Case Challenge: Evaluating and Managing the Many Variations of Snoring

Gordon H. Sun, MD, MS

Disclosures

October 19, 2018

Pharmacologic Interventions

Image from iStock

Pharmacologic therapy has little role in treating snoring in both patients with and those without OSA. Nasal decongestants, such as oxymetazoline and xylometazoline, have a limited role in snoring treatment owing to the propensity for rebound congestion with excessive use. Moreover, three randomized trials of nasal decongestants, with or without nasal dilator devices, demonstrated minimal effect on subjective and objective sleep outcomes.[3]

Although nasal corticosteroids, such as fluticasone and mometasone, effectively reduce nasal congestion, their impact on objective measures of OSA is limited. Most randomized trials of intranasal corticosteroid versus saline sprays demonstrated no significant impact on AHI or snoring.[3,4] An exception is a 2004 study by Kiely and colleagues,[5] which showed a significant decline in AHI among patients using fluticasone compared with those using an aqueous placebo spray.

Some alternative medicine practitioners and patients purport that homeopathic intranasal compounds, including essential volatile oils, reduce snoring by lubricating the upper airways. However, a review of multiple randomized trials of various homeopathic products demonstrated questionable methodology (eg, no objective outcomes, unexplained dropout rates) and mixed results.[6]

Heavy Snoring and Allergic Rhinitis

A 28-year-old male graduate student presented to a nurse practitioner at the university health clinic for evaluation of heavy snoring and nasal congestion. The patient stated that although he used over-the-counter external nasal dilator strips at bedtime, he still experienced episodes of snoring. He was taking intranasal fluticasone for allergic rhinitis but was otherwise healthy, with no other symptoms. He denied smoking or alcohol use, but admitted to frequent caffeine consumption.

Vital signs were within normal limits. Physical examination revealed a well-nourished man with a nasal septal deviation and 4+ tonsils bilaterally, but no other pertinent findings. A PSG demonstrated an AHI of six events per hour, indicating mild OSA.

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