History and exam

Key diagnostic factors

common

noisy breathing during sleep

The patient and/or bed-partner will report noisy breathing during sleep that is consistent with snoring.

Severity of the snoring can be assessed by asking if the snoring can be heard by the next-door neighbor, anywhere in the house, in an adjacent room, or just in the same room.

The level of disturbance caused by the snoring can be indicated by whether the partner sleeps separately and if so, how often.

uncommon

apneas

Witnesses noticing that the patient stops breathing for 10 seconds or more suggests obstructive sleep apnea (OSA), but this is not reliable.

choking or gasping

Such symptoms suggest apneas but are unreliable.

Other diagnostic factors

uncommon

waking up tired

Suggestive of OSA.

daytime somnolence

Suggestive of OSA.

hyperactivity

Associated with OSA in children.

behavioral problems

Associated with OSA in children.

night terrors

Rarely associated with OSA in children.

enuresis

Rarely associated with OSA in children.

Risk factors

strong

increasing age

In the 30- to 35-year-old age group, 20% of men and 5% of women will snore. By 60 years of age, 60% of men and 40% of women will snore habitually.[6][7]

male sex

A number of studies show the incidence of snoring is greater in men than in women.[1]​[5][6][8][13][14]​​​​

In the 30- to 35-year-old age group, 20% of men and 5% of women will snore. By 60 years of age, 60% of men and 40% of women will snore habitually.[6][7]

obesity (BMI >30)

The greater the BMI of a person, the more likely the person will snore.[1]​[5][6][14]​​​ However, it should also be noted that many thin, athletic people snore.

craniofacial abnormalities

Underlying skeletal anatomy may result in a narrowed airway predisposed to snoring.

Retro- or micrognathia prevents the tongue from being positioned sufficiently forward during sleep, thereby also predisposing to snoring.

endocrine disorders

Hypothyroidism can result in weight gain and reduce upper airway muscle tone.

Acromegaly can also lead to weight gain and enlargement of the tongue.

neck circumference over 40 cm

This is measured at the level of the cricothyroid space and gives an indication of fat deposits in the neck. Patients with a neck circumference over 40 cm are at an increased risk of snoring.[6] Some patients who snore can have a reasonable BMI, yet still have a relatively fat neck.

sedating medications

Sedating medications such as sleeping tablets, tranquilizers, and antihistamines lower upper airway muscle tone and predispose to snoring.[1]​[11]​​​​

adenotonsillar hypertrophy

The most common cause of snoring in children.[4]

Adenoid hypertrophy is rare in adults, but when it does occur it is usually in young adults.

Tonsillar hypertrophy is relatively common in adults and removal may cure snoring.

long soft palate and uvula

Predisposes to snoring by narrowing the opening from the nose into the throat and acting as a noisy flutter valve during relaxed breathing. Webbing of the uvula worsens the problem.

alcohol consumption

Causes a deeper sleep and lowering of upper airway muscle tone.[1]​[15][16][17]​​

Alcohol dependence has been associated with self-reported snoring in lean women.[18]

Down syndrome

The tendency for snoring is increased in patients with Down syndrome due to their narrowed craniofacial anatomy and comparatively large tongue.

active or passive smoking

Causes inflammation and congestion of the upper airway.[5][20][21]

Active and passive smoking are risk factors for snoring.[1]​ The frequency of habitual snoring increases with the amount of tobacco smoked.[20]

rhinitis/nasal obstruction

Those with allergic rhinitis/nasal obstruction are significantly more likely to report habitual snoring.[1]​[22]​​​​

Nasal surgery may help snoring but results are often unpredictable.[23]

weak

gastroesophageal reflux

May aggravate snoring by causing inflammation and congestion of the upper airway.[19]

abnormal epiglottis

Rare cause of upper airway obstruction predisposing to snoring.

hypopharyngeal cysts or tumors

Rare causes of upper airway narrowing predisposing to snoring.

asthma

The development of asthma may play a role in the development of habitual snoring.[5]

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