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Key Features

  • Noise produced on inspiration during sleep

  • Snoring is associated with obstructive sleep apnea (OSA) but has no disruption of sleep by clinical sleep evaluation

  • Sleep-disordered breathing problems are attributed to narrowing of the upper aerodigestive tract during sleep due to changes in position, muscle tone, and soft tissue hypertrophy or laxity

  • The most common sites of obstruction are the oropharynx and the base of the tongue

  • The spectrum of the problem ranges from simple snoring without cessation of airflow to OSA with long periods of apnea and life-threatening physiologic sequelae

Clinical Findings

  • All patients who complain of snoring should be evaluated for OSA (see Sleep Apnea, Obstructive)

  • Symptoms of OSA

    • Include snoring, excessive daytime somnolence, daytime headaches, and weight gain

    • May be present in as many as 30% of patients without demonstrable apnea or hypopnea on formal testing

  • Clinical examination should include the nasal cavity, nasopharynx, oropharynx, and larynx to help exclude other causes of dynamic airway obstruction

  • In many cases of isolated snoring, the palate and uvula appear enlarged and elongated with excessive mucosa hanging below the muscular portion of the soft palate

Diagnosis

  • Sleep examination with polysomnography is strongly advised

  • Radiographic imaging of the head or neck is generally not necessary

Treatment

  • Diet modification and a regimen of physical exercise can lead to improvement in snoring

  • Position change during sleep can be effective

  • Nonsurgical options include

    • Mandibular advancement appliances designed to pull the base of tongue forward

    • Continuous positive airway pressure via face or nasal mask

    • Compliance with both of these treatment options is problematic because snorers without OSA do not notice the physiologic benefits of these devices noted by patients with sleep apnea

  • Surgical correction

    • Most commonly directed at the soft palate

    • Procedures aim to stiffen the palate to prevent vibration rather than remove it

    • Injection snoreplasty, radiofrequency thermal fibrosis, and implantable palatal device have been used with variable success and patient tolerance

    • The durability of these procedures in alleviating symptoms is poorly understood

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