Snoring a sign of respiratory depression/oversedation?

  1. A comment in another thread got me thinking. I've heard this before, that if the patient is snoring, this can actually be a sign that they are oversedated. What if their respiratory rate is WNL and their sats are okay? You can walk down the hallway of any acute care unit and hear snoring emanating from a room or two. People snore. How does a nurse know when snoring is a sign that something is wrong?

    Discuss.
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    About Virgo_RN

    Joined: Oct '07; Posts: 3,673; Likes: 5,547
    RN; from US
    Specialty: Cardiac Telemetry, ED

    17 Comments

  3. by   roosmom
    Snoring respirations can be signs of brain injury or oversedation - people that are impaired are sometimes unable to maintain an open airway, their tongue can fall back causing soft tissue obstruction. In this instance, if you have evidence of desatting, altered LOC, ineffective respiratory effort, the airway needs to physically maintained by positioning (head-tilt chin-lift) until a definitive ariway can be placed.

    I think in the instance of a snoring pt in acute care setting, there may be an element of oversedation, but if sats, rr, and LOC (easily arousable) are WNL it may just be normal for the patient. I know I haven't liked taking care of patients in Med-Surg that snored, because it can be unnerving if you've seen this emergently before. I guess this is where more investigation comes in - pt history of snoring, on sedating medications, etc. I know alot of people with sleep apnea are snorers too.
  4. by   CaLLaCoDe
    I don't know if it has to do with over sedation from narcs but I do know if I sleep on my back I snore and my wife has to tell me to turn on my side then the snoring ceases immediately.
    Unrelated: I do suspect that a snorer may be subject to instances of sleep apnea and may be a ripe candidate for a cpap/bipap machine at night.
  5. by   wtbcrna
    Just something to think about:

    http://www.apsf.org/resource_center/...leepapnea.html

    "Preoperative Assessment

    The preoperative assessment includes a thorough history and physical examination. As the vast majority of sleep apnea patients are undiagnosed, it is not sufficient to simply ask if the patient has sleep apnea or disturbance. The typical patient with sleep apnea is male, overweight, and over the age of 40, but sleep apnea does occur in both sexes, in thin individuals, and in all age categories.1 Children, particularly those with tonsillar hypertrophy, can also be at risk. Key questions to ask a patient are:


    Do you snore nightly?
    Has anyone ever said that you stop breathing in your sleep?
    Do you feel tired and groggy on awakening?
    Do you fall asleep easily during the day?
    Do you frequently have headaches in the morning? (however, this symptom is non-specific.)"

    "Postoperative Care

    The period of awakening from anesthesia can be problematic for patients with OSA. In patients who have just undergone surgery for the treatment of their OSA, the airway can be narrowed from swelling and inflammation. Also, the lingering sedative and ventilatory depressant effects of the anesthetic can pose difficulty. Perioperative vigilance should continue into the postoperative period. Many patients require postoperative intubation and mechanical ventilation until fully awake. A CPAP (Continuous Positive Airway Pressure) machine can be employed in some patients postoperatively to support breathing. For certain patients, it may be prudent to admit them to an intermediate care or intensive care area postoperatively to facilitate close monitoring and airway support measures. Narcotic analgesics can precipitate or potentiate apnea that may result in a ventilatory arrest. If narcotics are deemed necessary in the postoperative period, appropriate monitoring of oxygenation, ventilation, and cardiac rhythm should be provided.

    Summary

    Obstructive sleep apnea patients undergo surgery for a variety of reasons. Airway maintenance issues and frequently associated cardiopulmonary abnormalities place OSA patients at risk for perioperative complications. Safe anesthetic care can be provided by thorough preoperative assessment, a thoughtful and well-executed anesthetic plan, and vigilance which extends well into the postoperative period. "
  6. by   Andrew, RN
    Snoring is fine as long as they are moving air and not having apnea. I snore all the time when I sleep. I don't have OSA.

    Most of the time, it's just an inconvenience to their room mate.

    But it all depends on the patient and their circumstances. I'd rather have someone snoring and sleeping than awake and having pain. If their RR is >10-12 or whatever your facility policy is, then they're fine. Just count their respirations for a full minute, check on them frequently, and make sure they aren't obstructing
  7. by   wtbcrna
    Quote from Andrew, RN
    Snoring is fine as long as they are moving air and not having apnea. I snore all the time when I sleep. I don't have OSA.

    Most of the time, it's just an inconvenience to their room mate.

    But it all depends on the patient and their circumstances. I'd rather have someone snoring and sleeping than awake and having pain. If their RR is >10-12 or whatever your facility policy is, then they're fine. Just count their respirations for a full minute, check on them frequently, and make sure they aren't obstructing
    Snoring is obstruction of the airway that is what the whole sound comes from. http://en.wikipedia.org/wiki/Snoring http://www.stanford.edu/~dement/snoring.html

    People with significant snoring often have undiagnosed OSA.

    Another problem with snoring d/t sedation can be negative pressure pulmonary edema. http://sciencelinks.jp/j-east/articl...01A0047488.php
  8. by   loricatus
    There is a different 'sound' to the obstructive caused snoring and the regular sleeping snore. Can't describe the sound here; but, it has nothing to do with the decibel level. Once you have heard the type where the patient desats d/t an obstruction, you will understand what I mean.
    Last edit by loricatus on Apr 18, '09
  9. by   cardiacRN2006
    Exactlty. Snoring is a result of airway obstruction.
  10. by   wtbcrna
    Quote from loricatus
    There is a deffernt 'sound' to the obstructive caused snoring and the regular sleeping snore. Can't describe the sound here; but, it has nothing to do with the decibel level. Once you have heard the type where the patient desats d/t an obstruction, you will understand what I mean.
    Would you care to site a reference for that?
  11. by   loricatus
    Quote from wtbcrna
    Would you care to site a reference for that?
    Citing a reference for a sound that you hear at the bedside of someone who has an obstruction versus a flapping tissue, variable, partial obstruction-come on, you should know better than asking for that
  12. by   leslie :-D
    Quote from loricatus
    There is a different 'sound' to the obstructive caused snoring and the regular sleeping snore. Can't describe the sound here; but, it has nothing to do with the decibel level. Once you have heard the type where the patient desats d/t an obstruction, you will understand what I mean.
    does the snore sound like an excited/agitated pig?
    short, abrupt, erratic type snorts?


    leslie
  13. by   wtbcrna
    Quote from loricatus
    Citing a reference for a sound that you hear at the bedside of someone who has an obstruction versus a flapping tissue, variable, partial obstruction-come on, you should know better than asking for that
    I basically know what you were trying to get at, but it is all obstruction. These people that have "significant snoring" often are able to maintain normal O2 sats, but oxygen saturation does not fall until you have used up all your Functional Residual Capacity. Often times these snorers have high PaCO2 levels and decreased oxygen to vital organs. There are several things that can happen to these people a long time before SaO2 drops ever become a problem. http://www.the-aps.org/education/ref...pt#259,1,Using the Pathophysiology of Obstructive Sleep Apnea (OSA) to Teach Cardiopulmonary Integration

    Snoring is not totally benign it usually a sign of something more significant. Most of us, including myself, treat snoring like it is of little to no consequence, but there many medical problems associated with snoring that shouldn't be totally ignored just because the patient's SaO2 hasn't started to drop.
  14. by   loricatus
    Quote from leslie :-D
    does the snore sound like an excited/agitated pig?
    short, abrupt, erratic type snorts?


    leslie
    Sorry Leslie, never heard an excited pig. But, what you described sounds more like a laryngospasms (also an obstruction)

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