Stertorous respirations are harsh, rattling, or snoring-like sounds produced by the vibration of relaxed oropharyngeal structures during sleep, coma, or partial upper airway obstruction. Less commonly, stertor results from retained mucus in the upper airway. Unlike stridor, which signals laryngeal or tracheal obstruction, stertor indicates obstruction at the level of the oropharynx or nasopharynx.

Prevalence and Risk Factors

• Occurs in ~10% of healthy individuals.

• More common in middle-aged men who are obese.

• Aggravated by alcohol, sedatives, or supine sleeping position.

• Major pathologic causes include obstructive sleep apnea and life-threatening upper airway obstruction (tumor, uvular/palatal edema, postictal airway blockage).

Emergency interventions

• Assess airway and breathing immediately.

• Inspect mouth and throat for edema, redness, masses, or foreign bodies.

• If edema is significant: check vital signs and oxygen saturation.

• Observe for dyspnea, tachypnea, accessory muscle use, intercostal retractions, cyanosis.

• Elevate head of bed 30 degrees to reduce airway obstruction.

• Administer supplemental oxygen via nasal cannula or face mask.

• Prepare for intubation, tracheostomy, or mechanical ventilation if obstruction persists.

• Insert IV access and begin cardiac monitoring.

Observation during Sleep:

• Monitor breathing for 3–4 minutes, noting if noisy respirations stop when patient turns to the side.

• Identify apneic episodes and their duration.

• Collect information from bed partner about snoring patterns, daytime sleepiness, personality changes, and headaches.

Medical causes

Other Causes: Retained mucus, alcohol or sedative-induced airway flaccidity, postictal obstruction after seizure, oropharyngeal tumors.

Special considerations

• Continuous monitoring of respiratory status.

• Administer corticosteroids, antibiotics, and cool humidified oxygen if edema is present.

• Consider laryngoscopy, bronchoscopy, or formal sleep studies for diagnosis.

• For OSA: weight management, smoking cessation, head-of-bed elevation, and CPAP or BiPAP therapy.

Patient counseling

• Explain underlying cause and treatment options.

• Discuss weight reduction, smoking cessation, and proper sleep positioning.

• Teach correct setup and use of CPAP/BiPAP devices.

Pediatric pointers

• Most commonly caused by nasal or pharyngeal obstruction (tonsillar/adenoid hypertrophy, foreign body).

• Evaluate children with stertorous breathing for airway compromise.

Geriatric pointers

• Encourage evaluation and treatment for sleep apnea or significant tonsillar/adenoid hypertrophy.

• Monitor for comorbid cardiovascular or pulmonary conditions.

References

1. Buttaro TM, Tybulski J, Bailey PP, Sandberg-Cook J. Primary Care: A Collaborative Practice. St. Louis, MO: Mosby Elsevier; 2008.

2. McCance KL, Huether SE, Brashers VL, Rote NS. Pathophysiology: The Biologic Basis for Disease in Adults and Children. Maryland Heights, MO: Mosby Elsevier; 2010.

3. Sommers MS, Brunner LS. Pocket Diseases. Philadelphia, PA: F.A. Davis; 2012.