Last reviewed: 23 Apr 2025
Last updated: 19 Jan 2024
Summary
Snoring is a common symptom caused by a spectrum of sleep-disordered breathing disorders, ranging from intermittent simple snoring to chronic heavy simple snoring, upper airway resistance syndrome, and obstructive sleep apnea.
It is important to rule out obstructive sleep apnea in patients who snore.
Can be a significant problem for both the patient and their bed partner. It may result in serious strain in a relationship and be socially disruptive.
Common clinical features in patients who snore are obesity, retrognathia, large tongue, and large tonsils.
Most patients will benefit from losing weight, stopping smoking, and avoiding alcohol.
Some patients may benefit from using a mandibular advancement splint or from upper airway surgery. Surgical options may produce high initial success rates, but this reduces over time.
Childhood snoring is most commonly due to adenotonsillar hypertrophy and usually resolves with age, but if associated with features of obstructive sleep apnea, refer to a specialist as adenotonsillectomy may be required.
Definition
Snoring is the noise produced by vibration of the upper airway walls as a result of partial upper airway obstruction during sleep. It can be caused by a spectrum of sleep-disordered breathing disorders, ranging from intermittent simple snoring to chronic heavy simple snoring, upper airway resistance syndrome (UARS), and obstructive sleep apnea-hypopnea.
History and exam
Key diagnostic factors
- noisy breathing during sleep
- apneas
- choking or gasping
Full details
Other diagnostic factors
- waking up tired
- daytime somnolence
- hyperactivity
- behavioral problems
- night terrors
- enuresis
Full details
Risk factors
- increasing age
- male sex
- obesity (BMI >30)
- craniofacial abnormalities
- endocrine disorders
- neck circumference over 40 cm
- sedating medications
- adenotonsillar hypertrophy
- long soft palate and uvula
- alcohol consumption
- Down syndrome
- gastroesophageal reflux
- active or passive smoking
- abnormal epiglottis
- hypopharyngeal cysts or tumors
- rhinitis/nasal obstruction
- asthma
Full details
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Diagnostic tests
1st tests to order
- nasal decongestant test
- Epworth sleepiness score (ESS)
Full details
Tests to consider
- snoring scale score
- TFTs
- growth hormone level
- skin-prick tests/serum allergen-specific IgE tests
- sleep study
- acoustic analysis
- pharyngeal manometry
- sleep nasendoscopy
Full details
Emerging tests
- head and neck 3-dimensional CT
- head and neck MRI
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Treatment algorithm
ONGOING
adult: without UARS or OSA
adult: with UARS or OSA
child: without concurrent indication for tonsillectomy or adenoidectomy
child: with concurrent indication for tonsillectomy or adenoidectomy
child: with UARS or OSA
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Contributors
Authors
Nadia Ashraf, BMBS, BMedSci(Hon), DA, DOHNS, FRCS(ORL-HNS)
Specialty Registrar in Otorhinolaryngology-Head & Neck Surgery
Sheffield Teaching Hospitals NHS Trust
Sheffield
UK
Disclosures
NA declares that she has no competing interests.
Showkat Mirza, BM, BS, BMedSci, FRCS(ORL-HNS)
Consultant in Otorhinolaryngology-Head & Neck Surgery
Sheffield Teaching Hospitals NHS Trust
Sheffield
UK
Disclosures
SM declares that he has no competing interests.
Peer reviewers
Jayant Pinto, MD
Assistant Professor of Surgery
Section of Otolaryngology-Head and Neck Surgery
University of Chicago
Chicago
IL
Disclosures
JP declares that he has no competing interests.
Michael J. Hensley, MBBS, PhD, FRACP
Director
Department of Respiratory and Sleep Medicine
John Hunter Hospital
Professor and Head
School of Medicine and Public Health
Faculty of Health
The University of Newcastle
NSW
Australia
Disclosures
MJH declares that he has no competing interests.
References
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Key articles
Savage CR, Steward DL. Snoring: a critical analysis of current treatment modalities. Does anything really work? Curr Opinion Otolaryngol Head Neck Surg. 2007 Jun;15(3):177-9.Abstract
Kubba H. A child who snores. Clin Otolaryngol. 2006 Aug;31(4):317-8.Abstract
Fairbanks DNF, Mickelson SA, Woodson BT, eds. Snoring and obstructive sleep apnea. 3rd ed. Philadelphia, PA: Lippincott, Williams & Wilkins; 2003.
Friedman M. Prognostic indicators for successful uvulopalatopharyngoplasty. Sleep. 2000;23:A268.
