Sleep-disordered breathing includes primary snoring and obstructive sleep apnea (OSA). Snoring occurs when tissues vibrate as air passes through a narrowed upper airway. In obstructive sleep apnea, the airway repeatedly narrows or closes, reducing or stopping airflow during sleep.
These problems may involve the nose, nasal passages, soft palate, tongue, throat or other upper airway passages. Problems that affect breathing or sleep quality may also come from a different sleep disorder or medical condition and require another medical speciality.
Causes, assessment and treatment of snoring, especially if you snore loudly or often have a stuffy nose.
These can be warning signs of obstructive sleep apnea, particularly with loud habitual snoring.
Brief arousals can interrupt deep sleep, even when you do not remember waking.
Fragmented sleep can affect alertness, concentration, memory, mood and driving safety.
These may require assessment for central sleep apnea or another medical cause.
Mouth breathing, restless sleep, bedwetting, hyperactivity or poor concentration may accompany paediatric obstructive sleep apnea.
Many people snore occasionally, such as when they have a cold. SingHealth cites a local study reporting that approximately 24% of adults were loud habitual snorers. Reduced muscle tone, sleep position, nasal congestion or a stuffy nose can narrow the airway and make the soft palate and other tissues vibrate. Primary snoring means snoring without obstructive sleep apnea or another associated sleep-related breathing disorder. The absence of witnessed breathing pauses does not rule out sleep apnea.
With obstructive sleep apnea, brief arousals reopen the airway so normal breathing resumes. These events can fragment sleep and lower blood oxygen levels. Not everyone who snores has sleep apnea. However, loud snoring followed by silence, gasping or choking should be assessed. A Singapore study published in 2016 estimated that 30.5% of adults aged 21 to 79 had moderate to severe sleep-disordered breathing, with many cases previously undiagnosed.
| Feature | Snoring | Obstructive sleep apnea | Central sleep apnea |
|---|---|---|---|
| Main problem | Tissue vibration in a narrowed airway | Repeated upper-airway narrowing or closure | Reduced or absent signals from the brain to breathe |
| Common night-time clue | Noisy breathing | Snoring, pauses, gasping or choking | Breathing pauses that may be quiet |
| Daytime effect | May be absent | Sleepiness, poor concentration or irritability | Fatigue, sleepiness or poor concentration |
| How it is confirmed | Clinical assessment, with testing when indicated | Sleep study | Sleep study and assessment for an underlying cause |
Snoring
Snoring occurs when tissues in the upper airway vibrate during sleep. Nasal blockage, mouth anatomy, alcohol, sleep position and excess weight can contribute.
Sleep apnea
An overview of this sleep disorder, its main types and the usual assessment pathway.
Obstructive sleep apneaÂ
Repeated airway obstruction during sleep. This is the most common type of sleep apnea.
Central sleep apnea
Breathing pauses caused by reduced brain signals rather than physical airway closure.
Complex sleep apnea
Central breathing events that emerge or persist during continuous positive airway pressure (CPAP) treatment.
Idiopathic central sleep apnea
Central sleep apnea for which no underlying cause is identified after assessment.
Children with persistent snoring need age-appropriate assessment. Enlarged tonsils and adenoids commonly contribute. Obesity, nasal allergies, craniofacial differences, and neuromuscular conditions may also increase risk.
Disruptive snoring can reduce a person’s sleep quality and affect a partner’s sleep. Whether snoring is dangerous depends mainly on whether breathing is disrupted. Untreated obstructive sleep apnea is associated with high blood pressure, heart rhythm problems, cardiovascular complications such as heart attacks and strokes, metabolic problems and accident risks.
Sleep disruption may contribute to sleep deprivation, daytime fatigue, poor concentration and mood disturbances. However, these potential health complications do not occur in every person with sleep apnea.
The medical assessment usually begins with your symptoms, sleep history, sleep patterns, medical history and information from a partner. Your doctor may ask about snoring, witnessed pauses, daytime sleepiness, weight changes, consumption of alcohol, sleeping pills and other medicines. Risk factors include excess weight, certain airway features and existing heart or metabolic conditions.
An ENT examination can assess the nasal passages, mouth, soft palate and throat. Possible contributors include nasal obstructions, nasal congestion, allergic rhinitis, a deviated septum, enlarged turbinates, nasal polyps, enlarged tonsils, or a crowded upper airway.
Sleep testing is needed to confirm sleep apnea and assess its type and severity. A laboratory sleep study records brain activity, breathing, heart rate and oxygen levels. A home sleep apnea test usually records fewer signals and may suit selected adults with suspected obstructive sleep apnea. Your doctor will recommend the appropriate test. If a home test is negative or inconclusive but concern remains, a laboratory study may be needed.
Lifestyle changes may help reduce snoring.
However, please note these measures do not stop snoring for everyone and do not replace prescribed therapy.
Continuous positive airway pressure (CPAP) delivers air through a mask to keep the upper airway open. It is the primary treatment for symptomatic obstructive sleep apnea and can reduce breathing events and daytime sleepiness with consistent use.
A mandibular advancement device holds the lower jaw forward during sleep. A dentist trained in dental sleep medicine may recommend this oral appliance therapy for selected people with primary snoring or mild to moderate sleep apnea. Follow-up checks comfort, bite changes, and treatment effectiveness.
Surgery for primary snoring or sleep apnea should address a confirmed obstruction site. An ENT assessment, test results, and sometimes a sleep endoscopy help determine whether surgery is appropriate.
Relevant procedures include:
These procedures serve different purposes and carry different risks. Nasal surgery may improve nasal airflow or CPAP tolerance without resolving obstruction elsewhere in the upper airway.
Arrange a medical assessment if you snore heavily, if snoring affects a bed partner, or if you notice:
Do not drive if you are struggling to stay awake or may fall asleep. Seek urgent medical care for severe breathing difficulty, chest pain, signs of stroke or another medical emergency.
At Barrie Tan ENT Head & Neck Surgery, Dr Barrie Tan assesses adults and children with snoring, suspected obstructive sleep apnea and upper-airway obstruction at Gleneagles Hospital in Singapore. Assessments may include a nose and throat examination, a nasal endoscopy, and a referral for an appropriate sleep study. The findings will help determine whether lifestyle changes, continuous positive airway pressure (CPAP), an oral appliance, treatment of a nasal disease, or a selected ENT procedure may be appropriate.
