Your "Uvula" Can Tell You a Lot About Whether You Have Snoring and Sleep Apnea! (2024)

Some Morphological Changes in the Uvula May Indicate Chronic Snoring and Obstructive Sleep Apnea Syndrome (OSAS)!

Snoring is the sound produced by the vibration of the areas in the upper respiratory tract during sleep. The soft palate and the uvula are usually the areas that vibrate the most. If the laxity or narrowing in the airways increases, complete closure "collapse" occurs during sleep and sleep apnea occurs as a result. It causes various changes in the upper respiratory tract due to long-term collapse or vibration trauma. In patients with long-term snoring and sleep apnea, sagging of the soft palate and uvula and the changes I have presented to you below may occur. If patients consume alcohol, smoke, use antidepressants or muscle relaxants, or sleep with their mouths open for long periods due to nasal congestion, live a sedentary life, or gain weight, these changes may occur much more quickly.

Wrinkling of the Uvula - Could be a Sign of Chronic Snoring and OSAS!

Horizontal Mucosal Lines on the Uvula is a Sign of OSAS or Snoring In the image above, there is an intraoral image of a patient who has been snoring for a long time and has obstructive sleep apnea, taken with the mouth open. Morphological changes in the uvula: - elongated uvula - horizontal mucosal lines (wrinkling) at the tip and base - edematous appearance in the tip of the uvula in the form of a drop (occurs due to collapse trauma during sleep and is especially noticeable after patients wake up)

Chronic vibratory snoring trauma, that is, the shaking and vibrating uvula and the root of the uvula cause horizontal lines in the mucosa. At the same time, the closure of this region during deep sleep and its exposure to repeated mechanical pressure may cause relaxation and these lines to become more apparent.

Dr. Koka et al. emphasized that wrinkling in the uvula and the base of the uvula is a sign of obstructive sleep apnea-hypopnea syndrome (OSAHS). They said that this is a strong predictor sign of OSAHS with a specificity of 100%. They called this morphological change finding in the uvula "The EK sign". In case these morphological changes are noticed, it is recommended to perform polysomnography (PSG - sleep test) for detailed evaluation.You can look this study at >>EK Sign: A Wrinkling of Uvula and the Base of Uvula in Obstructive Sleep Apnea-Hypopnea Syndrome - PMC

Horizontal Wrinkles Appear on the Uvula Base and Soft Palate!

The image on the side belongs to a 16-year-old male patient who had previously undergone adenoidectomy and tonsillectomy but still complained of snoring. In the photograph taken with the mouth open, it is seen that the soft palate and uvula are drooping, the tip of the uvula is not visible, and there are horizontal lines on the soft palate and uvula base. The patient has a narrow oral and nasal airway due to the patient having a "narrow and high palate". When this patient slept with his mouth open for a long time during infancy, negative effects occurred on the jaw and facial bones. Since the patient's retrolingual airway was narrow, tissue closure or collapse occurred on the soft palate and uvula when he slept on his back. Both the compressed and vibrating soft palate facilitates the appearance of horizontal lines on the uvula. If your baby has various problems such as sleeping with the mouth open, nasal congestion, and tongue tie, treatment is required as soon as possible in order to avoid a tendency to permanent sleep apnea and to prevent negative effects on the jaw and facial bones. Even adenoidectomy surgery alone, performed without delay, prevents most of these negative palate-jaw effects in children. In babies with tongue-tie and growing with their mouths open, a small lower jaw, narrow and high upper palate, and a short and wide tongue may cause a narrowed lingual airway. Unfortunately, after the development of the jaw and facial bones is complete, much more complicated operations and treatments may be required to treat all these changes. As a result of the review published by Dr. Bussi et al., which compared comprehensive scientific studies investigating the relationship between tongue-tie (ankyloglossia) and sleep apnea, they emphasized that it can lead to negative changes in craniofacial growth due to tongue-tie and various respiratory problems including obstructive sleep apnea. Related article link >>Is ankyloglossia associated with obstructive sleep apnea? - ScienceDirect

Elongated Uvula (Tip of Uvula in Contact with Tongue Base)

Causes of Long Uvula

When we open our eyes and look, if our uvula is longer than normal and the tongue base and the tip of the uvula are in contact as in the photo above, we need to consider the following reasons:

- Long-term snoring and vibratory trauma due to this (vibration trauma in the uvula over time can accelerate the sagging of the uvula)

- Sleep apnea syndrome (in patients with long-term airway collapse, edema and sagging may occur in the uvula due to repeated tissue closure. Especially in patients with a high tongue root and a narrow airway behind the tongue or with donsillar hypertrophy, it is easier for the uvula to compress and elongate due to trauma during sleep)

- Smoking, drinking alcohol, using antidepressants, anxiolytic drugs, muscle relaxants that can cause muscle relaxation

- Not doing enough cardio exercise and an inactive lifestyle (constantly sitting can cause many negative changes in our body. At least 10,000 steps per day (cardio steps) taken by taking in through the nose and exhaling through the mouth, Running with the same breathing technique for 15-20 minutes or swimming freestyle for about 30 minutes prevents most of these airway changes and can also protect you against possible cardiovascular diseases)

- Aging (it is natural for tissues to become loose and saggy as we age)

- Gaining weight and obesity (if you cannot see the airway behind the tongue by just looking with your mouth open, if your neck is short and thick, if you have significant fat in your belly area, try losing weight! Every 5 kg you lose from your belly area can provide 1 cm of fat loss and thinning in the floor of your mouth and neck area. In this way, there can be a volume increase close to a logarithmic mechanism in the oral airway as the root of the tongue and tongue move towards the ground. If you are obese and your sleep quality is poor, restricting sweets and increasing cardio exercise and losing weight can provide you with a much better sleep quality)

- Structural causes (patients may be born with a longer uvula than normal)

Edema Appearance at the Tip of the Uvula, More Noticeable in the Morning

In patients with long-term snoring and sleep apnea, "droplet-shaped edema at the tip of the uvula" can be detected at the tip of the uvula over time, especially in the morning. This condition, which appears as if the tip of the uvula has been pinched or pinched, may occur due to tissue closure (collapse) caused by sleep apnea. In the photograph above, there are also horizontal wrinkling lines on the patient's uvula as a result of vibratory shock trauma due to long-term snoring. This patient, who is 18 years old and smokes 2 packs of cigarettes a day and drinks alcohol, was advised to stop smoking and drinking alcohol and to do cardio exercise. The emergence of such morphological changes in the uvula despite his young age is a sign that the sleep apnea syndrome may become more severe in the coming years.

Murat Enoz, MD, Otorhinolaryngology, Head and Neck Surgeon

Private Office:

Address:İncirli Cad. No:41, Kat:4 (Dilek Patisserie Building), Postal code: 34147,Bakırköy - İstanbul
Appointment Phone:+90 212 561 00 52

Fax:+90 212 54274 47