Points in history, examination and assessment

Points in the history include:

• who is most affected by the snoring - the patient's partner or the patient
• assess how disruptive to life and relationships the snoring has become
• the length of time that snoring has been a problem
• has the patient put on weight or increased his collar size lately
• is there his of excessive alcohol intake - does alcohol intake affect effect snoring
• is the patient taking sleeping tablets or other sedatives
• does change of positon affect snoring - in general, snoring is worst when the person is supine
• is there a history of nasal problems, such as trauma, congestion, or anosmia associated with nasal polyps
• has the patient got obstructive sleep apnoea
  • has there been episodes where the patient has been noted to stop breathing (apnoeic episodes)
  • has the patient woken with a choking sensation
  • does the patient have excessive daytime sleepiness
  • other symptoms that may occur with obstructive sleep apnoea include non-refreshing sleep, nocturia, morning headaches, poor concentration, or car crashes attributable to sleepiness

Examination:

• weight and height, neck size (using a tape measure if possible, although accurate shirt size will suffice), body mass index
  • 50% of patients with obstructive sleep apnoea have a BMI > 30
  • neck circumference above 43 cm - a neck circumference of this size correlates well with snoring and obstructive sleep apnoea
• examination of nose
  • any obstruction e.g. polyps or septal deviation. Assess whether obstruction is this unilateral or bilateral
• examination of oropharynx
  • assess degree of crowding and size of tonsils and uvula
  • ? retrognathia—a receding lower jaw giving an overbite when the teeth are opposed

Investigations in primary care:

• could the patient by hypothyroid - consider TFTs

Reference:

1. Parker RJ et al. 10-minute consultation.Snoring.BMJ 2005;331:1063.