Case Challenge: Evaluating and Managing the Many Variations of Snoring

Gordon H. Sun, MD, MS


October 19, 2018

Images from Alamy (top) and Shutterstock (bottom)

In 2016, Camacho and colleagues[7] performed a meta-analysis of 14 studies examining external (Breathe Right® Nasal Strips) and internal (Nozovent®) nasal dilators for the treatment of OSA and snoring. Data from 10 eligible studies in their analysis showed that nasal dilators (regardless of type) had no significant impact on AHI. In addition, data from six of the studies demonstrated a statistically insignificant decline in snores per hour (pre-treatment, 148.2 ± 268.2; post-treatment, 96.3 ± 178.2; P = .09).

A secondary analysis of these data compared external and internal nasal dilators and found that external devices reduced snoring in 60 patients by 3.08 snores per hour, whereas internal devices reduced snoring in 51 patients by 86.54 snores per hour; both of these findings were statistically insignificant.

When Is Sleep Testing in Children Warranted?

A 10-year-old boy was brought by his parents to the pediatrician for evaluation of a 1-year history of witnessed snoring and apneic spells. The child conceded that he often felt sleepy during the day and his mother reported that, without complaint, he napped immediately upon returning home from school.

The child denied trouble breathing during daytime hours, dysphagia, or dysphonia. He had no recent fever or cough, although his younger brother had experienced intermittent sore throats over the past few months. Except for a previous diagnosis of obesity, his medical history was unremarkable. He had no surgical history; was not on any medications; and had no known drug, food, or environmental allergies. The patient's father admitted to smoking cigarettes, but said he only did so outside of the home.

On exam, the child's vital signs were within normal limits, and he appeared comfortable. His body mass index was above the 95th percentile for his age. No stridor or stertor was audible, and his voice was clear. Examination of the eyes, ears, and nose was unremarkable. The oral examination demonstrated grossly enlarged tonsils that touched at the midline; a normal-appearing uvula, palate, and tongue; and no mucosal lesions. The patient's neck was flat, with full range of motion; no masses were palpated, and the trachea was midline. The remainder of the physical examination was normal.


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