Snoring / Obstructive Sleep Apnea
Approximately 50% of healthy adults snore occasionally, and at least 25% are habitual snorers. Factors that increase the risk of snoring are being overweight, increased age, and being male. 10% of children snore regularly, which can disrupt normal sleep and affect growth, behavior, and learning. Snoring generally indicates obstructive breathing and should not be overlooked, as it can be a sign of something more serious like obstructive sleep apnea. In addition, snoring can cause the bed partner to experience sleep disturbance and fatigue.
Causes and Evaluation of Snoring
Obstruction to the free flow of air throughout the passages at the back of the mouth and nose cause snoring. The vibration of the collapsible part of the airway, where the tongue and upper throat meet the soft palate and uvula, causes the noisy sounds of snoring. In children, enlarged tonsils and adenoids are the most common cause of snoring. Obstruction of the nasal airways also can require extra effort to move air through the upper airway, pulling together the floppy tissues of the throat. An otolaryngologist evaluates for different causes of snoring by performing examination of the upper airway including the nose, mouth, throat, palate, and neck, sometimes using a fiberoptic scope.
Obstructive Sleep Apnea (OSA)
Patients with OSA experience multiple episodes of pauses in breathing greater than 10 seconds at a time, due to upper airway narrowing or collapse. This results in lower amounts of oxygen in the blood, causing the heart to work harder. Apnea patients may experience 30 to 300 such events per night. Sometimes, a sleep study or polysomnograph (PSG) is required to diagnose OSA. This test is done overnight, either at home or in a sleep lab, where wires are attached to the body to monitor oxygen, breathing, and air movement.
Treatment depends on the severity of the snoring and if OSA is present, and the level(s) of the upper airway that are narrow. Sometimes, more than one area is involved, requiring multiple different treatments. CPAP is the initial treatment of choice for patients with OSA. This device opens the airway with positive pressure delivered via a mask during sleep. Occasionally, surgery can be effective for opening a narrow portion of the upper airway. This can include nasal surgery for nasal airway obstruction, uvulopalatopharyngoplasty (UPPP) which removes and stiffens a portion of the tissue in the soft palate, and tonsillectomy with or without adenoidectomy. There are methods to increase the stiffness of the palate without removing tissue. Stiffening rods called “Pillar implants” can be inserted into the soft palate. Occasionally a custom-fit oral appliance can reposition the lower jaw forward to open the airway behind the tongue. This is something fitted by a dentist.