Snoring is a common complaint of patients (and their spouses) treated by otolaryngologists. Experts at a panel discussion during the AAO-HNSF annual meeting cautioned that although there are good treatments for snoring reduction, complete elimination of snoring is rare. Snoring should be regarded as a condition that is managed over time. Even when snoring is improved, partial setbacks are common.
Explore this issue:April 2008
You have to set realistic expectations for patients. Snoring can come back after it is treated, and it is almost never eliminated entirely. First make sure that the problem reported by the patient is actually simply snoring and not obstructive sleep apnea, said Edward M. Weaver, MD, Associate Professor of Otolaryngology and Surgical Program Director of the Sleep Disorders Center at the University of Washington School of Medicine in Seattle, who moderated the panel discussion.
Rule Out Sleep Apnea
Sleep apnea is associated with cardiovascular and other morbidity. Panelists agreed that sleep apnea should be ruled out by an overnight sleep study, although this is controversial among community otolaryngologists. B. Tucker Woodson, MD, Professor and Chief of the Division of Sleep Medicine and Department of Otolaryngology and Communication Sciences at the Medical College of Wisconsin in Milwaukee, said that patients with snoring are at risk of developing sleep apnea over time, and from a medicolegal point of view, testing should be done and documented.
There is a lot of denial on the part of the patient. The spouse will say the patient snores, but the patient says no. I encourage patients to take a sleep test, and I assess the patient for the likelihood of sleep apnea based on physical findings combined with history. If the patient is unwilling to have a sleep study, I would do a Pillar procedure, said Michael Friedman, MD, Professor of Otolaryngology and Chairman of the Section of Sleep Surgery at Rush University Medical Center and Chairman of Otolaryngology at Advocate Illinois Masonic Medical Center in Chicago.
Polysomnography should be done before any pharyngeal surgery, said Samuel A. Mickelson, MD, Medical Director of the Atlanta Snoring and Sleep Disorders Institute, a division of Advanced Ear Nose and Throat Associates in Atlanta. He said that he assesses all factors that could influence the development of sleep apnea, such as neck circumference, pharyngeal collapse on exam, Friedman tongue position II, III, and IV, and the presence of comorbidities such as coronary artery disease.
It will help to get reimbursement for polysomnography if these factors are present, Dr. Mickelson said. He noted that the American Academy of Sleep Medicine (www.aasmnet.org ) has a position paper on when to get a sleep study.