Staging of heavy snorers' disease. A proposal

E. Lugaresi, S. Mondini, M. Zucconi, P. Montagna, F. Cirignotta

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The passage from trivial snoring to heavy snorer's disease or obstructive apnea syndrome is a subtle and gradual process. The suspect clinical signs of this process are primarily the onset of intermittent snoring and daytime sleepiness. We propose a diagnostic assessment based on objective monitoring of respiratory behaviour (noise of snoring, endothoracic pressure, SaO2) during sleep and the tendency to daytime drowsiness (by means of the so-called multiple sleep latency test, MSLT). These parameters establish not only the presence of a disease state, but also give fairly accurate indication of the different stages of the disease. The nocturnal respiratory pattern emerging from this objective assessment can be divided into four stages : stage 0 (or preclinical), with sporadic obstructive apneas ; stage I (or initial), with obstructive apneas persisting during light (st. 1-2) and REM sleep ; stage II (or overt), with obstructive apneas persisting for the whole length of sleep ; stage III (or complicated), with alveloar hypoventilation persisting during wakefulness. In stage 0, episodes of O2 desaturation are sporadically present and linked to obstructive apneas or hypopneas. In stages I-II, phasic desaturations are correlated with the apneas. In stage II and above all stage III, phasic desaturation is associated with persistent falls of SaO2. The tendency to daytime sleepiness measured by MSLT can also be divided into four groups : group 0, with normal daytime alertness ; group I, with borderline sleepiness; group II, with excessive sleepiness; group III, with severe sleepiness. Monitoring of nocturnal breathing and daytime sleepiness gives a relatively simple but sufficiently accurate indication of the severity of respiratory impairment and daytime drowsiness. The diagnostic approach allows patient assessment based on objective findings both on the natural course of the disease and effectiveness of treatment. An objective classification of heavy snorer's disease would also allow an overall comparison of data from different research centers.

Original languageEnglish
Pages (from-to)590-594
Number of pages5
JournalClinical Respiratory Physiology
Issue number6
Publication statusPublished - 1983

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine


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