Snoring

Last reviewed: 4 Jun 2022
Last updated: 14 Dec 2021

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk factors
  • noisy breathing during sleep
  • apnoeas
  • choking or gasping
More key diagnostic factors

Other diagnostic factors

  • waking up tired
  • daytime somnolence
  • hyperactivity
  • behavioural problems
  • night terrors
  • enuresis
Other diagnostic factors

Risk factors

  • increasing age
  • male sex
  • 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
More risk factors

Diagnostic investigations

1st investigations to order

  • nasal decongestant test
  • Epworth sleepiness score (ESS)
More 1st investigations to order

Investigations to consider

  • snoring scale score
  • TFTs
  • growth hormone level
  • allergy tests
  • sleep study
  • acoustic analysis
  • pharyngeal manometry
  • sleep nasendoscopy
More investigations to consider

Emerging tests

  • head and neck 3-dimensional CT
  • head and neck MRI

Treatment algorithm

ONGOING

adult: without UARS or OSA

adult: with UARS or OSA

child: without concurrent indication for tonsillectomy or adenoidectomy

child: with concurrent indication for tonsillectomy or adenoidectomy

child: with UARS or OSA

Contributors

Authors

Nadia Ashraf, BMBS, BMedSci(Hon), DA, DOHNS, FRCS(ORL-HNS)

Specialty Registrar in Otorhinolaryngology-Head & Neck Surgery

Sheffield Teaching Hospitals NHS Trust

Sheffield

UK

Disclosures

NA declares that she has no competing interest.

Showkat Mirza, BM, BS, BMedSci, FRCS(ORL-HNS)

Consultant in Otorhinolaryngology-Head & Neck Surgery

Sheffield Teaching Hospitals NHS Trust

Sheffield

UK

Disclosures

SM declares that he has no competing interests.

Peer reviewers

Jayant Pinto, MD

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.

Michael J. Hensley, MBBS, PhD, FRACP

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.

  • Snoring images
  • Differentials

    • Upper airway resistance syndrome (UARS)
    • Obstructive sleep apnoea (OSA)
    • Stridor
    More Differentials
  • Guidelines

    • Practice parameters for the treatment of snoring and obstructive sleep apnea with oral appliances: an update for 2015
    • Assessment of sleep-disordered breathing in childhood
    More Guidelines
  • Patient leaflets

    Sleep apnoea in adults (obstructive)

    More Patient leaflets
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