The rattling or whistling noises of regular snorers are famously hard on those who share their beds. Middle-aged men and people who are overweight come frequently to mind as perpetrators because they are the most common sufferers of sleep apnea, often caused by a temporarily collapsing airway that makes the person snore heavily. But recent studies in children and pregnant women have revealed that even mild snoring can negatively affect health, behavior and quality of life.
“We know that disordered breathing and disturbed sleep can have myriad physiological effects,” says Susan Redline, a pulmonologist and epidemiologist at Brigham and Women’s Hospital in Boston. “More people have sleep-disordered breathing than have overt apneas. We shouldn’t forget about them.”
Almost everyone snores occasionally. Allergies and respiratory infections can trigger it. When the upper airway at the back of the throat narrows, it causes the tissues there to vibrate, creating the familiar rumble. Physicians worry if people habitually snore three or more nights a week, especially if they have other red flags such as unexplained high blood pressure.
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The category of sleep-disordered breathing includes apnea’s total pause in breathing, shallow breaths called hypopnea, snoring without apneas, and a subtler problem called flow limitation in which the shape of the airway is narrowed but the sleeper makes no noise. The standard measure of severity is the apnea-hypopnea index (AHI), which counts pauses in breathing per hour and associated drops in oxygen levels. The normal level in adults is fewer than five pauses; more than 30 is severe. In children, 10 pauses could be considered moderately severe.
It’s wise to pay attention not just to snoring but to other aspects of sleep such as duration and variability.
But in kids, it turns out the AHI isn’t always the best indicator of potential negative effects. A 2023 clinical trial published in the Journal of the American Medical Association followed 458 children aged three to 12 years with mild sleep-disordered breathing—an AHI of zero to three. Half got early treatment with tonsil surgery, long the most common approach for children who snore because tonsils can grow faster than young airways and cause obstructions. The other half were followed with “watchful waiting.” After 12 months no cognitive differences emerged between the two groups, but those who had surgery saw improvements in problem behaviors such as inattention and in socializing and emotional regulation. Their parents also reported less sleepiness, improved quality of life, and other benefits. And blood pressure, though not in the hypertensive range for anyone in the study, dropped in those who had surgery and went up in those who did not. (Adults who snore are at greater risk for hypertension.)
“The beauty of the trial is that it recruited children who wouldn’t necessarily be treated” because of their mild conditions, says pediatric pulmonologist Ignacio Tapia of the University of Miami Miller School of Medicine. Yet such children “would benefit from early treatment. It opens up a whole new avenue.”
In two recent papers using data from nearly 12,000 children enrolled in the ongoing Adolescent Brain Cognitive Development study, pediatric otorhinolaryngologist Amal Isaiah of the University of Maryland School of Medicine and his colleagues also found that habitual snoring (reported in about 700 of the children) was associated with behavioral issues such as an inability to follow rules or form friendships.
Isaiah found no cognitive problems among kids who snored, but his team did identify cell losses in the prefrontal cortex. That’s a part of the brain that is involved in behavioral control. “The prefrontal cortex is susceptible to hypoxia,” Isaiah says. “This area is undergoing protracted development throughout childhood. If you additionally expose it to stresses such as snoring, the brain’s compensation may not be sufficient in some children.”
In terms of pregnancy, in a 2022 study, nearly 2,000 women underwent a sleep study while they were pregnant. More than half were assessed two and seven years later. For participants with an AHI score above five, risk increased more than threefold for hypertension and twofold for a cluster of problems called metabolic syndrome. And in a 2024 study, pregnant women with flow limitation were at increased risk of preeclampsia and other complications.
Redline suspects that sleep-disordered breathing, even without apnea, increases the body’s workload and overstimulates the part of the nervous system that helps to control organs such as the heart and lungs.
Because of this issue, sleep psychologist Ariel Williamson of the University of Oregon points out that it’s wise to pay attention not just to snoring but to other aspects of sleep such as duration and variability, which have also been linked to emotional and behavioral functioning in children and to cognitive problems in adults. “Snoring could be the cause of the concern you’re seeing,” she says, but if not, “then there may be other sleep issues going on.”
Fortunately, there are treatments for children and adults. In children, as the clinical trials indicate, removing tonsils can benefit even those with mild snoring. For adults and a few children, continuous positive airway pressure (CPAP) masks, which keep airways open, are still the first option for apnea and can help habitual snorers as well. Some people find wearing CPAP masks intolerable, though. For them, a surgical solution called hypoglossal nerve stimulation, using an implanted device, can also work. Oral appliances such as the mandibular advancement device, a custom-fit mouth guard that holds the airway open without surgery or CPAP, is another option. Still other patients have success with “positional therapy” devices that help to keep them on their side during sleep, where they are less likely to snore.
At every age, losing weight and increasing physical activity improve sleep quality. And adhering to an anti-inflammatory diet—such as one that includes more omega-3 fatty acids—can help reduce snoring.
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