Snoring noise pollution—the need for objective quantification of annoyance, regulatory guidelines and mandatory therapy for snoring

Abstract

Habitual snoring without episodes of apnea or hypoventilation and without respiratory related arousals is considered to be annoying and without any need for treatment. However, studies seem to suggest an enormous psychosocial impact of annoyance for the bed partner. Apart from subjective questionnaires there still exists no generally accepted mode of measurement that can describe snoring objectively. We therefore adapted methods developed for environmental medicine and established a new snore score using psycho-acoustic parameters. For quantification of snoring noise we conducted nocturnal measurements in 19 habitual snorers. Free-field snore sounds were acquired with two low-cost non-contact microphones and transferred to a PC (sampling frequency 11 kHz). The data were recorded, analysed and stored automatically using a MATLAB script. Following the analysis of sound characteristics and levels, the score was computed from relevant parameters containing the rating level (L(R)), maximum level, two percentile levels for frequent maxima (L(5)S; L(1)) and snoring time. The determined values substantially exceeded the prescribed limits defined by WHO noise guidelines, and mainly affected the equivalent continuous sound exposure level, rating level and the immission standard values of brief noise peaks, whose maximum was exceeded by up to 32 dB(A). The Berlin snore score illustrated the objective acoustic annoyance on a scale from 0 to 100. It allows inter-individual comparison and objectifies the need for therapy. The clinical applicability of evaluating the reduction of snoring after surgical therapy is discussed exemplarily. The presented measuring method was found to be suitable for quantifying snoring noise and can be easily integrated into existing polysomnographic applications. In the case of habitual snoring with objective evidence of psychosocially disturbing acoustic annoyance, health fund providers should assume the costs of mandatory medical therapy.

Acoustic analysis of overnight consecutive snoring sounds by sound pressure levels

“…A L10 value of 45 dB(A) was exceeded by 49.5% of the cases. This is the same with Caffier et al's [14] study, in which the LAeq maximum was 47dB(A), which greatly exceeded the recommended emission levels from the WHO noise guidelines. Loud snoring sound could influence the quality of sleep for both snorer and bed partner.…”

The annoyance of snoring and psychoacoustic parameters: a step towards an objective measurement

“…They have to be diVerentiated from the regular respiratory sounds, which is not diYcult for the human brain [6]. But there is an urgent need to Wnd a generally accepted deWnition of snoring sounds by physical measured values, which has not yet been fulWlled [16]. The reason for this is particularly the lack of standardized measurement methods: contact microphones are used as well as free hanging microphones, but at diVerent distances from the patients.…”

“…CaYer et al [16] developed the "Berlin snore score" for this purpose. This is calculated, with diVerent weighting, from the sound pressure levels with correction factors or their percentile values and the snoring time to give a score of between 0 and 100.…”

Acquisition and analysis of snore signals for diagnosis of obstructive sleep apnea

“…Based on the dataset of 13 snore sound samples and sample size of 25 listeners, the diagnostic accuracy was quantified using ROC curves [155][156][157] and notched box plots [139,140,181,182] Moreover, the typical threshold separating these two diagnostic classes of snore sounds falls on the rating of 4 (neutral response), except for the metric of annoyance whose threshold is 5, emphasizing that snoring is often considered as a nuisance. A study on 37 consecutive snoring men has found that 55% of their bed partners are irritated by snoring, and 40% of them chose to sleep in a separate room more than once a week in order to get a more restful and recuperative sleep [246], negatively affecting their partners' health and well-being [105,247,248]. Other studies have further reported the devastating consequences of snore-induced noise pollution on couple's relationship, for example, marital strife, divorces, and attempted murder [249][250][251].…”

“…In spite of the UA inherent intricacy, it can be regarded as a concatenation of cylindrical sections whose lengths are shorter than 1/8th the acoustic wavelength of interest [158,159,266]. With the maximum frequency of interest for snore signals as 5000 Hz [99,105] and the speed of sound for moist air at 37ºC as 35400 cm/s, the account for energy loss and mass inertia of air. The UA acoustic transfer function can be ultimately described by the product of all section transfer matrices.…”