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# Approach to snoring and suspected sleep apnoea

- Approach to a complaint

Snoring with breathing pauses, night-time choking or daytime sleepiness suggests obstructive sleep apnoea, which is confirmed with a sleep study.

Updated Nov 5, 2026

**See it in 3D:** [Soft palate](https://durgical.com/en/anatomy/soft-palate/) · [Palatine tonsils](https://durgical.com/en/anatomy/palatine-tonsil/) · [Tongue](https://durgical.com/en/anatomy/tongue/)

## Key points

- Snoring + witnessed pauses + daytime sleepiness = suspected obstructive sleep apnoea.
- Risk factors: obesity, large tonsils and hormonal changes; alcohol and tobacco make it worse.
- Diagnosis: a sleep study, in a laboratory (polysomnography) or at home with a portable device.
- Treatment: weight loss, avoiding alcohol, stopping smoking and sleeping on the side; CPAP and similar machines; oral devices and surgery in selected cases.
- In children, enlarged tonsils and adenoids are a common cause; tonsillectomy is a treatment option.
- Central apnoea: the brain does not send the signal to breathe (opioids, heart failure, high altitude).

## What it is

Snoring is vibration of the soft tissues of the pharynx, above all the soft palate, during sleep. On its own it is harmless, but it can be the first sign of obstructive sleep apnoea: repeated collapse of the upper airway that interrupts breathing, fragments sleep and causes daytime sleepiness. Untreated, sleep apnoea affects concentration and memory and raises the risk of stroke and heart attack. The general doctor suspects it from the history, examines the upper airway and requests a sleep study; in children, large tonsils and adenoids are a common cause.

## Key questions in the history

- Has anyone seen the patient stop breathing or choke during sleep?
- Does the patient fall asleep in the day without meaning to, for example while driving?
- Trouble concentrating or remembering?
- What is the patient's weight? Any alcohol, sedatives or opioids?
- Hypertension, diabetes, arrhythmias or heart disease?
- A blocked nose, or known large tonsils?
- Does the patient work as a driver or operate machinery?

## Causes and classification

- Simple snoring: soft palate vibration with no breathing pauses or sleepiness.
- Obstructive sleep apnoea: repeated collapse of the upper airway during sleep.
- Central apnoea: the brain does not send the signal to breathe (opioids, heart failure, high altitude).
- Anatomical factors: obesity, large tonsils and adenoids, nasal obstruction, a small or set-back jaw.
- Aggravating factors: alcohol, sedatives, sleeping on the back, tobacco and hypothyroidism.

## Step-by-step approach

- Ask the bed partner about snoring, pauses and choking; ask about daytime sleepiness.
- Measure weight, body mass index and blood pressure; examine the nose, palate, tonsils, tongue and jaw.
- Review drugs (sedatives, opioids), alcohol and associated diseases; check TSH if hypothyroidism is suspected.
- If apnoea is suspected, request a sleep study: polysomnography or a portable home test.
- Simple snoring without apnoea: weight loss, no alcohol at night, sleep on the side.
- Confirmed apnoea: CPAP or another positive pressure device; a custom oral device if CPAP is not tolerated.
- Treat nasal obstruction; airway surgery is considered if other treatments fail.
- Child with snoring and pauses: assess tonsils and adenoids and refer to ENT.

## Snoring: what it may be

| Condition | Clues | Management |
| --- | --- | --- |
| Simple snoring | No pauses and no sleepiness | Lifestyle measures |
| [Adult obstructive sleep apnoea](https://durgical.com/en/conditions/obstructive-sleep-apnoea/) | Snoring, pauses, sleepiness, obesity | Sleep study and CPAP |
| [Sleep apnoea in children](https://durgical.com/en/conditions/tonsillar-hypertrophy-and-recurrent-tonsillitis/) | Large tonsils and adenoids, mouth breathing | Referral to ENT; tonsillectomy and adenoidectomy |
| Central sleep apnoea | Opioids, heart failure, high altitude | Sleep study and treat the cause |
| [Hypothyroidism](https://durgical.com/en/conditions/hypothyroidism/) | Tiredness, cold intolerance, weight gain | TSH and thyroid treatment |

## Red flags

- Witnessed breathing pauses or waking up choking.
- Sleepiness while driving or operating machinery.
- Hard-to-control hypertension, arrhythmias, heart failure or previous stroke.
- Severe obesity with low oxygen levels during the day.
- Child with snoring, pauses, attention or behaviour problems.

## Next step / Initial management

- First step: history from the bed partner, upper airway exam, weight and blood pressure; a sleep study if apnoea is suspected.
- For everyone: weight loss if overweight, physical activity, no alcohol or sedatives at night, stop smoking and sleep on the side.
- Confirmed apnoea: CPAP or similar machines; custom oral devices or surgery (tonsillectomy, hypoglossal nerve stimulation) in selected patients.
- Refer as a priority to a sleep clinic or respiratory medicine for sleepiness while driving, cardiovascular disease or witnessed pauses; routine referral to ENT for nasal obstruction or large tonsils.
- Child with snoring and pauses: referral to paediatric ENT.

## Test yourself

Think of the answer, then tap the question to see it.

## A 50-year-old obese bus driver snores; his wife notices pauses and he falls asleep in the day. Next step?

Suspected obstructive sleep apnoea: a priority sleep study and a warning about driving while sleepy; if confirmed, CPAP.

## What is the main treatment for confirmed obstructive sleep apnoea in adults?

Continuous positive airway pressure (CPAP), together with weight loss, avoiding alcohol and sedatives and sleeping on the side.

## What separates central from obstructive sleep apnoea?

In central apnoea the brain does not send the signal to breathe, for example with opioids or heart failure; in obstructive apnoea there is breathing effort but the airway collapses.

## A 5-year-old snores, has pauses in sleep and large tonsils. What do you do?

Refer to paediatric ENT: large tonsils and adenoids are a common cause of sleep apnoea in children, and tonsillectomy with adenoidectomy may be the treatment.

[Add to my cards (4)](https://durgical.app/estudiar/?add=/en/ent/approach-to-snoring-and-suspected-sleep-apnoea/)

## Connections

## See it in 3D 3

The structures of Durgical's 3D anatomy where it is found.

- [Soft palate](https://durgical.com/en/anatomy/soft-palate/)
- [Palatine tonsils](https://durgical.com/en/anatomy/palatine-tonsil/)
- [Tongue](https://durgical.com/en/anatomy/tongue/)

## Related 3

- [Tonsils and adenoids in children: obstruction, sleep apnoea and when to operate](https://durgical.com/en/ent/tonsils-and-adenoids-in-children-obstruction-sleep-apnoea-and-when-to-operate/)
- [Approach to nasal blockage](https://durgical.com/en/ent/approach-to-nasal-blockage/)
- [Pharynx and Waldeyer's ring](https://durgical.com/en/ent/pharynx-and-waldeyer-s-ring/)

## Related conditions 3

- [Obstructive sleep apnoea](https://durgical.com/en/conditions/obstructive-sleep-apnoea/)
- [Tonsillar hypertrophy and recurrent tonsillitis (post-tonsillectomy care)](https://durgical.com/en/conditions/tonsillar-hypertrophy-and-recurrent-tonsillitis/)
- [Hypothyroidism](https://durgical.com/en/conditions/hypothyroidism/)

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Educational content; it does not replace a medical assessment and is not a clinical instruction. For a real case, follow current guidelines and specialist advice.

Sources: [Sleep Apnea: What Is Sleep Apnea?](https://www.nhlbi.nih.gov/health/sleep-apnea) (National Heart, Lung, and Blood Institute (NHLBI), NIH, 2025); [Sleep Apnea: Treatment](https://www.nhlbi.nih.gov/health/sleep-apnea/treatment) (National Heart, Lung, and Blood Institute (NHLBI), NIH, 2025); [Sleep Studies](https://www.nhlbi.nih.gov/health/sleep-studies) (National Heart, Lung, and Blood Institute (NHLBI), NIH, 2022).

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Representative model, for educational purposes only.

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Source: https://durgical.com/en/ent/approach-to-snoring-and-suspected-sleep-apnoea/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/ent/approach-to-snoring-and-suspected-sleep-apnoea/