Even in the absence of apnoeic episodes, the patient who snores may be suffering from the upper airway resistance syndrome. This syndrome is associated with hypertension and heart problems. In the upper airway resistance syndrome, polysomnography findings show no apnoeic episodes or oxygen desaturation but repeated transient arousals and fragmented sleep.
Snoring and obstructive sleep apnea syndrome
In adults, snoring and obstructed sleep apnea syndrome (OSAS) are considered as related entities along a disease severity curve, with OSAS the more severe condition. Virtually all patients with OSAS snore. In simple snoring, the airway remains normal, or slightly narrowed; however, moderate to severe narrowing produces heavy snoring and sleep apnea, which is a serious life threatening condition.
CPAP (continuous positive airway pressure) via a face mask is the accepted treatment for moderate to severe OSAS. Unfortunately up to 30% of sufferers either refuse or cannot comply with CPAP. Some of these patients can be helped by LAUP (Laser assisted Uvulopalatoplasty) particularly if the major obstruction is in the soft palate and tonsillar regions.
In children, snoring and OSAS are also common; however, in this group, the features of the disease and its management are unique and are outside the scope of this article.
Evaluating the snorer
It is important for the GP to make the distinction between the fit, healthy 'snorer' with adequate breathing and the patient who may have sleep apnea that is life-threatening.
