Snoring

Snoring.png


Red Flags requiring urgent ENT review:

  •   Difficulty breathing while awake


Assessment

History

  • Duration

  • Pauses in breathing when asleep (apnoeas)

  • Effect on daytime function (tiredness, hyperactivity, focus, behavioural difficulties)

  • Occupation

  • Related symptoms (tonsillitis, rhinitis)

Examination

  • Mouth: Tonsillar hypertrophy, nasal airflow (misting on a metal object – adenoidal hypertrophy)

  • BMI

  • Neck circumference

Epworth Sleepiness Scale (link)

  • This scale determines the likelihood of obstructive sleep apnoea. It will help guide you decision making regarding onward referral if the patient’s score is >12. Assessment and treatment of simple snoring is not usually funded by CCGs.

 

Sleep Disordered Breathing

Obstructive Sleep Apnoea (OSA)

OSA in adults has a similar detrimental affect as in children. Obesity and a large neck size can be attributing factors. After conservative management (weight loss, alcohol avoidance, sleep hygiene) has failed, patients can be trialled with continuous positive airway pressure machines or mandibular advancement devices. Surgical management have poor outcomes so is only used in selected cases but these can be helpful to take patients off CPAP.

 

Referral Pathways 

Same day

  • Difficulty breathing while awake

Routine referral

  • Adults with a history suggestive of OSA to respiratory or a sleep medicine specialist

 

More Information:

https://www.england.nhs.uk/evidence-based-interventions/interventions/

  

 

Author: Elliot Heward ENT Registrar North West Deanery