AbstractThis paper aims to develop a reliable

psychoacoustic evaluation tool for measuring snoring sounds.

Thirteen snoring sound samples were assessed by 25 listeners, in
terms of psychoacoustic metrics (loudness, sharpness,
roughness, fluctuation strength, and annoyance) using a 7-point
semantic differential scale with bipolar adjective pairs. The
accuracy of this study was quantified by receiver operating
characteristic curves, together with Pearsons product-moment
and Spearmans rank correlation coefficients. Results
consistently show that loudness, annoyance, and roughness are
the best three metrics for classifying apneic and benign snorers
as they can achieve high diagnostic accuracy and good
correlation with apnea-hypopnea index, body mass index, and
neck circumference. With these encouraging results, further
research and development of an effective psychoacoustic
evaluation tool is promising.
I. INTRODUCTION
NORING is increasingly recognized as more than just a
social nuisance: it is a medical problem that often
associates with obstructive sleep apnea (OSA), a common
sleep-related breathing disorder which negatively affects
ones quality of life both in socioeconomic and health factors
[1,2]. The prevalence of snoring increases with age, being
higher in males than females (60% verses 40% at age of 60
years) [3], and loud snoring occurs in more than 80% of OSA
patients [4].
Snoring sounds are usually originated by the vibration of
soft tissues (e.g., soft palate, uvula, tonsils, tonsillar pillars,
base of tongue, lateral pharyngeal walls, and mucous
membranes) in the upper airway (UA) owing to turbulent
airflow through a partially obstructed UA [1]. Borrowed from
the concepts of speech processing, several researchers [5-8]
have tried to utilize acoustical signatures (e.g., power spectral
densities, formant frequencies, and phase couplings) in snore
signals to provide early diagnosis of OSA. Although these
studies lend support to the hypothesis that snore signals might
carry important cues for OSA detection, the diagnostic
accuracy could be further improved if the patients spouse or
bed partner could provide a reliable report of the perceived
snoring sound quality without any recall bias prior to
analyzing snore signals. This paper, therefore, aims to fill this
gap in the literature by exploring the application of
psychoacoustic metrics [9] to snoring sounds for the
classification of snorers with OSA (i.e., apneic snorers whose

Manuscript received April 14, 2008.
*A.K. Ng, and T.S. Koh are with the School of Electrical and Electronic
Engineering, Nanyang Technological University, Singapore 639798,
Republic of Singapore (e-mail: ngke0002@ntu.edu.sg).
apnea-hypopnea index, AHI 10 events/h) and without OSA
(i.e., benign snorers whose AHI < 10 events/h), hoping to
develop and implement an effective psychoacoustic
evaluation tool for measuring snoring sounds.
This paper is organized as follows. Section II provides an
overview of the various psychoacoustic metrics (loudness,
sharpness, roughness, fluctuation strength, and annoyance)
applied in this study. Section III highlights the evaluation
setup, focusing on the snoring sound sample preparation and
evaluation procedures. Subsequently, results are illustrated
and discussed in Section IV, followed by concluding remarks
in Section V. All analysis in this study was performed within
a statistical software package (MedCalc version 9.3.6.0).
II. PSYCHOACOUSTIC METRICS
Human hearing is a complicated system that always
appraises the acoustic environments by means of sound
perception mechanisms, also known as psychoacoustic
metrics [9], such as loudness, sharpness, roughness,
fluctuation strength, and even annoyance. These metrics play
important roles in the active noise control research for
reducing engine noise, designing quality engines, and
improving human comfort [10,11]. Here, we fully extend the
usage of these metrics to valuate snoring sounds based on the
previous brief discussions in [12,13].
A. Loudness
Loudness is a key parameter for any sound quality survey.
It is a measure of sound strength defined by [9]

=
Bark 24
0
dz N N
(1)
where N is the loudness in sone which is referenced to a 1 kHz
tone at a sound pressure level of 40 dB, N is the specific
loudness in sone/Bark, and dz is the increment in the critical
band rate z. The specific loudness represents the amount of
loudness attributed to the auditory filters, and is closely
related to the hearing system excitation E through the
following equation,

= 1 5 . 0 5 . 0 08 . 0
23 . 0
TQ
23 . 0
0
TQ
E
E
E
E
N
(2)
where E
TQ
is the excitation at threshold in silence, and E
0
is
the excitation corresponding to the reference intensity I
0
=
10
-12
W/m
2
. Moreover, the specific loudness serves as a basis
for many other psychoacoustic metrics.
Using Psychoacoustics of Snoring Sounds to
Screen for Obstructive Sleep Apnea
Andrew Keong Ng*, Student Member, IEEE, and Tong San Koh
S
30th Annual International IEEE EMBS Conference
Vancouver, British Columbia, Canada, August 20-24, 2008
978-1-4244-1815-2/08/$25.00 2008 IEEE. 1647

B. Sharpness
Sharpness is an attribute that describes the tone color of a
sound in terms of its powerfulness or aggressiveness. It relies
on the weighted centroid of the specific loudness content [9],
as shown below

( )

=
Bark 24
0
Bark 24
0
11 . 0
dz N
dz z z g N
S
(3)
where S denotes the sharpness in acum, and g(z) denotes the
weighing function of the critical band rate z. An acum is
referenced to a band of noise centered at 1 kHz with 60 dB.
Higher sharpness value indicates greater energy in high
frequencies.
C. Roughness
Roughness is a sensation that arises from rapid temporal
variations of sounds caused by beats between tones in a
critical band, or by amplitude- or frequency-modulated tones.
Using the boundary criterion, a 1 kHz tone at 60 dB with
100% amplitude modulation at 70 Hz can generate the
roughness R of 1 asper [9]. Explicitly,

( )

=
Bark 24
0
E mod
Bark dB kHz
3 . 0
dz z L f
R
(4)
where f
mod
signifies the modulation frequency, and L
E

signifies the range of excitation level within an auditory filter.
Roughness increases with increasing modulation depth of the
temporal masking pattern of sounds.
D. Fluctuation Strength
In contrast to roughness, fluctuation strength reveals
human sensitivity towards slow moving amplitude
modulation for sound with frequency modulated at
approximately 4 Hz. The unit of fluctuation strength is vacil,
referenced to a 1 kHz tone at 60 dB with 100% amplitude
modulation at 4 Hz, and the fluctuation strength of a sound
can be expressed as

( )
( ) ( )
mod mod
Bark 24
0
Hz 4 Hz 4
Bark dB 008 . 0
f f
dz L
F
+

=

(5)
where L is the masking depth (i.e., difference between the
maxima and the minima in the temporal masking pattern) [9].
Fluctuation strength is associated with the fluent speech at a
speaking rate of 4 syllables/s, since its amplitude modulation
is concentrated around 4 Hz.
E. Annoyance
Annoyance PA is a mixture of different hearing sensations,
including loudness N, sharpness S, roughness R, and
fluctuation strength F [9]. It can be estimated by

+ +
2
FR
2
S 5
1 w w N PA
(6)
where
( ) ( ) 75 . 1 for 10 log 25 . 0 75 . 1
5 e S
> + = S N S w , (7)

( )
( ) with , 6 . 0 4 . 0
18 . 2
4 . 0
5
FR
R F
N
w + =
(8)
N
5
indicating the percentile loudness in sone. From (6), it is
apparent that loudness has a dominant impact in the
estimation of annoyance.
III. EVALUATION SETUP
A. Snoring Sound Sample Preparation
Snoring sounds of 8 apneic snorers (mean standard
deviation age of 42 13 years; body mass index, BMI = 34.9
8.4 kg/m
2
; neck circumference, NC = 42.5 4.5 cm; AHI =
55.0 25.6 events/h) and 5 benign snorers (age = 42 10
year; BMI = 24.3 2.9 kg/m
2
; NC = 38.5 2.0 cm; AHI = 4.0
3.5 events/h) were recorded in a sleep laboratory (Sleep
Disorders Unit, Singapore General Hospital) via a
high-fidelity acquisition system [14]. This study was
approved by the local Institutional Review Board, and written
informed consent was obtained from all patients.
To further improve signal quality and intelligibility, the
recorded snore signals were preprocessed through a
wavelet-driven noise suppression and snore activity detection
system in a translation invariant domain [15]. The denoised
signals were then viewed using a digital audio software
package (Cool Edit Pro version 1.2). A snoring sound sample,
which consists of 5 consecutive snoring episodes, lasting
about 30 s, was chosen from each snorer, thereby giving a
total of 13 samples for the subsequent listening tests.
B. Evaluation Procedures
Twenty-five healthy listeners (age = 26 3 year) took part
in this study, one at a time. A snoring sound sample was
presented 3 times continuously in a quiet environment, and
the listener was asked to pass judgments on the sample based
on the 5 psychoacoustic metrics (i.e., loudness, sharpness,
roughness, fluctuation strength, and annoyance), via a 7-point
semantic differential scale (range from 1 to 7) with bipolar
adjective pairs [16] as depicted in Fig. 1, before continuing to
the next snoring sound sample. The semantic differential
scale is widely used for conveying the denotative (e.g.,
loudness) and connotative (e.g., annoyance) meaning of the
sounds.
Fig. 1. A 7-point semantic differential scale with bipolar adjective
pairs.
1648

IV. RESULTS AND DISCUSSION
A. Receiver Operating Characteristic Curve Analysis
Based on the existing dataset (i.e., snoring sound samples =
13, and listeners = 25), the diagnostic accuracy of this study
was quantified using notched box plots and receiver operating
characteristic (ROC) curves [17] as illustrated in Figs. 2 and
3, respectively. The results for ROC curve analysis are
summarized in Table I. Apneic snoring sounds achieve higher
ratings for all the metrics than the benign ones, as rendered in
Fig. 2. In other words, the qualities of apneic snoring sounds
are usually louder, sharper, rougher, higher fluctuation
strength, and more annoying. Among these metrics, loudness,
annoyance, and roughness rank the top three, in sequence,
that best discriminate apneic from benign snoring sounds
(area under the ROC curves, AUC = 0.852-0.899; significant
P-value = 0.0001; sensitivity = 72-78%; specificity =
82-92%), followed by sharpness and fluctuation strength
(AUC = 0.780-0.787; significant P-value = 0.0001;
sensitivity = 61-63%; specificity = 82-88%).
Correspondingly, the typical threshold that can optimally
separate these two groups of snoring sounds falls on the rating
of 4 (i.e., 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 [18].
B. Pearsons and Spearmans Correlation Analysis
To further exam the clinical usefulness of the proposed
psychoacoustic metrics, we attempted to establish the
correlations between the metrics, AHI (i.e., a marker of OSA
severity), BMI, and NC via Pearsons and Spearmans
correlation techniques [19]. In short, the Pearsons
product-moment correlation coefficient (r) valuates the
strength of a linear relationship between two variables,
whereas the Spearmans rank correlation coefficient (rho) is a
non-parametric measure of monotone association between a
pair of variables. Nonetheless, both the coefficients lie in the
range of -1 and +1, where the negative or positive sign
indicates a negative or positive association, respectively,
along with the magnitude that reflects the association
strength.
The statistical results from both the parametric and
non-parametric correlational analysis constantly demonstrate
that loudness, annoyance, and roughness are the three most
preferable psychoacoustic metrics for assessing snoring
sounds, with loudness being the best metric as it yields the
greatest association strength with AHI (r = 0.743; rho =
0.706), BMI (r = 0.496; rho = 0.588) and NC (r = 0.556; rho =
0.683). These outcomes are in agreement with the earlier
findings from ROC curve analysis. The significant P-values
computed from the correlational analysis of all possibilities
have the same value of less than 0.0001, which are deemed
statistically significance.
Furthermore, the correlation results in Table I suggest that
the psychoacoustic metrics are more closely related to the NC
than the BMI. Thus, one may infer that NC is a stronger
predictor of OSA relative to BMI because the neck
measurements correspond more directly to the UA tissues
that possess an immediate influence on the pathophysiology
of OSA [20]. In addition, excessive soft tissues surrounding
the UA, which is in the case of most apneic snorers [1], may
considerably reduce the airway space and vibrate vigorously,
thereby amplifying snoring loudness and increasing the
complexity of snoring sound qualities (e.g., frequency or
harmonic pattern and temporal regularity) when air flows

Fig. 2. Notched box plots of apneic and benign snoring sound samples under the evaluation of psychoacoustic metrics using a 7-point semantic
differential scale with bipolar adjective pairs.

Fig. 3. Receiver operating characteristic curve analysis of snoring
sound samples and psychoacoustic metrics.
1649

through the constrictions in the UA. Hence, apneic snoring
sounds are undoubtedly annoying.
V. CONCLUDING REMARKS
This paper explores the use of psychoacoustic metrics
(loudness, sharpness, roughness, fluctuation strength, and
annoyance) to examine snoring sounds, with an intention to
develop and implement a reliable and inexpensive
psychoacoustic evaluation tool for detecting OSA. Snoring
sound samples from 8 apneic and 5 benign snorers were
appraised by 25 listeners by means of a 7-point semantic
differential scale with bipolar adjective pairs.
Statistical results from ROC curve analysis, as well as
Pearsons and Spearmans correlation analysis of the metrics,
AHI, BMI, and NC, consistently recommend that the
psychoacoustic metrics of loudness, annoyance, and
roughness are the three most potential and appropriate
metrics, in sequence, for differentiating apneic and benign
snorers via psychoacoustics of snoring sounds, followed by
fluctuation strength and sharpness.
Despite of the relatively modest sample size of this study,
the diagnostic results are encouraging for continued research
and development of a psychoacoustic evaluation tool with
both objective and subjective features to characterize snorers
with and without OSA.
ACKNOWLEDGMENT
The authors thank Dr. K. Puvanendran and Dr. L. L. Lim
from Sleep Disorders Unit, Singapore General Hospital,
Singapore, for the clinical support, as well as the 25 listeners
for their active involvement in this study.
REFERENCES
[1] D. N. F. Fairbanks, "Snoring: An overview with historical
perspectives," in Snoring and Obstructive Sleep Apnea, D. N. F.
Fairbanks and S. Fujita, Eds. New York: Raven Press, 1994, pp. 1-16.
[2] K. Banno and M. H. Kryger, "Sleep apnea: Clinical investigations in
humans," Sleep Med., vol. 8, no. 4, pp. 400-426, 2007.
[3] E. Lugaresi, F. Cirignotta, G. Coccagna, and A. Baruzzi, "Snoring and
the obstructive apnea syndrome," Electroencephalogr. Clin.
Neurophysiol. Suppl., vol. 35, pp. 421-430, 1982.
[4] M. S. Aldrich, Sleep Medicine. New York: Oxford University Press,
1999.
[5] U. R. Abeyratne, A. S. Karunajeewa, and C. Hukins, "Mixed-phase
modeling in snore sound analysis," Med. Biol. Eng. Comput., vol. 45,
no. 8, pp. 791-806, 2007.
[6] H. Michael, S. Andreas, B. Thomas, H. Beatrice, H. Werner, and K.
Holger, "Analysed snoring sounds correlate to obstructive sleep
disordered breathing," Eur. Arch. Otorhinolaryngol., vol. 265, no. 1,
pp. 105-113, 2008.
[7] A. K. Ng, T. S. Koh, E. Baey, T. H. Lee, U. R. Abeyratne, and K.
Puvanendran, "Could formant frequencies of snore signals be an
alternative means for the diagnosis of obstructive sleep apnea?," Sleep
Med., 2008, doi: 10.1016/j.sleep.2007.07.010.
[8] A. K. Ng, K. Y. Wong, C. H. Tan, and T. S. Koh, "Bispectral analysis
of snore signals for obstructive sleep apnea detection," in Proc. Annu.
Int. Conf. IEEE Eng. Med. Biol., 2007, pp. 6195-6198.
[9] E. Zwicker and H. Fastl, Psychoacoustics: Facts and Models. New
York: Springer, 1999.
[10] A. Gonzalez, M. Ferrer, M. De Diego, G. Pinero, and J. J.
Garcia-Bonito, "Sound quality of low-frequency and car engine noises
after active noise control," J. Sound Vibration, vol. 265, no. 3, pp.
663-679, 2003.
[11] S. K. Lee, "Objective evaluation of interior sound quality in passenger
cars during acceleration," J. Sound Vibration, vol. 310, no. 1-2, pp.
149-168, 2008.
[12] A. Dreher, R. de la Chaux, C. Klemens, T. Rader, U. Baumann, and G.
Rasp, "Psychoacoustic evaluation of snoring," 2005,
http://www.egms.de/de/meetings/hno2005/05hno233.shtml.
[13] A. K. Ng, T. S. Koh, L. L. Lim, and K. Puvanendran, "Psychoacoustic
evaluation of snoring sounds: a useful supplement to
polysomnographic assessment?," Sleep Biol. Rhythms, vol. 5, pp.
A39-A40, 2007.
[14] A. K. Ng and T. S. Koh, "A high-fidelity acquisition system for snore
signals: Design and implementation," in Proc. IEEE Instrum. Meas.
Tech. Conf., 2007, pp. 1-5.
[15] A. K. Ng, T. S. Koh, K. Puvanendran, and U. R. Abeyratne, "Snore
signal enhancement and activity detection via translation-invariant
wavelet transform," IEEE Trans. Biomed. Eng., 2008, to be published.
[16] N. Otto, S. Amman, C. Eaton, and S. Lake, "Guidelines for jury
evaluations of automotive sounds," S V Sound and Vibration, vol. 35,
no. 4, pp. 24-47, 2001.
[17] M. H. Zweig and G. Campbell, "Receiver-operating characteristic
(ROC) plots: A fundamental evaluation tool in clinical medicine," Clin.
Chem., vol. 39, no. 4, pp. 561-577, 1993.
[18] P. Virkkula, A. Bachour, M. Hytonen, H. Malmberg, T. Salmi, and P.
Massita, "Patient- and bed-partner-reported symptoms, smoking, and
nasal resistance in sleep-disordered breathing," Chest, vol. 128, no. 4,
pp. 2176-2182, 2005.
[19] D. J. Sheskin, Handbook of Parametric and Nonparametric Statistical
Procedures. Chapman & Hall/CRC, 2007.
[20] Y. H. Lee, A. Johan, K. K. H. Wong, N. Edwards, C. Sullivan,
"Prevalence and risk factors for obstructive sleep apnea in a multiethnic
population of patients presenting for bariatric surgery in Singapore,"
Sleep Med., 2008, doi: 10.1016/j.sleep.2008.01.005.
TABLE I
STATISTICAL RESULTS FOR RECEIVER OPERATING CHARACTERISTIC CURVE ANALYSIS AND CORRELATIONAL ANALYSIS
Receiver operating characteristic curve analysis Pearsons and Spearmans correlation analysis
AHI BMI NC
Metric AUC P-value Threshold Sens (%) Spec (%) r rho r rho r rho
Loudness 0.899 0.0001 4 78 91 0.743 0.706 0.496 0.588 0.556 0.683
Sharpness 0.787 0.0001 4

61

88 0.567

0.511

0.301 0.369 0.405

0.474

Roughness 0.852 0.0001 4 74 82 0.684

0.652

0.369 0.470 0.487 0.588
Fluctuation
strength
0.780

0.0001

4 63 82

0.580

0.530

0.289 0.340 0.480 0.570
Annoyance 0.883 0.0001 5 72 92 0.718

0.716

0.436 0.534 0.531 0.664
Legend: AUC = area under receiver operating characteristic curve, P-value = level of significance where P-value < 0.05 was considered statistically
significance, Sens = sensitivity in percentage, Spec = specificity in percentage, AHI = apnea-hypopnea index in events/h, BMI = body mass index in
kg/m
2
, NC = neck circumference in cm, r = Pearsons product-moment correlation coefficient, rho = Spearmans rank correlation coefficient.

1650