Case Challenge: Evaluating and Managing the Many Variations of Snoring

Gordon H. Sun, MD, MS

Disclosures

October 19, 2018

Oral Appliances to Ameliorate Snoring

Image from iStock

OA devices protrude and stabilize the mandible to open the upper airway during sleep.[1] The 2015 American Academy of Sleep Medicine and American Academy of Dental Sleep Medicine clinical practice guideline update for the treatment of OSA and snoring with OA therapy presented high-quality evidence that patients who use OAs experience reductions in snoring nights per week, snores per hour, and snoring loudness.[2] However, owing to insufficient evidence, the guideline was unable to determine whether OAs improved quality of life in patients with primary snoring, or whether OAs were more or less effective than continuous positive airway pressure for the reduction of primary snoring.

Nasal Congestion and Snoring: Is Surgery Always the Answer?

A 27-year-old female emergency medical technician presented to her family physician for evaluation of intermittent bilateral nasal congestion, which, according to the patient's boyfriend, caused her to snore loudly and frequently. She denied rhinorrhea, epistaxis, sneezing, daytime sleepiness, voice or swallowing difficulties, dyspnea, or constitutional symptoms. Her medical history was unremarkable, and she had no prior surgical history. Her social history was negative for smoking and alcohol consumption. She was not taking any medications and had no known drug or environmental allergies.

Vital signs were within normal limits. Physical examination revealed a mildly deviated nasal septum and 3+ tonsils, but no other notable pathology. A PSG study documented an AHI of seven events per hour, suggesting mild OSA.

On the basis of the PSG findings, the patient was referred to an otolaryngologist for possible oropharyngeal surgery. However, she was reluctant to pursue surgery, citing concerns about the potential for severe throat pain and a protracted recovery period, and inquired about nonsurgical alternative therapies, including medications, to relieve her snoring.

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