Snoring Issues: When to Seek Medical Help - Otolaryngology

Dr. Ye Dawei reply Otolaryngology

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If internal medicine treatment does not improve after a period of time, surgical intervention should be considered.
Here is an article for your reference: "The Child's Snoring is Thunderous" – Snoring and Sleep Apnea Syndrome.

In Su Dongpo's poem "Linjiang Xian," he vividly describes the scene of a child's snoring as thunderous, making one feel as if they are experiencing it firsthand.
In the ENT clinic, it is common to see many patients, regardless of age, who are forced to seek treatment due to loud snoring, often at the insistence of parents or partners who fear that the patient may experience sudden death due to breathing cessation.

Here is a brief introduction to snoring and the more severe condition known as sleep apnea syndrome.
"Snoring" refers to the sound produced by the vibration of soft tissues in the soft palate when breathing through the mouth, influenced by airflow.
More severe is "sleep apnea syndrome," which not only includes snoring but also other symptoms such as observable breathing cessation during sleep, sudden awakenings, difficulty breathing, frequent urination, choking, and coughing.
During the day, patients may exhibit symptoms of poor sleep quality, such as fatigue, lack of concentration, memory decline, restlessness, and daytime drowsiness.
Under normal circumstances, both adults and children should not snore if they are breathing through their noses; snoring occurs when mouth breathing causes airflow to vibrate the soft tissues of the soft palate.
Therefore, snoring is more common in patients with upper respiratory infections or allergic rhinitis.
Children may snore due to enlarged adenoids causing nasal obstruction, while adults, particularly overweight middle-aged men with short necks, large tongues, or short jaws, are more prone to snoring due to the necessity of mouth breathing.
"Sleep apnea syndrome" is defined as intermittent cessation of breathing during sleep due to airway obstruction, characterized by more than five episodes of breathing cessation per hour, with each episode lasting more than ten seconds.
During these apneic episodes, although chest movements may be observed, there is little to no airflow through the mouth or nose.
The obstruction may occur at various sites, including the nasal passages, soft palate, or base of the tongue.
This obstruction leads to decreased blood oxygen levels and increased carbon dioxide levels, stimulating the respiratory center to initiate forceful breathing, which results in snoring.
This process repeats throughout the sleep period.
To accurately diagnose this condition, the most important factors are the descriptions provided by family members regarding the patient's sleep patterns, along with the patient's self-reported sleep quality and daytime alertness.
Additionally, the physician will conduct a clinical examination of potential obstruction sites in the nose, mouth, tongue, jaw, or throat, and assess for obesity.
Hospitals can utilize sleep questionnaires, physiological monitoring devices, nocturnal oxygen monitoring, skull X-rays, CT scans, and even MRI to observe changes in snoring, eye movements, brain waves, blood pressure, heart rate, muscle activity, and blood oxygen levels during sleep.
A fiberoptic endoscope can simulate the narrowing of the oropharynx during sleep.
The easiest condition to treat is snoring caused by nasal obstruction, which can be resolved with medication or surgery to clear the nasal passages.
For sleep apnea syndrome, medication is often ineffective.
Initially, physicians will emphasize the importance of weight loss, maintaining a regular schedule, engaging in appropriate exercise, avoiding smoking and alcohol, and refraining from medications that may cause muscle relaxation, such as sedatives or antihistamines.

Snoring or mild sleep apnea syndrome can be treated surgically under local anesthesia using lasers, radiofrequency, or local injection of sclerosing agents.
Moderate to severe sleep apnea syndrome requires more complex surgeries, typically performed under general anesthesia, such as uvulopalatopharyngoplasty (UPPP).
More invasive procedures may include mandibular advancement, tongue base reduction, and hyoid suspension, all aimed at increasing airway space and strengthening surrounding tissues to prevent symptoms caused by tissue relaxation in related areas.

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Reply Date: 2005/04/03