Snoring versus obstructive sleep apnea: a case report.

Report of a Case A 67-year-old man with a long-standing history of snoring noted that, in recent years, the snoring had worsened so much that his wife banned him from their bedroom. Since his retirement, he gained 20 pounds, and knee problems reduced his physical activity. His nasal allergies also had worsened. He noted increased fatigue, daytime sleepiness, and some trouble concentrating. He reported following a medication regimen as treatment for hypertension, but he otherwise denied having any medical problems. He had a tonsillectomy and adenoidectomy as a child and had no history of thyroid disease. Physical examination showed nasal congestion with moderately swollen, pale turbinates and no purulent discharge. The septum was midline. Oropharyngeal examination showed no tonsils and a low soft palate with elongated uvula that tended to collapse against the posterior aspect of the pharynx and abutted the base of tongue. Fiberoptic laryngeal examination showed a normal larynx with moderate collapse of the lateral pharyngeal walls in “blocked” inspiration (a reverse Müller’s maneuver whereby the patient holds his nose, closes his mouth, and attempts to breathe inward). He had a short, thick neck and was overweight. The working diagnosis was obstructive sleep apnea.