SNORING - Nuisance or serious medical problem?

by Timothy A. Queen, MD

What is snoring?

Snoring is a common problem caused by partial upper airway obstruction during sleep. It affects many Americans, more often males than females. Although many children snore, the incidence of snoring increases with age. At age thirty, 20% of men and 5% of women snore. By age sixty, 60% of men and 40% of women snore. The causes of snoring include excessively long soft palate or uvula, large tonsils or adenoids, increased vibration or loss of muscle tone in the throat, nasal septal deviation or allergies, excessively large tongue or abnormalities of the lower jaw, obesity, and the use of alcohol or sedating medications. For children, the primary cause is enlargement of the tonsils and adenoids. For adults, obesity and loss of muscle tone increase the incidence with age. In Hampton Roads, nasal causes are quite frequent, due to the extremely allergic environment in which we live.

Is it just a nuisance?

At first glance, snoring may appear to be a cosmetic problem, leading to no long term health risk, except for occasional disruption of the family unit. But further examination may reveal far more serious and even deadly medical problems. Children with allergies and large tonsils are more likely to develop chronic tonsillitis, bronchitis and asthma. Teens and adults with nasal septal deviation have lower exercise tolerance due to chronic mouth breathing. Frequent snoring can be a clue to check for these other conditions.

Can it be a serious medical problem?

While most snoring is not associated with life-threatening conditions, some patients may have sleep apnea. These patients stop breathing while sleeping. During the apnea event, oxygen levels in the blood fall, stimulating the patient to awaken. This leads to excessive daytime sleepiness which can result in accidents. Over time, the apnea events, increased lung pressure and low oxygen levels can lead to heart and lung failure. Although rare, sudden death syndrome has also occurred from sleep apnea.

How can you tell?

Snoring is an obvious symptom that can be diagnosed by any family member or bed partner. Sleep apnea can be witnessed by an observer, but the patient is usually unaware of the apnea events. Daytime sleepiness or chronic fatigue may be noticed by the patient.Any apnea in a child is considered abnormal, thus witnessed apnea is an indication for treatment. Adults can tolerate a small amount of apnea, so a sleep study is indicated to determine if the amount of apnea is significant. Evaluation by an otolaryngologist (ENT) can determine the cause of the snoring or sleep apnea and allows a treatment plan to be developed.

What can you do about it?

Treatment of snoring is entirely voluntary and is not usually covered by insurance.A variety of products exist to treat snoring, including nasal strips, throat sprays, pillows, and mouth guards, but all have very limited success. A number of in-office procedures have been developed to treat snoring by decreasing palatal vibration. These include laser or radiofrequency procedures on the palate, injection snoreplasty and palatal implants. All have about 80% success with 20% recurrence at one year. They vary in the amount of discomfort and cost. When nasal congestion or sleep apnea is present, treatment is usually covered by insurance. Surgery to improve the nasal airway also reduces snoring, if the patient snores with the mouth open. Sleep apnea can be treated with a machine called CPAP, which keeps the airway open at night. In children, removal of the tonsils and adenoids usually cures sleep apnea. In adults, surgical options exist as an alternative to CPAP. These usually revolve around a palatal procedure called UPPP. Other procedures on the tongue or jaw are sometimes added to improve success. Overall, the success of UPPP can be as high as 80%, depending on patient selection. The biggest cause of failure in the treatment of snoring and sleep apnea is obesity. Thus weight loss is usually a part of the treatment plan.

Timothy A. Queen, M.D., is a board-certified otolaryngologist (ear, nose and throat) with Hampton Roads ENT & Allergy, located in Oyster Point of Newport News. He treats surgical and allergic disorders of the ears, nose and throat in children and adults.