Snoring means a sound heard along with breathing during sleep, caused by turbulent airflow and vibration of tissues due to partial obstruction of the upper airway.
About 40% of men and 20% of women snore. Snoring tendency increases with age.
Hypnotics, sedatives and alcohol increase snoring.
Snoring occurs most commonly in the supine position.
Overweight predisposes people to snoring, as adipose tissue obstructs the airway.
Symptoms
The following aspects in the patient's history should be considered.
What harm does snoring cause?
Are there symptoms suggestive of sleep apnoea, such as observed pauses in breathing, daytime fatigue, nocturnal sweating, nycturia, sleeplessness, memory or concentration problems or affective syndromes?
Is there nasal congestion?
Workup
Weight and height (BMI)
Clinical examination, assessing
nasal breathing, patency of the nasal meatuses (mucosal swelling, septum deviation, nasal polyps, nasal discharge)
If there are symptoms suggestive of sleep apnoea, a night polygraphy should be performed.
Treatment
Conservative treatment
Weight loss, as necessary
Avoidance of smoking
Avoidance of hypnotics, sedatives and alcohol before going to bed
Postural therapy (avoiding the supine position)
Treatment of nasal congestion (nasal glucocorticoids and moistening sprays)
Assessment of the usefulness of a biteplate in a snoring patient without sleep apnoea, if appropriate.
Surgical management
Facilitating nasal breathing (septoplasty/rhinoplasty, radiofrequency ablation (RFA) of the inferior nasal conchae, nasal polypectomy, sinus surgery)
If the palatine tonsils are large (grade 3-4), tonsillectomy can be considered.
According to currently available evidence, the long-term benefit of RFA treatment of the palate is minor.
Criteria for referral
If a normal-weight patient suffers from severe, socially disturbing snoring (every night and in all sleeping positions) and conservative treatment is not helpful, the patient can be referred to an ENT specialist for assessment of elective surgical treatment.
Indications for referral to specialized care
Prolonged nasal congestion despite conservative treatment and suspicion of an obstructive structural defect
Large, obstructive palatine tonsils
If sleep apnoea is detected in night polygraphy Sleep Apnoea in the Adult, the patient should be referred to a pulmonary specialist, as necessary.
References
Sinkkonen ST, Ruohoalho J, Pietarinen P et al. Limited long-term outcome of single-session soft palate interstitial radiofrequency surgery for habitual snoring in tertiary care academic referral centre: Our experience on 77 patients. Clin Otolaryngol 2017;42(2):470-473. [PubMed]