveys show that individuals with lower education levels (e.g., 9th–11th grade) and food insecurity report higher rates of habitual snoring and snorting/gasping/choking during sleep, independent of other demographics, as economic pressures disrupt sleep hygiene and increase cortisol-related inflammation.^[122] These patterns persist across racial/ethnic lines, exacerbating health inequities in underserved communities.^[122] Looking ahead, projections forecast continued growth in snoring prevalence, tied to aging populations and persistent obesity trends. In the US, obstructive sleep apnea—a condition often marked by snoring—is expected to affect nearly 77 million adults by 2050, a 35% relative increase from 2020 levels, with aging contributing to anatomical changes like reduced pharyngeal muscle tone.^[123] Globally, similar dynamics suggest a 10–35% rise by mid-century, underscoring the need for preventive strategies in expanding elderly demographics.^[123] Occupational differences further highlight variations, as shift workers face elevated snoring risks from circadian disruption and irregular sleep. Prevalence of SDB in this group ranges from 7% to 34%, approximately 1.5 times higher than day workers, due to fragmented rest that impairs airway muscle recovery and heightens fatigue-related breathing instability.^[124]

Society and Culture

Historical Context

Snoring has been recognized since ancient times, with early medical texts documenting symptoms suggestive of sleep-related breathing issues, including potential snoring, and its dangers. Around 400 BCE, Hippocrates described individuals in sleep who groaned, cried out, or appeared to suffocate, interpreting these episodes as indicators of underlying health issues or poor prognosis.^[125] In ancient Egypt, snoring was treated using herbal remedies such as thyme to alleviate respiratory issues and promote clearer breathing.^[126] These early observations often framed snoring within broader concerns about respiratory distress during sleep, though it was not yet systematically classified as a distinct medical phenomenon. The 19th century saw advancements in understanding the anatomy of the upper airway, contributing to views of snoring as resulting from vibrations in the throat structures. Initial surgical interventions targeted severe cases, including tracheotomies to bypass obstructions in the upper airway, a procedure with roots in ancient practices but refined for respiratory conditions during this era.^[127] Pre-modern treatments also included folk remedies like herbal snuffs derived from plants such as thyme to reduce inflammation and congestion, alongside rudimentary positional devices to encourage side-sleeping and minimize airway collapse.^[126] The 20th century marked significant milestones in linking snoring to serious pathology. Christian Guilleminault's research in the 1970s and 1980s helped establish the connection between habitual snoring and obstructive sleep apnea (OSA), showing that snoring often indicated repeated airway obstructions leading to fragmented sleep and health risks.^[128] By the late 1990s, the American Academy of Sleep Medicine (AASM) had developed practice parameters for polysomnography (PSG) to evaluate sleep-related breathing disorders, including those associated with snoring, enabling precise diagnosis via overnight monitoring of airflow, oxygen levels, and sleep stages.^[129] This evolution transformed snoring's perception from a mere humorous anecdote or benign habit to a key public health concern by the 2000s, with widespread recognition of its association with cardiovascular and neurocognitive complications through OSA.^[130]

Modern Perceptions and Stigma

In contemporary media, snoring is frequently portrayed as a comedic trope, often used to generate humor through exaggerated depictions of disrupted sleep or embarrassing situations. For instance, in films like The Hangover (2009), characters are shown snoring loudly during chaotic wake-up scenes, reinforcing the idea of snoring as a relatable yet comical nuisance that highlights vulnerability or lack of self-awareness.^[131] Such portrayals normalize snoring as a common human quirk but simultaneously stigmatize it by associating it with sloppiness or undesirability, contributing to cultural embarrassment around the issue.^[132] Snoring significantly impacts relationship dynamics, with surveys indicating that it contributes to sleep disruptions and relational tension for many couples. According to the American Academy of Sleep Medicine, more than one-third of Americans have engaged in a "sleep divorce"—sleeping in separate rooms—often due to a partner's loud snoring, which can lead to resentment and reduced intimacy.^[133] In some studies, snoring or related sleep disorders have been cited as a contributing factor in up to 47% of divorces among surveyed individuals in the UK, underscoring its role as a "silent relationship killer" that exacerbates conflicts when untreated.^[134] Awareness campaigns, such as the American Academy of Sleep Medicine's "More than a Snore" initiative launched in 2023, aim to address this by educating the public on snoring as a potential symptom of obstructive sleep apnea, encouraging couples to seek medical evaluation rather than letting it strain partnerships.^[135] As of 2025, the campaign continues to promote recognition of sleep apnea risks through public resources and partnerships.^[135] Gender differences play a key role in modern perceptions of snoring, with societal stigma disproportionately affecting women. Research shows that women snore with similar prevalence and intensity as men but underreport their snoring prevalence by 16 percentage points (88% objectively measured versus 72% self-reported), often due to embarrassment and the cultural notion that snoring is unladylike or vain to admit.^[136]^[137] Men, in contrast, face less social stigma—snoring is sometimes even viewed as a masculine trait—but are more frequently urged by partners or healthcare providers to seek treatment, leading to higher diagnosis rates among them.^[138] This disparity perpetuates underdiagnosis in women, as the vanity-driven reluctance to discuss symptoms delays intervention. In the 2020s, advancements in public health tools like smartphone apps and wearable devices have begun to mitigate snoring stigma by enabling private self-monitoring. Apps such as SnoreLab, used by millions, record and analyze snoring patterns discreetly via microphone or integrated sensors, allowing users to track severity and experiment with remedies without involving others, which reduces the embarrassment of partner complaints.^[139] Wearables, including smartwatches and rings like the SomnoRing, provide objective sleep data including oxygen levels and movements that can indicate snoring-related issues, empowering individuals to address them proactively and fostering a shift toward viewing snoring as a manageable health metric rather than a personal failing.^[140] These technologies promote greater awareness and self-efficacy, particularly among those hesitant to seek professional help due to cultural taboos.

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Risk factors associated with habitual snoring and sleep-disordered ...
The adjusted odds ratio (95% C.I.) of association with snoring were: male ... Obesity (BMI⩾30), 25 (3.1), 59 (7.6), 59 (8.2), 143 (6.2). Hypertension, 79 ...
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Prevalence of obstructive sleep apnea (OSA) among preschool ...
... COVID-19 pandemic is associated with significant increase in weight gain among young children [22]. However, the relationship between obesity and SDB in ...
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Sleep Symptoms, Race/Ethnicity, and Socioeconomic Position
In particular, lower socioeconomic status was generally associated with increased likelihood of sleep latency > 30 min and, to a lesser degree, snorting/gasping ...
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Obstructive Sleep Apnea Expected to Affect Nearly 77 million U.S. ...
Aug 27, 2025 · The study estimates that by 2050, OSA will affect nearly 77 million U.S. adults, representing a relative1 increase of nearly 35% from 2020 and ...
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Diagnosis and management of sleep disorders in shift workers, with ...
In shift workers, prevalence rates of OSA vary between 7 % and 34 % [[6], [7], [8]], insomnia rates between 6 % and 15 % [2,6,9], and leg movements (including ...
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History of Sleep Medicine and Physiology - Neupsy Key
Jul 11, 2016 · 400 bce Hippocrates (Fig. 2-1). wrote, “I have known many persons in sleep groaning and crying out, some in a state of suffocation, ...
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A brief history of snoring: from ghastly to gimmicky - Chicago ENT
Sep 17, 2019 · There is evidence of snoring going back 3500 years to the ancient Egyptians, who were known to have treated snoring with thyme.
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Otolaryngology | Ear, Nose & Throat Surgery - Britannica
With the development of laryngology in the late 19th century, the connection between the ear and throat became known, and otologists became associated with ...<|separator|>
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Original Article, Issue 6.1 - AADSM
Although Galen reported that the procedure was first performed by Asclepiades of Bithynia (a Roman province in Asia Minor) around 100 BC, the procedure was ...
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Christian Guilleminault, researcher who coined 'obstructive sleep ...
Jul 22, 2019 · Guilleminault also recorded the condition in children, finding a correlation between sleep apnea and learning and attention disorders. He ...
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[PDF] Practice Parameters for the Indications for Polysomnography and ...
Since that time awareness of sleep disorders has grown. For example, in 1990 there were. 110,000 office visits for sleep apnea. By 1998, this had risen to. 1.3 ...
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[PDF] History of Dental Sleep Medicine - AADSM
Snoring is no longer thought to be benign, and obstructive sleep apnea is viewed in epidemic proportion worldwide. Fortunately, continuous posi- tive airway ...
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Scene Description Spotlight: “The Hangover” (2009) | by Scott Myers
Aug 9, 2013 · ... movie hard on GITS, starting with this post on … ... SNORING on the couch, wearing only his jeans and one shoe, the ...<|separator|>
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Loud Sleeper Gag - TV Tropes
This is a very common gag in fiction. Loud snoring is no laughing matter to the person who can't sleep because of the symphony that's playing right beside them.
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Over a third of Americans opt for a “sleep divorce”
Jul 29, 2024 · According to a recent AASM survey, more than one-third of people say they sleep in another room to accommodate a bed partner.
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Snoring is a 'silent relationship killer' - here's why short-term fixes ...
Oct 21, 2025 · In a survey of recently divorced Brits, 47 per cent of them said that snoring or sleep disorders contributed to the breakdown of their marriage.Missing: statistics | Show results with:statistics<|separator|>
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New campaign to raise awareness that sleep apnea is 'more than a ...
Feb 9, 2023 · This campaign will inform the public that untreated sleep apnea is “More than a Snore,” affecting a person's long-term health and quality of life.
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Women underreport prevalence and intensity of their own snoring
Women underreport prevalence and intensity of their own snoring. Social stigma may deter women from admitting that they snore. Date: April 24, ...Missing: gender vanity
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Women underreport prevalence and intensity of their own snoring
May 21, 2019 · A new study in the Journal of Clinical Sleep Medicine suggests that women tend to underreport snoring and underestimate its loudness.Missing: vanity | Show results with:vanity
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The social stigma of snoring among women – why it's bad for her ...
Jun 21, 2022 · Women snore too, just as loudly as men and with the same health risks. So why is snoring among women so often overplayed and overlooked?Missing: underreport vanity
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SnoreLab: Record Your Snoring
SnoreLab is the No.1 iOS and Android app for recording and tracking snoring and discovering solutions. Discover why millions trust SnoreLab to monitor ...About SnoreLab · Reviews · Contact us · Privacy NoticeMissing: wearables stigma
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Acceptability and Usability of a Wearable Device for Sleep Health ...
This study aims to evaluate the usability and acceptability of a wearable sleep monitoring device-SomnoRing-and its accompanying mobile app among patients ...Missing: embarrassment | Show results with:embarrassment