CLINICAL REVIEW The management of simple snoring

Simple snoring is a very common problem that presents a number of different challenges. The initial difficulty is in confirming the presence of snoring, next one must exclude any other nocturnal respiratory pathology and finally a decision as to an appropriate treatment must be made. There are many different ways of achieving these objectives, but no one-way has a clear advantage in terms of both accuracy and cost effectiveness. In this review the authors do not intend to give a didactic method for the management of simple snoring but to discuss the pros and cons of various different options in order to help physicians make a choice based on local priorities. Snoring is not a new phenomenon. It has been recognised as a social problem for thousands of years, and is regularly referred to in classical literature. In these early references there is often little distinction between the words for snoring or for sleep, which may well have the same origin in ancient Greek. Some of the predisposing factors to snoring were also frequently noted in ancient literature, but probably none more succinctly than in Virgil's Aeneid where three—obesity, alcohol and position—are mentioned in a single line Who, gorged, and drunk with wine, supinely snore. A potential, albeit radical, solution is also mentioned With his drawn sword… him and his sleeping slaves he slew. The treatment of snoring has, happily, moved on somewhat since Virgil's day. The recognition of sleep apnoea, of which snoring is the cardinal symptom, has led to one of the major priorities in the modern treatment of snoring, the exclusion of pathological respiratory disturbance. It is still not entirely clear whether simple snoring in itself is the direct cause of any adverse health consequences. The prevalence of snoring in the population of the UK has been estimated at around 25 –40%. 1 In mid 2002 the population of the UK stood at 59,206,700. Eighty percent of these were over the age of 16 and approximately 70% were cohabiting. This means that approximately 10 million UK adults are likely to experience problems because of snoring. The equivalent figures for the United States are a population of 285 million and approximately 47 million sufferers from snoring. Obviously a large proportion of these people will not be sufficiently disturbed by snoring to seek medical 1087-0792/$-see front matter q 2004 Elsevier Ltd. All rights reserved.