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ESSENTIALS OF DIAGNOSIS

  • Noise produced on inspiration during sleep.

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

GENERAL CONSIDERATIONS

Ventilation disorders during sleep are extremely common. While OSA occurs in 5–10% of Americans, clinically relevant snoring may occur in as many as 59%. In general, 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. OSA is discussed in Chapter 9-42. In contrast to OSA, snoring is almost exclusively a social problem, and despite its prevalence and association with OSA, there is comparatively little known about the management of this problem.

CLINICAL FINDINGS

A. Symptoms and Signs

All patients who complain of snoring should be evaluated for OSA as discussed in Chapter 9-42. Symptoms of OSA (including 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 examination of 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.

B. Imaging and Diagnostic Testing

Sleep examination with polysomnography is strongly advised in the evaluation of a patient with complaints of snoring. Radiographic imaging of the head or neck is generally not necessary.

TREATMENT

Expeditious and inexpensive management solutions of snoring are sought, often with little or no benefit. Diet modification and physical exercise can lead to improvement in snoring through the weight loss and improvement in pharyngeal tone that accompanies overall physical conditioning. Position change during sleep can be effective, and time-honored treatments, such as placing a golf or tennis ball into a pocket sewn on the back of the pajama top worn during sleep, may satisfactorily eliminate symptoms by ensuring recumbency on one side. Although numerous pharmacologic therapies have been endorsed, none demonstrate any significant utility when scrutinized.

Anatomic management of snoring can be challenging. As with OSA, snoring can come from a number of sites in the upper aerodigestive tract. While medical or surgical correction of nasal obstruction may help alleviate snoring problems, most interventions aim to improve airflow through the nasopharynx and oropharynx. Nonsurgical options include mandibular advancement appliances designed to pull the base of the tongue forward and continuous positive airway pressure via face or nasal mask. ...

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