Should Patients with Primary Snoring Be Screened for Carotid Artery Stenosis?

TRIO Best Practice articles are brief, structured reviews designed to provide the busy clinician with a handy outline and reference for day-to-day clinical decision making. The ENTtoday summaries below include the Background and Best Practice sections of the original article. To view the complete Laryngoscope articles free of charge, visit Laryngoscope.

Background

Sleep-disordered breathing has long been associated with adverse health outcomes. Particularly in the context of obstructive sleep apnea (OSA), there is a strong association between severity of sleep disordered breathing and cardiovascular events and mortality as well as cerebrovascular disease. Patients with severe OSA, in whom loud snoring is common, have a well-established increased risk of carotid artery stenosis that in turn is considered a risk factor for stroke. It can be argued that the association between OSA and cerebrovascular disease is to be understood in the context of comorbidities frequently associated with OSA, such as hypertension, type 2 diabetes, and metabolic syndrome. Recent studies, however, have suggested a possible unique link between loud snoring and carotid artery stenosis, even in patients without OSA or with only very mild disease. This raises the question of whether patients with primary snoring should in fact undergo screening for carotid artery intimal thickening and stenosis as a potential means of stroke prevention.

Best Practice

Based on the evidence presented herein, the literature would suggest that primary snorers have a higher incidence of carotid artery stenosis and intimal thickening even in the absence of OSA. This finding carries clinical significance considering the robust body of data from the OSA literature showing that effectively managing OSA and snoring can at least partially reverse intimal thickness changes and the carotid atherosclerotic process. The utility in screening heavy snorers for carotid atherosclerosis and IMT might thus truly lie in initiating treatment early and preventing or at least slowing the progression of carotid atherosclerosis. In general, it would seem reasonable based on the available evidence to propose that loud snorers, and in particular female loud snorers, be offered a carotid ultrasound during the management process of their snoring. This recommendation is independent of the presence or absence of OSA, which the current study did not purport to address (Laryngoscope. 2017;127:2687–2688).