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Risk Factors for Snoring

by Marianne J Davey MSc

Most doctors and epidemiologists agree that an unhealthy lifestyle is a major cause of modern disease. Indeed, we all know the devastating effects that excessive consumption of alcohol, overeating and faulty nutrition, lack of exercise, smoking and the misuse of drugs can have on our health and well-being.

Day To Day Habits

We tend to associate the term 'lifestyle' with people's day to day habits and behaviour patterns. A healthy lifestyle is exemplified by a life that reflects a pattern of ongoing healthy behaviours. These health related behaviours are subject to environmental and social influences. Personal choice and responsibility are important aspects of leading a healthy lifestyle but they occur within a physical and social environment with both facilitating and inhibiting influences.

If there is the case for a healthy lifestyle an 'unhealthy' lifestyle would be construed as a form of self-destruction in terms of habits and behaviours. We are generally responsible for creating our own natural and social living conditions, therefore, we should also be capable of changing them or at least ameliorating their dangerous effects.

Life's Pleasures

Unfortunately, the excesses of life's pleasures are the main causes of snoring and sleep apnoea. Snoring and sleep apnoea as a rule, have not one single, but several causes; it is often multifactorial in its etiology. This means that there may be more than one area of lifestyle that is responsible for the snoring or sleep apnoea. In fact, lifestyle behaviours such as diet and smoking may affect physical activity, fitness and health, and these three factors in turn, may influence lifestyle behaviours. It is not difficult to get into a downward spiral of ill health.

A healthy way of life involves a number of personal choices that may enhance the quality and possibly the quantity of life.

Nicotine, Tar And Carbon Monoxide

A major area of concern for health professionals is the misuse or abuse of substances that may adversely influence health status - alcohol, tobacco and drugs. The evidence of substance abuse from a global prospective indicates that their use is widespread and is associated with public health and social problems of great magnitude. Substance abuse may predispose an individual to an array of health problems. The inhalation of smoke from cigarettes introduces a number of compounds into the body, most notably nicotine, tar and carbon monoxide, and may substantially increase health risks. The United States Public Health Service has identified smoking as the single most important preventable source of morbidity and mortality, as the number of health risks associated with cigarette smoke is so extensive. Cigarette smoking frequently results in a chronic productive cough and smokers often have evidence of upper airway inflammation. Alcohol attenuates the activity of the pharyngeal dilator muscles and sedative-hynotic medications have a similar effect.

Regardless of gender, snoring prevalence has been shown in a recent study to be three fold greater in obese individuals than in non- obese subjects. In the same study the prevalence of snoring in smokers was four times higher than in non-smokers, with snoring increasing in intensity with the increase of cigarette smoking. The same was found for those individuals who used alcohol or sedative medications. Several research studies suggest that weight loss is an effective treatment for obese individuals and in most cases it has been shown that even if ideal body weight is not obtained, snoring and sleep apnoea can be significantly reduced following weight loss. The more the weight loss, the more the snoring and sleep apnoea can be reduced. These observations suggest that cigarette smoking, obesity, use of alcohol and sedativehynotics are factors which can cause the collapse of the upper airway during sleep and predispose individuals to snore and to have sleep apnoea.

Consideration of the available evidence leads to the following general conclusions about the relationship of lifestyle behaviours and physical activity. Studies generally indicate that there is a negative association with level of leisure time, physical activity and smoking. That is, for example, the more an individual smokes the less likely he/she is to exercise. Males are more likely to smoke than females. They are also more likely to snore.

There is a tendency for more active individuals to exhibit better nutritional practices, and better nutrition practices are related to increased exercise intensity.

Health Status Of The Nation

There is little doubt that we do not exercise as much as we used to and this has led to serious consequences for some people. In 1996 The Health Education Authority submitted a report showing that most sedentary individuals (those taking less than 30 minutes of physical activity per week) have almost double the risk, compared to more active people, of dying from coronary artery disease. Killoran et al (1996) in their paper discussing the health status of the nation, state that physical activity provides a protective effect against some cancers, stroke, non- insulin dependent diabetes mellitus and many other health problems. 'Clearly there is a need to encourage more people to be more active more often', they said.

The Allied Dunbar National Fitness Survey came to the same conclusions, when they reported that there is a major public health risk for nearly a third of all adults who are living inactive lives. Their research observed that the prevalence of sedentary behaviour increases as age advances. For example, 15% of men and 25% of women aged 16-24, 32% of individuals aged 45-64 and 55% of individuals aged 65 and over were unable to report participation in any bout of moderate physical activity.

In view of these reports perhaps it is time for a 'lifestyle' change - or at least a modification of present lifestyle? Why and how do people choose a certain lifestyle? Why do individuals eat, drink and smoke excessively? Why don't they get enough exercise or misuse drugs?

Most of us are well aware that in our modern society, health risks are part of everyday life. In choosing a 'dangerous' lifestyle one assumes the individual is aware that the benefits of that behaviour outweigh the risks. But do they? Perhaps the situation is much more complex than we think. Only empirically based theories can give us further insight into this complex social problem. Clearly, all the evidence to date suggests that the vast array of benefits one would gain from a healthy lifestyle far outweigh the limited amount of benefit one would gain from an unhealthy lifestyle.

Undoubtedly, the consensus is that a healthy lifestyle is a good lifestyle and we should all endeavour to improve our way of life by eliminating those areas that are known to cause ill health.

The Royal College of Physicians in their report of 1991, Medical Aspects of Exercise conclude: 'There is now good evidence to shows that there are many physical and psychological benefits to the population when regular exercise is undertaken, which should be recognised by all those involved in health care. It is of particular value in the prevention of coronary disease and has a useful role in weight control, the management of late onset diabetes and many musculo-skeletal disorders. It is important where possible, to continue such activity beyond youth and middle age into old age'.

References:
Bloom J et al (1988) Risk factors in a general population for snoring
Chest 93(4) 678-683

Bouchard C et al (1994) Physical activity, fitness and health:
International proceedings and concensus statement
Human Kinetics Inc: Leeds England

Bandura B (1984) Lifestyle & health
Soc Sci Med 19(4) 341-347

Killoran A et al (1996) Are we moving on?
Health Education Authority: Oxford England

Medical Aspects of Exercise: Benefits & Risks
Royal College of Physicians of London May 1991