Snoring

1
Snoring and OSA

• Snoring a noise generated as a result of
  partial upper airway obstruction during sleep
• Apnoea a period of no airflow in the nose or
  mouth for at least 10 seconds

2
Pathophysiology

• Snoring - Partial obstruction of the upper
  airway leads to vibration of the soft palate and
  pharyngeal walls
• Nose
• Soft palate
• Tongue base
• Apnoea complete obstruction of the airway due
  to complete collapse
• Both associated with obesity but up to 1/3rd of
  OSA sufferers may have a BMI lt25

3
History

• Try to see with the sleep partner It is usually
  the partner who has a problem with the snoring
  and they can describe it
• Apnoea episodes described?
• Day time somnolence
• Alcohol
• Smoking
• Sedatives
• Shift work
• Weight gain
• Nasal obstruction

4
Examination and Investigation

• BMI
• Nose
• Oropharynx crowded ?
• Retrognathia
• Neck mass
• FBC, TFT, FBS other cause of fatigue
• Epworth score lt 10 reasurring

5
Management

• Patient presents with snoring or ?OSA 
• GP does Epworth
• Epworth lt10 - OSA unlikely. If anatomical cause
  for snoring - nasal polyps, large tonsils Rx /
  consider referral to ENT
• Treat rhinitis or nasal polyps if found
• Nasal expanders from pharmacist
• Lifestyle advice weight loss, reduce alcohol,
  sleep on side etc
• Epworth lt10 - OSA unlikely. No anatomical cause
  found - lifestyle advice - stop smoking, lose
  weight etc

6

• Epworth lt10 - OSA unlikely. No anatomical cause.
  Lifestyle change not worked. Consider mandibular
  advancement splint. Patient needs to have a
  dentist. Dentists can make these but will charge.
  GPs can refer direct to Simon Littlewood an
  Orthodontist at St Lukes who will make them on a
  no charge NHS basis. (We should look at the
  tariffs for this and if a commissioning group
  could ask local dentists to make them cheaper
  than a referral to St lukes. Also a long waiting
  list at St Lukes.)

7

• Epworth gt/ 10 - possible OSA. If anatomical
  cause for snoring/OSA could refer direct to sleep
  studies or ENT. Will probably need both anyway as
  wouldn't usually operate without sleep study
  results.
• Epworth gt/ 10 - possible OSA. No anatomical
  cause for snoring/OSA - refer direct to sleep
  studies