Snoring

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

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

Sleep examination with polysomnography is strongly advised

Radiographic imaging of the head or neck is generally not necessary

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