Omission of polysomnography in treatment of snoring: common reasons and medico-legal implications

Although polysomnography (PSG) is an important investigation in the treatme nt of snorers, it was observed that a large number of patients did not have pre-operative PSG assessment in a tertiary hospital in Singapore. Of the 1 18 Asian patients who underwent surgery for snoring from January 1997 to De cember 1998, 36 (30.5 per cent) of patients did not have pre-operative PSG and only 21 (17.8 per cent) of patients had post-operative PSG. In this coh ort, 43 (36.4 per cent) patients presented with snoring as their only compl aint and not associated with symptoms indicative of obstructive sleep apnoe a syndrome (OSAS). Thirty-one of these 'simple snorers' underwent sleep stu dies with the following outcome: two (6.5 per cent) true simple snorers, tw o (6.5 per cent) upper airway resistance syndrome, nine (29 per cent) mild OSAS, seven (22.6 per cent) moderate OSAS and 11 (35.5 per cent) severe OSA S. Our study showed that without the aid of PSG, it would be difficult to p redict the severity of sleep apnoea based on clinical history alone. In an increasingly litigation-conscious society such as Singapore, there is there fore little justification in omitting PSG in the treatment of snoring. The common reasons for omission of preoperative PSG and the medico-legal implic ations are also discussed.