Editing Snoring (section)

==Classification==
In the [[International Classification of Sleep Disorders]] third edition (ICSD-3), snoring is listed under "Isolated symptoms and normal variants" in the section "[[Sleep_and_breathing#Sleep-disordered_breathing_(abnormal_sleep_and_breathing_or_sleep-related_breathing_disorders)|Sleep-related breathing disorders]]". The manual defines snoring as "a respiratory sound generated in the upper airway during sleep that typically occurs during inspiration but may also occur in expiration."<ref name="ICSD-3" />

'''Primary snoring''' (also termed '''simple snoring''', '''non-apneic snoring''', or '''isolated snoring''') is snoring without any other associated medical condition.<ref name="DeMeyer2019">{{cite journal |last1=De Meyer |first1=MMD |last2=Jacquet |first2=W |last3=Vanderveken |first3=OM |last4=Marks |first4=LAM |title=Systematic review of the different aspects of primary snoring. |journal=Sleep Medicine Reviews |date=June 2019 |volume=45 |pages=88–94 |doi=10.1016/j.smrv.2019.03.001 |pmid=30978609|url=https://repository.uantwerpen.be/docman/irua/57f58d/160283_2019_09_07.pdf }}</ref><ref name="ICSD-3">{{cite book |editor1-last=Sateia |editor1-first=M |title=International Classification of Sleep Disorders |date=2014 |publisher=American Academy of Sleep Medicine |isbn=978-0-9915434-1-0 |pages=139–140 |edition=3rd |language=en}}</ref> Primary snoring is not associated with episodes of [[sleep apnea]] (cessation of breathing), [[hypopnea]], [[respiratory-effort related arousal]]s, or [[hypoventilation]].<ref name="ICSD-3" /> Traditionally, primary snoring is considered as benign<ref name="Biggs2014" /> and having no significant health effects for the individual.<ref name="DeMeyer2019" /><ref name="ICSD-3" /> However, the idea that primary snoring without sleep apnea has no negative health effects is being increasingly challenged,<ref name="Yaremchuk2020" /><ref name="Chawla2015" /><ref name="Huang2023" /><ref name="Ramar2015">{{cite journal |last1=Ramar |first1=K |last2=Dort |first2=LC |last3=Katz |first3=SG |last4=Lettieri |first4=CJ |last5=Harrod |first5=CG |last6=Thomas |first6=SM |last7=Chervin |first7=RD |title=Clinical Practice Guideline for the Treatment of Obstructive Sleep Apnea and Snoring with Oral Appliance Therapy: An Update for 2015. |journal=Journal of Clinical Sleep Medicine |date=15 July 2015 |volume=11 |issue=7 |pages=773–827 |doi=10.5664/jcsm.4858 |pmid=26094920 |pmc=4481062}}</ref> especially primary snoring in children.<ref name="Biggs2014">{{cite journal |last1=Biggs |first1=SN |last2=Nixon |first2=GM |last3=Horne |first3=RS |title=The conundrum of primary snoring in children: what are we missing in regards to cognitive and behavioural morbidity? |journal=Sleep Medicine Reviews |date=December 2014 |volume=18 |issue=6 |pages=463–75 |doi=10.1016/j.smrv.2014.06.009 |pmid=25060969}}</ref> For example, there is evidence that primary snoring causes [[excessive daytime sleepiness]],<ref name="Huang2023" /> and it may be linked with several other medical problems, some of which are serious. Even so, it is generally accepted that primary snoring cannot be diagnosed in the presence of sleep apnea.<ref name="ICSD-3" /> 

Snoring is one of the main symptoms of obstructive sleep apnea, in which case it is '''apneic snoring'''.<ref name="ICSD-3" /> In obstructive sleep apnea, snoring occurs in combination with other features such as breath holding (breathing cessation), gasping, or choking.<ref name="ICSD-3" /> There are also other features like daytime sleepiness, nonrestorative sleep, fatigue, or [[insomnia]].<ref name="ICSD-3" />

Snoring has also been classified according to frequency as '''occasional snoring''' (occurring on three nights or less per week) and '''habitual snoring''' (occurring on most nights; synonymous with primary snoring).<ref name="Chang2023">{{cite journal |last1=Chang |first1=JL |last2=Goldberg |first2=AN |last3=Alt |first3=JA |last4=Mohammed |first4=A |last5=Ashbrook |first5=L |last6=Auckley |first6=D |last7=Ayappa |first7=I |last8=Bakhtiar |first8=H |last9=Barrera |first9=JE |last10=Bartley |first10=BL |last11=Billings |first11=ME |last12=Boon |first12=MS |last13=Bosschieter |first13=P |last14=Braverman |first14=I |last15=Brodie |first15=K |last16=Cabrera-Muffly |first16=C |last17=Caesar |first17=R |last18=Cahali |first18=MB |last19=Cai |first19=Y |last20=Cao |first20=M |last21=Capasso |first21=R |last22=Caples |first22=SM |last23=Chahine |first23=LM |last24=Chang |first24=CP |last25=Chang |first25=KW |last26=Chaudhary |first26=N |last27=Cheong |first27=CSJ |last28=Chowdhuri |first28=S |last29=Cistulli |first29=PA |last30=Claman |first30=D |last31=Collen |first31=J |last32=Coughlin |first32=KC |last33=Creamer |first33=J |last34=Davis |first34=EM |last35=Dupuy-McCauley |first35=KL |last36=Durr |first36=ML |last37=Dutt |first37=M |last38=Ali |first38=ME |last39=Elkassabany |first39=NM |last40=Epstein |first40=LJ |last41=Fiala |first41=JA |last42=Freedman |first42=N |last43=Gill |first43=K |last44=Gillespie |first44=MB |last45=Golisch |first45=L |last46=Gooneratne |first46=N |last47=Gottlieb |first47=DJ |last48=Green |first48=KK |last49=Gulati |first49=A |last50=Gurubhagavatula |first50=I |last51=Hayward |first51=N |last52=Hoff |first52=PT |last53=Hoffmann |first53=OMG |last54=Holfinger |first54=SJ |last55=Hsia |first55=J |last56=Huntley |first56=C |last57=Huoh |first57=KC |last58=Huyett |first58=P |last59=Inala |first59=S |last60=Ishman |first60=SL |last61=Jella |first61=TK |last62=Jobanputra |first62=AM |last63=Johnson |first63=AP |last64=Junna |first64=MR |last65=Kado |first65=JT |last66=Kaffenberger |first66=TM |last67=Kapur |first67=VK |last68=Kezirian |first68=EJ |last69=Khan |first69=M |last70=Kirsch |first70=DB |last71=Kominsky |first71=A |last72=Kryger |first72=M |last73=Krystal |first73=AD |last74=Kushida |first74=CA |last75=Kuzniar |first75=TJ |last76=Lam |first76=DJ |last77=Lettieri |first77=CJ |last78=Lim |first78=DC |last79=Lin |first79=HC |last80=Liu |first80=SYC |last81=MacKay |first81=SG |last82=Magalang |first82=UJ |last83=Malhotra |first83=A |last84=Mansukhani |first84=MP |last85=Maurer |first85=JT |last86=May |first86=AM |last87=Mitchell |first87=RB |last88=Mokhlesi |first88=B |last89=Mullins |first89=AE |last90=Nada |first90=EM |last91=Naik |first91=S |last92=Nokes |first92=B |last93=Olson |first93=MD |last94=Pack |first94=AI |last95=Pang |first95=EB |last96=Pang |first96=KP |last97=Patil |first97=SP |last98=Van de Perck |first98=E |last99=Piccirillo |first99=JF |display-authors=1 |last100=Pien |first100=GW |last101=Piper |first101=AJ |last102=Plawecki |first102=A |last103=Quigg |first103=M |last104=Ravesloot |first104=MJL |last105=Redline |first105=S |last106=Rotenberg |first106=BW |last107=Ryden |first107=A |last108=Sarmiento |first108=KF |last109=Sbeih |first109=F |last110=Schell |first110=AE |last111=Schmickl |first111=CN |last112=Schotland |first112=HM |last113=Schwab |first113=RJ |last114=Seo |first114=J |last115=Shah |first115=N |last116=Shelgikar |first116=AV |last117=Shochat |first117=I |last118=Soose |first118=RJ |last119=Steele |first119=TO |last120=Stephens |first120=E |last121=Stepnowsky |first121=C |last122=Strohl |first122=KP |last123=Sutherland |first123=K |last124=Suurna |first124=MV |last125=Thaler |first125=E |last126=Thapa |first126=S |last127=Vanderveken |first127=OM |last128=de Vries |first128=N |last129=Weaver |first129=EM |last130=Weir |first130=ID |last131=Wolfe |first131=LF |last132=Woodson |first132=BT |last133=Won |first133=CHJ |last134=Xu |first134=J |last135=Yalamanchi |first135=P |last136=Yaremchuk |first136=K |last137=Yeghiazarians |first137=Y |last138=Yu |first138=JL |last139=Zeidler |first139=M |last140=Rosen |first140=IM |title=International Consensus Statement on Obstructive Sleep Apnea. |journal=International Forum of Allergy & Rhinology |date=July 2023 |volume=13 |issue=7 |pages=1061–1482 |doi=10.1002/alr.23079 |pmid=36068685 |pmc=10359192}}</ref> 

Snoring has been classified according to [[apnea–hypopnea index]] score and severity of associated [[sleep disorder]]s. Therefore, snoring as a symptom exists as a spectrum of severity, with primary snoring being the least severe, snoring with [[upper airway resistance syndrome]] being of intermediate severity, and snoring associated with obstructive sleep apnea being the most medically significant.<ref name="DeMeyer2019" /> This spectrum of conditions represents increasing degrees of airway obstruction and severity and frequency of disruption of breathing during sleep.<ref name="Biggs2014" />

Obstructive sleep apnea may be subdivided into mild, moderate, and severe types.<ref name="Yap2022" /> 

* Asymptomatic, non-apneic snoring (primary snoring). No daytime sleepiness and apnea–hypopnea index less than 5 per hour.
* Non-apneic snoring with upper airway resistance syndrome. Daytime sleepiness present. Apnea–hypopnea index less than 5 per hour. Between 5 and 10 respiratory-effort-related arousals per hour. [[Oxygen saturation]] more than 90%.
* Apneic snoring (snoring associated with obstructive sleep apnea). Apnea–hypopnea index more than 5 per hour. Oxygen saturation less than 90%. Deviating pattern on [[electroencephalogram]].

Primary snoring is occasionally defined as apnea-hypopnea less than 15 (or less than 10) with [[body mass index]] less than 32 kg/m<sup>2</sup>. It has been suggested that individuals with primary snoring may gradually progress towards obstructive sleep apnea<ref name="Huang2023" /> as causative factors such as aging and obesity change over time. However, there is limited evidence for this. 37% of children with primary snoring progressed to obstructive sleep apnea after 4 years.<ref name="Huang2023" /> On the other hand, in many cases snoring is resolved over time rather than getting worse.<ref name="DeMeyer2019" />

Snoring severity has also been classified according to average maximum volume:<ref name="Yaremchuk2020" />

* Mild (40-50 [[Decibel|decibels]]). Roughly equivalent to quiet conversation.
* Moderate (50–60 dB). Roughly equivalent to a car driving past at low speed.
* Severe (>60 dB). Roughly equivalent to busy traffic or a vacuum cleaner.

In snoring associated with obstructive sleep apnea, louder snoring is correlated with severity of sleep apnea.<ref name="Yaremchuk2020" /> On average, males snore more loudly than females, and people with higher body mass index snore louder than those with lower body mass index.<ref name="Yaremchuk2020" />