Snoring surgery (in the absence of obstructive sleep apnoea)
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.
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.
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.
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.
WHEN (LEFT(der.Spell_Dominant_Procedure,4) in ('F324','F325','F326’) AND der.Spell_Primary_Diagnosis like '%R065%’) AND apcs.der_diagnosis_all not like '%G473%’ AND isnull(APCS.Age_At_Start_of_Spell_SUS,APCS.Der_Age_at_CDS_Activity_Date) between 19 and 120 AND APCS.Admission_Method not like ('2%') THEN 'A_snoring'
Procedure codes (OPCS)
F324 Operations on uvula NEC
F328 Other specified other operations on palate
Y067 Radiofrequency excision of lesion of organ NOC (Secondary to F328)
Y081 Laser excision of organ NOC (Secondary to F328)
Diagnosis codes (ICD)
R065 Mouth breathing
G473 Sleep apnoea
apcs.der_diagnosis_all not like '%C[0-9][0-9]%' and apcs.der_diagnosis_all not like '%D0%' and apcs.der_diagnosis_all not like '%D3%' and apcs.der_diagnosis_all not like '%D4%’
This code captures code in the ranges C00-C99, D00-D09 and D37-D48.
Age range: the codes use the following age ranges 0-18 for children and 19-120
— Private Appointment Exclusion
- 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.
How up to date is this information?
Last revised December 2023
December 2023 - Coding updated. August 2022 - Coding updated