Snoring

Snoring in children

Causes of nasal blockage that can lead to snoring, mouth breathing, reduced sense of smell, dribbling, and possibly obstructive sleep apnoea (OSA): rhinitis (if transient); rhinosinusitis (less common in children, if intermittent with associated symptoms); adenoid hypertrophy causing postnasal space obstruction; nasal foreign body; unilateral choanal atresia; tumour (rare — consider juvenile nasopharyngeal angiofibroma).

Snoring and OSA are almost always due to adenotonsillar hypertrophy in children.

Not all snoring is OSA — polysomnography is the gold-standard diagnostic test; overnight oximetry is a useful screening tool where polysomnography isn’t readily accessible. Watchful waiting is appropriate for mild cases; intranasal steroids can help mild-moderate disease. Adenotonsillectomy is effective for otherwise-healthy children with moderate-severe OSA and adenotonsillar hypertrophy — most cases are relieved by surgery.

Snoring in adults

Features: sometimes indicates OSA, especially in perimenopausal women; three times more common in obese people. Generally harmless, but if severe, unusual, or associated with periods of no breathing, further assessment is warranted.

Aggravating factors: obesity; older age; sleeping on the back; sleep deprivation; excess alcohol; neck problems (especially a “thick”, inflexible neck); drugs (especially sedatives/sleeping pills); hay fever and other causes of nasal congestion; upper airway problems (nasal polyps, enlarged tonsils, foreign body); endocrine abnormalities (e.g. acromegaly, hypothyroidism).

Adult OSA diagnosis and management sits primarily within respiratory medicine — see the respiratory category for the full adult OSA pathway.