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Snoring

Evidence last reviewed: 13 Mar 2026
Topic last updated: 31 Mar 2026

Summary

Definition

History and exam

Key diagnostic factors

  • snoring (noisy breathing during sleep)
  • witnessed apneas
  • choking or gasping
Full details

Other diagnostic factors

  • waking up tired
  • daytime somnolence
  • behavioral problems
  • faltering growth
Full details

Risk factors

  • increasing age
  • male sex
  • overweight/obesity
  • craniofacial abnormalities
  • endocrine disorders
  • neck circumference >40 cm
  • sedating drugs
  • adenotonsillar hypertrophy
  • long soft palate and uvula
  • alcohol consumption
  • gastroesophageal reflux
  • active or passive smoking
  • abnormal epiglottis
  • hypopharyngeal cysts or tumors
  • nasal obstruction
  • asthma
Full details

Diagnostic tests

1st tests to order

  • clinical exam
  • snoring scale score
  • Epworth sleepiness score (ESS)
Full details

Tests to consider

  • thyroid function tests (TFTs)
  • growth hormone level
  • skin-prick tests/serum allergen-specific IgE tests
  • nasal decongestant test
  • sleep study
  • acoustic analysis
  • pharyngeal manometry
  • flexible nasendoscopy
Full details

Emerging tests

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

Treatment algorithm

ONGOING

adult: without upper airway resistance syndrome (UARS) or obstructive sleep apnea (OSA)

adult: with upper airway resistance syndrome (UARS) or obstructive sleep apnea (OSA)

child: without concurrent indication for tonsillectomy or adenoidectomy

child: with concurrent indication for tonsillectomy or adenoidectomy

child: with upper airway resistance syndrome (UARS) or obstructive sleep apnea (OSA)

Contributors

Authors

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.

Christine Fabri, MD (Melit), MRCS (Ed), DOHNS (Ed), MCh, FEB ORL-HNS

Rhinology Fellow

Sheffield Teaching Hospitals NHS Trust

Sheffield

UK

Disclosures

CF declares that she has no competing interests.

Acknowledgements

Mr Showkat Mirza and Dr Christine Fabri would like to gratefully acknowledge Miss Nadia Ashraf, a previous contributor to this topic.

Disclosures

NA declares that she 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.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

American Academy of Sleep Medicine. The AASM international classification of sleep disorders - third edition, text revision (ICSD-3-TR). Jun 2023 [internet publication].Full text

Fairbanks DNF, Mickelson SA, Woodson BT, eds. Snoring and obstructive sleep apnea. 3rd ed. Philadelphia, PA: Lippincott, Williams & Wilkins; 2003.

Ramar K, Dort LC, Katz SG, et al. Clinical practice guideline for the treatment of obstructive sleep apnea and snoring with oral appliance therapy: an update for 2015. J Clin Sleep Med. 2015 Jul 15;11(7):773-827.Full text  Abstract

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
  • Snoring images
  • Differentials

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

    • The AASM manual for the scoring of sleep and associated events
    • British Thoracic Society guideline for diagnosing and monitoring paediatric sleep-disordered breathing
    More Guidelines
  • Patient information

    Sleep apnea in adults (obstructive)

    More Patient information
  • Videos

    How to examine the nasal cavity

    More videos
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