Summary
Definition
History and exam
Key diagnostic factors
- presence of risk factors
- noisy breathing during sleep
- apnoeas
- choking or gasping
Other diagnostic factors
- waking up tired
- daytime somnolence
- hyperactivity
- behavioural problems
- night terrors
- enuresis
Risk factors
- increasing age
- male gender
- obesity (BMI >30)
- cranio-facial abnormalities
- endocrine disorders
- neck circumference above 40 cm
- sedating medications
- adenotonsillar hypertrophy
- long soft palate and uvula
- alcohol consumption
- Down's syndrome
- gastro-oesophageal reflux
- active or passive smoking
- abnormal epiglottis
- hypo-pharyngeal cysts or tumours
- rhinitis/nasal obstruction
- asthma
Diagnostic investigations
1st investigations to order
- nasal decongestant test
- Epworth sleepiness score (ESS)
Investigations to consider
- snoring scale score
- TFTs
- growth hormone level
- allergy tests
- sleep study
- acoustic analysis
- pharyngeal manometry
- sleep nasendoscopy
Treatment algorithm
Contributors
Authors
Specialty Registrar in Otorhinolaryngology-Head & Neck Surgery
Sheffield Teaching Hospitals NHS Trust
Sheffield
UK
Disclosures
NA declares that she has no competing interest.
Consultant in Otorhinolaryngology-Head & Neck Surgery
Sheffield Teaching Hospitals NHS Trust
Sheffield
UK
Disclosures
SM has been reimbursed by Arthocare, one of the manufacturers of radiofrequency hardware, for attending a conference and course.
Peer reviewers
Assistant Professor of Surgery
Section of Otolaryngology-Head and Neck Surgery
University of Chicago
Chicago
IL
Disclosures
JP declares that he has no competing interests.
Director
Department of Respiratory and Sleep Medicine
John Hunter Hospital
Professor and Head
School of Medicine and Public Health
Faculty of Health
The University of Newcastle
NSW
Australia
Disclosures
MJH declares that he has no competing interests.
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