Assessment and management of the patient presenting with snoring

Snoring is experienced regularly by approximately 30% of male adults, of whom one in seven will have obstructive sleep apnoea syndrome. Women experience snoring and apnoea at a rate of approximately half of that of men.

General practitioners have a key role in the management of snoring. Patients whose symptoms of excessive sleepiness and loud habitual snoring more than three times per week, should alert the GP to the presence of apnoeas.

The co-existence of systemic essential hypertension, especially if more than two drugs are required for its control, or any other cardiovascular disease, would increase suspicion of significant sleep apnoea. Conservative measures such as reduction in weight, alcohol and nasal resistance can be instigated in such patients immediately. Patients who have failed conservative treatment, or have suspected moderate to severe apnoea, need to be referred to a physician trained in sleep disorders for further evaluation and management. Snoring represents a trumpeters introduction to the three spectra of sleep related breathing disorders. These vary from simple snoring to profoundly severe snoring associated with obstructive sleep apnoea syndrome and cardiovascular sequelae, through to orthopnoea, paroxysmal nocturnal dyspnoea and fragmented sleep associated with unstable or decompensated cardiovascular and/or pulmonary disease.