Snoring

Key Features

• Noise produced on inspiration due to upper aerodigestive tract blockage during sleep

• Snoring is associated with obstructive sleep apnea (OSA) but may not alone disrupt sleep quality

• 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

• Additional testing may include sleep endoscopy

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