points in history, examination and assessment
Last reviewed 01/2018
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: