Consultation with the specialist
Snoring
John T. McBride MD1
1 Associate Professor of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, NY.
Snoring is the audible consequence of the pharyngeal airway collapsing when one inspires. Snoring can disrupt sleep, cause a variety of important but nonspecific symptoms, and suggest the presence of the obstructive sleep apnea syndrome, which can lead to cor pulmonale and sudden death. Therefore, the review of systems for a child at any age should include questions regarding snoring and breathing during sleep. Most normal children snore at one time or another, and many, particularly those who have nasal allergies, snore almost nightly. Pediatricians should be able to identify which snoring children do not require treatment or referral, which are candidates for tonsillectomy or adenoidectomy, and which should be referred for polysomnography (sleep study) or more specialized evaluation.
Physiologic Sources of the Problem
Snoring and obstructive sleep apnea do not represent structural upper airway narrowing alone, but rather an imbalance between the degree of airway narrowing and the ability of the respiratory centers in the brainstem to use the muscles of the pharynx and tongue to maintain airway patency. For each child who has tonsillar hypertrophy and who snores, there are many who have larger tonsils who do not snore because they use their pharyngeal muscles to keep the airway open during sleep.
