Snoring – a noise generated as a result of partial upper airway

obstruction during sleepApnoea – a period of no airflow in the

nose or mouth for at least 10 seconds

Snoring and OSA

PathophysiologySnoring - Partial obstruction of the upper

airway leads to vibration of the soft palate and pharyngeal walls

NoseSoft palateTongue base

Apnoea – complete obstruction of the airway due to complete collapse

Both associated with obesity but up to 1/3rd of OSA sufferer’s may have a BMI <25

HistoryTry to see with the sleep partner – It is

usually the partner who has a problem with the snoring and they can describe it

Apnoea episodes described?Day time somnolenceAlcoholSmokingSedativesShift workWeight gainNasal obstruction

Examination and InvestigationBMINoseOropharynx – crowded ?RetrognathiaNeck massFBC, TFT, FBS – other cause of fatigueEpworth score < 10 reasurring

Management:Patient presents with snoring or ?OSA GP does EpworthEpworth <10 - OSA unlikely. If anatomical cause for

snoring - nasal polyps, large tonsils – Rx / consider referral to ENTTreat rhinitis or nasal polyps if foundNasal expanders from pharmacistLifestyle advice – weight loss, reduce alcohol, sleep on

side etc

Epworth <10 - OSA unlikely. No anatomical cause found - lifestyle advice - stop smoking, lose weight etc

Epworth <10 - OSA unlikely. No anatomical cause. Lifestyle change not worked. Consider mandibular advancement splint. Patient needs to have a dentist. Dentists can make these but will charge. GPs can refer direct to Simon Littlewood an Orthodontist at St Lukes who will make them on a no charge NHS basis. (We should look at the tariffs for this and if a commissioning group could ask local dentists to make them cheaper than a referral to St lukes. Also a long waiting list at St Lukes.)

Epworth >/= 10 - possible OSA. If anatomical cause for snoring/OSA could refer direct to sleep studies or ENT. Will probably need both anyway as wouldn't usually operate without sleep study results.

Epworth >/= 10 - possible OSA. No anatomical cause for snoring/OSA - refer direct to sleep studies