Snoring surgery (in the absence of obstructive sleep apnoea)
Statutory Guidance
How up to date is this information?
Published January 2019 | Last reviewed September 2024
Using this guidance
The guidance set out here was reviewed extensively in the Autumn of 2024. There are no plans for any further reviews.
Medicine is constantly evolving and over time it is inevitable that the evidence base will change. Please use your own judgement and/or other sources of clinical guidance alongside the information set out here.
Please note this guidance is a recommendation and it should be used in the context of the overall care pathway and when all alternative interventions that may be available locally have been undertaken.
Summary
Snoring is a noise that occurs during sleep that can be caused by vibration of tissues of the throat and palate. It is very common and as many as one in four adults snore, as long as it is not complicated by periods of apnoea (temporarily stopping breathing) it is not usually harmful to health, but can be disruptive, especially to a person’s partner.
This guidance relates to surgical procedures in adults to remove, refashion or stiffen the tissues of the soft palate (Uvulopalatopharyngoplasty, Laser assisted Uvulopalatoplasty & Radiofrequency ablation of the palate) in an attempt to improve the symptom of snoring. Please note this guidance only relates to patients with snoring in the absence of Obstructive Sleep Apnoea (OSA) and should not be applied to the surgical treatment of patients who snore and have proven OSA who may benefit from surgical intervention as part of the treatment of the OSA.
It is important to note that snoring can be associated with multiple other causes such as being overweight, smoking, alcohol or blockage elsewhere in the upper airways (e.g. nose or tonsils) and often these other causes can contribute to the noise alongside vibration of the tissues of the throat and palate.
Recommendation
It is on the basis of limited clinical evidence of effectiveness, and the significant risks that patients could be exposed to, this procedure should no longer be routinely commissioned in the management of simple snoring.
Alternative Treatments
There are a number of alternatives to surgery that can improve the symptom of snoring. These include:
- Weight loss
- Stopping smoking
- Reducing alcohol intake
- Medical treatment of nasal congestion (rhinitis)
- Mouth splints (to move jaw forward when sleeping)
Rationale for recommendation
In two systematic reviews of 72 primary research studies there is no evidence that surgery to the palate to improve snoring provides any additional benefit compared to other treatments. While some studies demonstrate improvements in subjective loudness of snoring at 6-8 weeks after surgery; this is not longstanding (> 2years) and there is no long-term evidence of health benefit. This intervention has limited to no clinical effectiveness and surgery carries a 0-16% risk of severe complications (including bleeding, airway compromise and death). There is also evidence from systematic reviews that up to 58-59% of patients suffer persistent side effects (swallowing problems, voice change, globus, taste disturbance & nasal regurgitation). It is on this basis the interventions should no longer be routinely commissioned.
Patient information
Information for Patients
Surgery to help you stop snoring is a procedure that should only be carried out when specific criteria are met. This is because the medical evidence tells us that the intervention can sometimes do more harm than good and there are alternative treatments which are usually far more effective.
About the condition
Snoring is a noise that occurs during sleep that can be caused by vibration of tissues of the throat and palate. It is very common and as many as one in four adults snore.
As long as it is not complicated by periods of apnoea (temporarily stopping breathing) it is not usually harmful to health, but can be disruptive, especially to a person’s partner.
It’s important you and your doctor make a shared decision about what’s best for you if your snoring is becoming a problem. When deciding what’s best you should both consider the benefits, the risks, the alternatives and what will happen if you do nothing.
What are the BENEFITS of the intervention?
Surgery for snoring in patients without Obstructive Sleep Apnoea (OSA) has been shown to have limited to no long term clinical effectiveness.
What are the RISKS?
Surgery carries a small risk of severe complications including bleeding, airway compromise and in rare cases death. There is also evidence that the majority of patients suffer persistent side effects including: swallowing problems, voice change, globus (a persistent sensation of having a lump in the back of your mouth), taste disturbance and nasal regurgitation.
What are the ALTERNATIVES?
There are a number of alternatives to surgery that can improve the symptom of snoring. These include, losing weight, stopping smoking, cutting down on alcohol, medical treatments for a blocked nose or mouth splints which can help to move your jaw forward when you are sleeping.
What if you do NOTHING?
Doing nothing is not likely to be harmful. Snoring is a common condition and can be frustrating for both the patient and partner. It is recommended a clinician rules out reversible causes and Obstructive Sleep Apnoea. The alternatives suggested above may help and far outweigh the benefits of any surgical intervention.
Coding
WHEN Primary_Spell_Procedure IN ('F324','F325','F326')
AND Primary_Spell_Diagnosis like '%R065%'
AND Primary_Spell_Diagnosis not like '%G473%'
-- Age between 19 and 120
AND ISNULL(APCS.Age_At_Start_of_Spell_SUS,APCS.Der_Age_at_CDS_Activity_Date) between 19 AND 120
-- Only Elective Activity
AND APCS.Admission_Method not like ('2%')
THEN 'A_snoring'
Exclusions
WHERE 1=1 -- Cancer Diagnosis Exclusion AND (Any_Spell_Diagnosis not like '%C[0-9][0-9]%' AND Any_Spell_Diagnosis not like '%D0%' AND Any_Spell_Diagnosis not like '%D3[789]%' AND Any_Spell_Diagnosis not like '%D4[012345678]%' OR Any_Spell_Diagnosis IS NULL)
-- Private Appointment Exclusion AND apcs.Administrative_Category<>'02'
References
- Franklin KA, Anttila H, Axelsson S, Gislason T, Maasilta P, Myhre KI, Rehnqvist N. Effects and side-effects of surgery for snoring and obstructive sleep apnoea- a systematic Sleep. 2009 Jan. 32(1):27-36.
- Main C, Liu Z, Welch K, Weiner G, Jones SQ, Stein K. Surgical procedures and non-surgical devices for the management of non-apnoeic snoring: a systematic review of clinical effects and associated treatment Health Technol Assess 2009;13(3). https://www.ncbi.nlm.nih.gov/pubmed/19091167.
- Jones TM, Earis JE, Calverley PM, De S, Swift AC. Snoring surgery: A retrospective review. Laryngoscope. 2005 Nov 115(11): 2015-20.
