Sonorous breathing: a theoretical and treatment outcome study

Abstract

Numerous theories of snoring have been offered, however only a few, such as Tsukamoto, Nagami and Tsunematsu (1938), are sufficiently precise to allow derivation of clinically useful treatments. The purpose of this study was to propose a behavioral theory of snoring for comparison to the Tsukamoto et al. theory. The two theories were evaluated by deriving a treatment technique for reducing snoring from each theory. Prediction of treatment efficacy differed for the two theories.

The behavioral theory proposed that snoring is a learned adaptation to a blood gas tension imbalance caused initially by an upper airway restriction. The adaptation response of reduced muscle tonus and mouth breathing causes snoring. Altering the stimulus configuration which elicits the respiration response was predicted to be effective in reducing snoring. An electrically-induced muscle contraction in the throat was utilized to replace the low muscle tonus with a high muscle tension response thereby preventing velar tissue vibration.

Tsukamoto et al. theorized snoring is caused by insufficient skeletal muscle relaxation at sleep onset to trigger a change in the vascular system. The nasal vascular bed remains dilated thus restricting air flow to the lungs. Snoring occurs as mouth breathing is utilized to obtain sufficient air flow. Relaxation training was predicted to reduce snoring by inducing constriction of the nasal vascular bed, thus increasing air flow through the nasal passages.

Thirtytwo subjects were assigned to one of four groups: Relaxation (RX), Snore Collar (SC), Placebo Control (PC) and No Treatment (NT). The SC subjects wore a collar that caused an electrically-induced muscle contraction at the onset of a snore. The increased muscle tension gradually replaced the low muscle tonus of the respiration response. The RX subjects received relaxation training predicted by Tsukamoto et al. to reduce snoring. The PC and NT subjects comprised the control conditions.

The SC subjects exhibited a significant, stable reduction on multiple duration snoring measures. The RX subjects exhibited a reduction on one snoring measure. The results of the study supported a behavioral interpretation and treatment of snoring. Personality concomitants and roommate perception of snoring were also briefly examined.