Last updated: 11/24/2009

Diagnosis

The most important task in diagnosing a patient's snoring is to distinguish between primary snoring and obstructive sleep apnea. The reason for care in the diagnosis is that surgical treatment without the recommended tests for OSA can complicate later diagnosis of the disorder.

The sounds made when a person snores have a number of different physical causes. Snoring noises may result from one or more of the following:

• An unusually long soft palate and uvula. These structures narrow the airway between the nose and the throat. They act like noisy flutter valves when the person breathes in and out during sleep.
• Too much tissue in the throat. Large tonsils and adenoids can cause snoring, which is one reason why tonsillectomies are sometimes recommended to treat heavy snoring in children.
• Nasal congestion. When a person's nose is stuffy, their attempts to breathe create a partial vacuum in the throat that pulls the softer tissues of the throat together. This suction can also produce a snoring noise. Nasal congestion helps to explain why some people snore only when they have a cold or during pollen season.
• Anatomical deformations of the nose. People who have had their noses or cheekbones fractured or who have a deviated septum are more likely to snore, because their nasal passages develop a twisted or crooked shape and vibrate as air passes through them.
• Sleeping position. People are more likely to snore when they are lying on the back because the force of gravity draws the tongue and soft tissues in the throat backward and downward, blocking the airway.
• Obesity. Obesity adds to the weight of the tissues in the neck, which can cause partial blockage of the airway during sleep.
• Use of alcohol, sleeping medications, or tranquilizers. These substances relax the throat muscles, which may become soft or limp enough to partially close the airway.

Because snoring may be related to lifestyle factors, upper respiratory infections, seasonal allergies, and sleeping habits as well as the anatomy of the person's airway, a complete medical history is the first step in determining suitable treatments. In some cases the patient may have been referred by his or her dentist on the basis of findings during a dental procedure. A primary care doctor can take a history and perform a basic examination of the patient's nose and throat. In addition, the primary care doctor may give the patient one or more short questionnaires to evaluate the severity of daytime sleepiness and other problems related to snoring. The test most commonly used is the Epworth Sleepiness Scale (ESS), which was developed by an Australian physician, Dr. Murray Johns, in 1991. The ESS lists eight situations (reading, watching TV, etc.) and asks the patient to rate his or her chances of dozing off in each situation on a four-point scale (0–3, with 3 representing a high chance of falling asleep). A score of 6 or lower indicates that the person is getting enough sleep; a score higher than 9 is a danger sign. The ESS is often used to measure the effectiveness of various treatments for snoring as well as to evaluate patients prior to surgery.

The next stage in the differential diagnosis of snoring problems is a detailed examination of the patient's airway by an otolaryngologist, who is a physician who specializes in diagnosing and treating disorders involving the nose and throat. The American Sleep Apnea Association (ASAA) maintains that no one should consider surgery for snoring until their airway has been examined by a specialist. The otolaryngologist will be able to determine whether the size and shape of the patient's uvula, soft palate, tonsils and adenoids, nasal cartilage, and throat muscles are contributing factors, and to advise the patient on specific procedures. It may be necessary for the patient to undergo more than one type of treatment for snoring, as some surgical procedures correct only one or two structures in the nose or throat.

A complete airway examination consists of an external examination of the patient's face and neck; an endoscopic examination of the nasal passages and throat; the use of a laryngeal mirror or magnifying laryngoscope to study the lower portions of the throat; and various imaging studies. The otolaryngologist may use a nasopharyngoscope, which allows for evaluation of obstructions below the palate and the tongue, and may be performed with the patient either awake or asleep. The nasopharyngoscope is a flexible fiberoptic device that is introduced into the airway through the patient's nose. Other imaging studies that may be done include acoustic reflection, computed tomography (CT) scans, or magnetic resonance imaging (MRI).

In addition to the airway examination, patients considering surgical treatment for snoring must make an appointment for sleep testing in a specialized laboratory. The American Academy of Sleep Medicine recommends this step in order to exclude the possibility that the patient has obstructive sleep apnea. Sleep testing consists of an overnight stay in a special sleep laboratory. Before the patient goes to sleep, he or she will be connected to a polysomnograph, which is an instrument that monitors the patient's breathing, heart rate, temperature, muscle movements, airflow, body position, and other measurements that are needed to evaluate the cause(s) of sleep disorders. A technician records the data in a separate room. As of 2003, some companies are developing portable polysomnographs that allow patients to connect the device to a computer in their home and transmit the data to the sleep center over an Internet connection.

Preparation

Apart from the extensive diagnostic testing that is recommended, preparation for outpatient snoring surgery is usually limited to taking a mild sedative before the procedure. Preparation for UPPP requires a physical examination, EKG, blood tests, and a preoperation interview with the anesthesiologist to evaluate the patient's fitness for general anesthesia.