Management of snoring

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Management of snoring

• John Waldron
• 15 October 2008

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Snoring basics

• Common
• 15-20 of children
• 60 60 year old men
• 40 60 year old women
• Directly related to BMI
• Most common exacerbating factor is alcohol

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Snoring basics 2

• Vibration of the upper airways
• Inspiration
• Collapse of the upper airway
• A minority of cases caused by nasal obstruction
• Very rarely caused by unusual pathology
• Severe snorers may have obstructive sleep apnoea
  (OSA)

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Snoring basics 3

• In patients with a BMI in the normal range
  vibration of the soft palate and uvula is the
  most common cause
• In overweight patients multi level collapse of
  the pharyngeal airway due to sub mucosal adipose
  tissue narrowing is common

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Obstructive sleep apnoea

• Breathing stops due to complete collapse of the
  airway
• Period of silence, may last 30 seconds or more
• Frequency of episodes is a measure of severity
• May wake the patient
• Prevents them reaching deeper (REM) restorative
  sleep levels
• Wake feeling unrefreshed, headache,
  hypersomnolence, tiredness, accidents, reportable
  to the DVLA
• May lead to cardiac problems in severe cases

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Snoring history

• How long
• How often
• Time course
• Positional
• Consequences for the partner, patient, others
• History of apnoea, patient waking, quality of
  sleep, hypersomnolence (Epworth)

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Snoring history 2

• BMI
• Weight change over time and relationship to
  snoring
• Collar size
• Nasal obstruction
• Smoking
• Alcohol intake, timing, and relationship to
  snoring

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Snoring examination

• Mouth including soft palate and tongue
• Jaw (retrognathia)
• Nasal airway
• Nasendoscopy
• NE with forced inspiration
• NE with forced snoring
• Measure BMI

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Snoring investigations

• Sleep study if concern about significant sleep
  apnoea
• If doubt about frequency/length of apnoeas ask
  partner to observe

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Snoring treatment

• Is treatment necessary?
• Earplugs
• Sleeping position
• Separate rooms
• Stop smoking
• Alter alcohol intake
• Treat nasal obstruction with topical steroid or
  topical/systemic decongestant

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Snoring treatment 2

• Treat nasal obstruction which is significant on
  its own with medical treatment or surgery
• Weight reduction

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Snoring treatment 3

• Mandibular advancement splint can be tried in
  any patient
• CPAP for patients with significant sleep apnoea
• Surgery can be considered in patients who do not
  have significant sleep apnoea

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Surgery for snoring

• Trimming of soft palate /- tonsillectomy
• Laser/electrocautery/microfrequency
• Much less successful in significantly overweight
  patients
• Much less successful in patients with significant
  sleep apnoea
• Painful, small risk of significant complications
  with speech and swallowing