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Snoring Clinic

Snoring, a form of sleep-disordered breathing, is very common. Almost half of the UK's population snore from time to time, and around a quarter of those are regular snorers. Snoring does not usually cause any problems for the person doing it but it does affect partners, family and even neighbours if it keeps them awake and can therefore be socially disruptive leading to disharmony and marital difficulties.

Snoring in adults is more common with increasing age, in men, in overweight individuals and in those with high alcohol intake.

Snoring Clinic, Southampton

What is snoring?

Snoring is a noise made during breathing which results from narrowing or blockage of the upper part of your airway during sleep. This reduced airflow causes structures in your throat and palate to vibrate generating the snoring noise. If the airway blockage is severe, this may result in sleep apnoea.

What is sleep apnoea?

The vast majority of snorers fall into the category of ‘simple snorers’. In some cases, however, snoring can be a sign of a more serious condition - sleep apnoea. This is when the blockage in your airway causes you to stop breathing for a few seconds resulting in a fall in oxygen levels in your blood causing the sufferer to wake up many times during the night. You might not even be aware that you're waking up. This causes sleep disruption, tiredness and can affect your day-to-day life. In severe cases, it can cause personality changes, intellectual deterioration, impotence and an increased risk of road traffic accidents. Because of the drop in the oxygen concentrations in the body, it can also put significant stress on the heart therefore increasing the risk of conditions such as high blood pressure and heart disease.

What can the Spire Snoring Clinic do for me?

In order to tailor effective interventions, it is important to differentiate between ‘simple snoring’ and ‘sleep apnoea’, exclude any exacerbating factors (anatomical, thyroid disorders, medications etc) and identify the level of obstruction. The dedicated Spire Snoring Clinic, exclusively at the Spire Southampton Hospital, will enable you to seek specialist advice and treatment from Mr. Rami J. Salib FRCS (ORL-HNS) Consultant ENT Surgeon, with a specialist interest in sleep-related breathing disorders. You will undergo an initial consultation and assessment by Mr. Salib where a thorough history and examination is undertaken. It is preferable to have the bed partner present at the consultation.

Investigations

  • General investigations including body mass index (BMI) to help define degree of obesity, Epworth Sleepiness Score – a questionnaire which assesses the risk of sleep apnoea, blood tests including full blood count and thyroid function if indicated.
  • Sleep study – Overnight sleep study which involves monitoring of certain parameters including oxygen levels within the body to detect those suffering with significant sleep apnoea.
  • Full ENT assessment – including an examination of the nasal airway and throat with a telescope to identify likely site of obstruction.
  • Sleep nasendoscopy - In some cases where the site of obstruction is unclear or where it is suspected that there may be multiple sites involved, a procedure known as sleep nasendoscopy may be helpful. This is not an operation and involves an examination of the airway under a light general anaesthetic. During this procedure, done as a day case, an anaesthetist will give you an injection sufficient to induce natural sleep for 10-15 minutes and Mr Salib will examine your throat with a small flexible endoscope (camera), which he will pass through your nose. This helps assess the three-dimensional dynamic anatomy of the upper airway improving accuracy of diagnosing the site of obstruction, thus enabling a more focused management strategy.

Treatment options

Snoring and sleep apnoea are often multi-factorial conditions with a variety of contributory factors, hence there will never be one single universal cure for snoring. Therefore, accurate assessment is essential to guide appropriate treatment.


Non-surgical treatments

General lifestyle measures – This is the mainstay of treatment in the majority of simple snorers. Weight loss, reduction of alcohol intake, stopping smoking and stopping any sedative medication can all be useful. In particular, weight loss alone can cure many cases of snoring.

Treatment of nasal blockage – including medical treatment of rhinitis with decongestants, nasal steroid sprays and nasal douches (Sterimar™ / SinuRinse™); the use of nasal splints such as ‘Nozovent™’ and ‘Breathe Right™’ nasal strips to open the nasal airway.

Mandibular positioning devices – dental splint which you can wear at night and holds the lower jaw forward. This stops the tongue from collapsing backward and blocking the airway.

Nasal continuous positive airways pressure (CPAP) – Gold standard treatment for sleep apnoea. Air under pressure is delivered via a tight fitting nasal mask. This acts as a pneumatic splint holding the airway open thus preventing snoring and obstruction.


Surgical treatments

It should be emphasised that surgery for snoring is only considered as last resort and only when conservative measures have failed. Furthermore, the results of surgery are poor in those individuals with BMI > 30.

Nasal surgery – To deal with septal deviation, turbinate enlargement, nasal polyps or enlarged adenoids may help snoring by overcoming nasal obstruction.

Palatal surgery – Limited uvulopalatoplasty with or without tonsillectomy. This involves partial excision of the uvula (the structure that dangles at the back of the throat and which normally vibrates to create the noise of snoring), as well as scarring of the soft palate by creating gutters on either side of the uvula. This can also be done using laser or low-temperature radiofrequency energy delivered via a needle into the soft palate (Somnoplasty™). This results in an area of scarring and hence stiffening of the soft palate. In individuals with large obstructive tonsils, these can also be removed as part of the procedure if necessary. In children with sleep apnoea, most cases are adequately dealt with by removal of the adenoids and tonsils as this is usually the site of obstruction.

Tongue base surgery – Reduction of tonsil tissue at the tongue base (lingual tonsils) can be useful in a small number of patients with significant lingual tonsil enlargement. This is normally performed in conjunction with other procedures and rarely in isolation.

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Mr Rami Salib

Mr Rami Salib, Snoring Clinic, Hampshire

Click here to view Mr Salib's profile

Nose and Sinus Allergy Clinic

Nose and Sinus Allergy Clinic, Hamsphire

The  Nose and Sinus Allergy Clinic at Spire Southampton Hopsital, also run by Mr Salib.
Please click here for further information.

Further Information

For further information or to make an appointment, please contact Mr Salib’s private secretary Karen Healey on 023 8076 4325 or fax referrals to 023 8091 4418 or email karen.healey@spirehealthcare.com.
 

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