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management of snoring

Snoring basics. Common15-20% of children60% 60 year old men 40% 60 year old womenDirectly related to BMIMost common exacerbating factor is alcohol. Snoring basics 2. Vibration of the upper airwaysInspirationCollapse of the upper airwayA minority of cases caused by nasal obstructionVery rarely caused by unusual pathologySevere snorers may have obstructive sleep apnoea (OSA).

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management of snoring

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    1. Management of snoring John Waldron 15 October 2008

    2. Snoring basics Common 15-20% of children 60% 60 year old men 40% 60 year old women Directly related to BMI Most common exacerbating factor is alcohol

    3. Snoring basics 2 Vibration of the upper airways Inspiration Collapse of the upper airway A minority of cases caused by nasal obstruction Very rarely caused by unusual pathology Severe snorers may have obstructive sleep apnoea (OSA)

    4. Snoring basics 3 In patients with a BMI in the normal range vibration of the soft palate and uvula is the most common cause In overweight patients multi level collapse of the pharyngeal airway due to sub mucosal adipose tissue narrowing is common

    5. Obstructive sleep apnoea Breathing stops due to complete collapse of the airway Period of silence, may last 30 seconds or more Frequency of episodes is a measure of severity May wake the patient Prevents them reaching deeper (REM) “restorative” sleep levels Wake feeling unrefreshed, headache, hypersomnolence, tiredness, accidents, reportable to the DVLA May lead to cardiac problems in severe cases

    6. Snoring history How long How often Time course Positional Consequences for the partner, patient, others History of apnoea, patient waking, quality of sleep, hypersomnolence (Epworth)

    7. Snoring history 2 BMI Weight change over time and relationship to snoring Collar size Nasal obstruction Smoking Alcohol intake, timing, and relationship to snoring

    8. Snoring examination Mouth including soft palate and tongue Jaw (retrognathia) Nasal airway Nasendoscopy NE with forced inspiration NE with forced snoring Measure BMI

    9. Snoring investigations Sleep study if concern about significant sleep apnoea If doubt about frequency/length of apnoeas ask partner to observe

    10. Snoring treatment Is treatment necessary? Earplugs Sleeping position Separate rooms Stop smoking Alter alcohol intake Treat nasal obstruction with topical steroid or topical/systemic decongestant

    11. Snoring treatment 2 Treat nasal obstruction which is significant on its own with medical treatment or surgery Weight reduction

    12. Snoring treatment 3 Mandibular advancement splint – can be tried in any patient CPAP for patients with significant sleep apnoea Surgery can be considered in patients who do not have significant sleep apnoea

    13. Surgery for snoring Trimming of soft palate +/- tonsillectomy Laser/electrocautery/microfrequency Much less successful in significantly overweight patients Much less successful in patients with significant sleep apnoea Painful, small risk of significant complications with speech and swallowing

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