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PubMed1999

A Randomized Double-Blind Placebo-Controlled Evaluation of the Safety and Efficacy of a Natural Over-The-Counter (OTC) Medication in the Management of Snoring.

More than 40 million American adults snore. Habitual snoring afflicts 44% of adult males and 28% of females.(1) Uncomplicated snoring is generally due to vibration of the palatal soft tissues or the tongue base, causing intermittent airway obstruction. Loudness is correlated with the degree of vibration and/or obstruction. The tendency, frequency, duration, intensity, and sequelae of snoring are influenced by myriad structural, physiological, environmental and pharmacological factors. Uncomplicated, nonapneic snoring is treated in a wide variety of ways, ranging from self-help methods, such as positional therapy, to laser surgery. The purpose of this report is to evaluate the safety and efficacy of a natural medication for snoring in a randomized double-blind placebo-controlled trial. The treatment is significantly more effective than placebo. Neither side effects nor intolerance to the product was reported.

Journal Article↗
PubMed1975

Snoring.

Eight heavy snorers underwent nocturnal polygraphic recordings. The principal results are the following: 1. Snoring is an inspiratory (or primarily inspiratory) noise linked to subobstruction of the upper airways. It appears with falling asleep (stage 1) and intensified progressively through the deepening of slow sleep; in REM sleep it becomes discontinuous and is comparable to stage 2 snowing in intensity. 2. In heavy snorers, obstructive apneas are always present and particularly abundant during light sleep (state 2) and REM sleep. 3. In heavy snorers during sleep the systemic arterial pressure reaches and remains at levels higher than those of wakefulness instead of diminishing normally. 4. Some degree of alveolar hypoventilation is associated with snoring when the apneas are especially abundant. These findings confirm the existence of significant polygraphic analogies between snoring and hypersomnia with periodic apneas and indicate that snoring may represent the first phase in the development of this syndrome. Moreover, the effects of snoring on alveolar ventilation and the systemic pressure during sleep suggest that heavy, constant snoring has physio-pathological implications for the cardio-circulatory apparatus.

Adolescent↗
PubMed1992

Epidemiology of snoring and obstructive sleep apnoea in a Danish population, age 30-60.

Several epidemiological studies have estimated the prevalence of obstructive sleep apnoea syndrome (OSAS). As many of those suffering from sleep apnoea may be asymptomatic, the occurrence of sleep apnoea may be underestimated. The epidemiology of self-reported snoring, sleep apnoea and OSAS, and their relationships with various symptoms, were evaluated in 1504 randomly selected males and females, aged 30, 40, 50 and 60 years. Nocturnal respiration was determined in 748 participants using inductive plethysmography. Habitual snoring was reported by 19.1% (9.2-24.2%, age 30-60 years) of the males and 7.9% (3.8-11.7%, age 30-60 years) of the females. Respiratory Distress Index (RDI) was calculated as the number of apnoeas and hypopnoeas per hour lasting longer than 10 s. RDI >/= 5 per hour was found in 10.9% (7.1-18.3%, age 30-60 years) of the males and in 6.3% (5.3-7.6%, age 30-60 years) of the females. Hypersomnia increased with the severity of sleep apnoea (P < 0.005) and was reported by 15.9% of those with RDI >/= 5. The prevalence of OSAS (hypersomnia and RDI >/= 5) was 0.9% in the females, 1.9% in the males, and in total 1.4% of all aged 30-60 years. The sensitivity was 70.8% and the specificity was 47.7% for self-reported snoring predicting RDI >/= 5. The following factors were associated with RDI >/= 5: age (P < 0.05), gender (P < 0.0001), BMI (P < 0.0001), tobacco (P < 0.02) and alcohol (P < 0.05) consumption. Snoring correlated with age (P < 0.02), gender (P < 0.001), BMI (P < 0.0001) and alcohol consumption (P < 0.05). We conclude that sleep apnoea is common and many of those with sleep apnoea are asymptomatic. Self-reported hypersomnia and snoring are not sensitive enough alone to identify those with sleep apnoea. Sufficient control of the questionnaire is thus essential in studies on snoring and the risk of cardiovascular diseases.

Journal Article↗
PubMed1995

Ischaemic stroke, snoring and obstructive sleep apnoea.

Ischaemic stroke occurs most often during the morning hours before noon. In recent studies the peak time of onset has been between 10.00 and 12.00 hours. Snoring every night or almost every night (habitual snoring) is in relation with ischaemic stroke. Snoring occasionally, on the contrary, is not significantly related with stroke. Habitual snoring is the most typical sign of obstructive sleep apnoea syndrome and it is strongly associated with being overweight. Other possible pathophysiological factors that are in relation with habitual snoring, obstructive sleep apnoea and stroke include arterial hypertension, changes in fibrinolytic activity, adult onset diabetes and smoking. It remains to be seen whether nightly occurring partial upper airway obstruction (habitual snoring) with intrathoracic pressure changes is an independent risk factor of ischaemic stroke, There is recent evidence that everything cannot be explained by other known risk factors.

Journal Article↗
PubMed1999

Better quality of life when nasal breathing of snoring men is improved at night.

OBJECTIVE: To evaluate whether improved nasal breathing changes the quality of life in snoring men and improves the female sleeping partners' well-being in the morning. DESIGN: During 1 month, 42 heavily snoring men slept with a nostril dilator. Before and after 1 month, the snorers rated their daytime tiredness and completed the Nottingham Health Profile questionnaire. Female sleeping partners rated the snoring, the quality of their sleep, and their sense of well-being in the morning. A population sample was used for comparison. SETTING: The Central Hospital, Skövde, Sweden. RESULTS: The snorers' quality of life before the study was significantly worse (P<.001) than that of the comparison population and improved significantly (P = .001). The men were significantly (P<.001) less tired during the day when their nasal airflow was increased. Female sleeping partners had significantly (P = .005) better sleep and an improved sense of well-being in the morning during the test period. Both were correlated with a significant reduction in the snoring (P<.001). CONCLUSIONS: When nasal breathing of snoring men was improved at night, their quality of life was significantly improved. The female sleeping partners had a reduction in sleep disturbance that correlated well with an improvement in their own sleep and feelings of well-being in the morning.

Adult↗
PubMed2000

Snoring and obstructive sleep apnea in children: a 6-month follow-up study.

BACKGROUND: Snoring children may present symptoms suggestive of obstructive sleep apnea syndrome (OSAS). Different and controversial methods to establish the diagnosis and to choose the treatment modalities have been proposed. OBJECTIVES: To study children with symptoms raising the suspicion of OSAS with overnight polysomnography (PSG). To evaluate the efficacy of adenotonsillectomy as treatment of pediatric OSAS and to elucidate the natural history of OSAS and primary snoring. DESIGN: A controlled, prospective, nonrandomized clinical trial. SETTING: Academic medical center. SUBJECTS: Fifty-eight snoring but otherwise healthy children aged 3 to 10 years with symptoms suggestive of OSAS underwent PSG twice, 6 months apart. Thirty healthy children served as controls. RESULTS: Twenty-seven children had OSAS with an obstructive apnea/hypopnea index greater than 1, while 31 had primary snoring. There were statistical differences in the symptoms and signs among the 3 study groups. Adenotonsillectomy was curative in the 21 children with OSAS who were operated on. Obstructive apneas and hypopneas in the healthy, nonsnoring children were almost nonexistent in this study. CONCLUSIONS: Half of the children or fewer with symptoms suggestive of OSAS actually had the condition. Clinical symptoms may raise the suspicion, but it is not possible to establish the diagnosis without PSG. Because snoring and obstructive symptoms may resolve over time, a normal PSG finding may help the clinician decide on an observation period. Adenotonsillectomy is curative in most cases of pediatric OSAS. Obstructive symptoms may continue after adenoidectomy alone.

Adenoidectomy↗
PubMed2000

Radiofrequency tissue volume reduction of the soft palate in simple snoring.

BACKGROUND: Snoring is common and often associated with social morbidity. Current therapies are generally unsatisfactory, but radiofrequency tissue volume reduction (RFTVR) palatoplasty offers a new approach. OBJECTIVE: To assess the outcomes and morbidity associated with RFTVR palatoplasty. DESIGN: Open, prospective trial. SETTING: Tertiary referral center. PATIENTS: 20 adults with loud habitual snoring without clinically significant obstructive sleep apnea. INTERVENTIONS: Three treatments with RFTVR to the middle, distal, and proximal thirds of the midline of the soft palate. MAIN OUTCOME MEASURES: Clinical assessment (visual analog scores) before and after each treatment, polysomnography (with sound intensity measurements), and lateral cephalometry performed prior to the first treatment and 2 months following the final treatments. RESULTS: After treatment, there was a significant overall improvement in the snoring visual analog score (7.5+/-1.5 to 4.6+/-2.5; P<.001), a small reduction in the proportion of sleep spent snoring at 50 to 60 dB (P = .03), and mild pain that was controlled with simple analgesia. There were no long-term adverse effects. Individual response could not be predicted by demographic, polysomnographic, or cephalometric data. Treatment of the proximal third of the soft palate was associated with fewer adverse effects but also seemed less effective than at the other sites. CONCLUSIONS: (1) The RFTVR palatoplasty is well tolerated with very low morbidity. (2) It is associated with subjective improvement in snoring in most patients. (3) Placement of lesions seems to influence outcome. (4) The improvement is accompanied by a marginal change in objective measurements, suggesting either an acoustic change independent of sound intensity or a placebo effect. (5) A randomized controlled trial is needed to further evaluate this therapy.

Adult↗
PubMed1998

Natural history of primary snoring in children.

It is not known whether children with primary snoring (PS) progress to develop obstructive sleep apnea syndrome (OSAS). Therefore, we repeated polysomnography in a cohort of 20 children diagnosed 1-3 years previously with PS. All children initially presented with symptoms suggestive of OSAS. They were diagnosed with PS when initial polysomnography demonstrated snoring, with less than one obstructive apnea per hour, normal gas exchange, and infrequent arousals. Of 75 potential candidates, 20 were available for reevaluation (33 could not be contacted, 8 had undergone tonsillectomy and adenoidectomy, and 14 declined). Mean age was 6 +/- 4 (SD) years at the time of the initial study. The initial apnea index was 0.2 +/- 0.3, SpO2 nadir 95 +/- 2%, and peak end-tidal PCO2 was 47 +/- 3 mm Hg. At follow-up, all children were reported by their parents to still be snoring; in 20% snoring had reportedly increased, and in 70% there was no change. Eighty percent were thought to have difficulty breathing during sleep. For the group as a whole, there were no significant changes in apnea index, SpO2, or peak end-tidal PCO2. However, two children had mild OSAS on repeat polysomnography (apnea index of 3). We conclude that, in most children, primary snoring does not progress to OSAS over the course of several years. This study indicates that OSAS in the few individuals who do progress is mild. Parental concern about children's breathing patterns during sleep is a poor predictor of polysomnographic abnormalities. However, because many patients were lost to follow-up in this study, further prospective studies are needed.

Adolescent↗
PubMed2001

Snoring and obstructive sleep apnea in Thai school-age children: prevalence and predisposing factors.

We studied the prevalence of habitual snoring and its associations with tonsillar size, allergic rhinitis, obesity, and parental smoking, as well as prevalence of obstructive sleep apnea (OSAS) in a sample of 1,142 children aged 6-13 years (mean, 7.25 +/- 0.58) from seven randomly selected schools in Hat yai, Southern Thailand. Eighty-five (8.5%) of the children were habitual snorers; the prevalence was the same in boys and girls. Significant and independent association was present between snoring and allergic rhinitis with an odds ratio of 5.27 (95% CI, 1.57-17.77). The odds ratio was significantly increased to 2.65 (CI, 1.31-5.39), 5.72 (CI, 2.67-12.25), and 11.06 (CI, 1.91-63.84) in children with tonsillar size of 2+, 3+, and 4+, respectively. Of the 85 habitual snorers, 69 could be contacted by telephone call or by hospital visit. Eight of these were reported to have at least one of the following symptoms: difficulty breathing during sleep, stop breathing at night, restless sleeping and frequent awakening, sleeping with the head tipped back, and a tendency to breathe through the mouth rather than the nose. Polysomnographic studies in these 8 children demonstrated an apnea/hypopnea index of 0.6-4.7 per hr. Seven children met the criteria for OSAS. Thus, our estimate of the prevalence of OSAS among Thai schoolchildren was 7/1,008 (0.69%). We have shown that the prevalence of habitual snoring was 8.5%, and the prevalence of OSAS in a sample of Asian school-age children in Southern Thailand was 0.69%, which was similar to that observed in Western populations. An association of snoring with tonsillar size or allergic rhinitis was demonstrated. All but one of the snoring children with sleep-related symptoms had OSAS, but all were mild cases.

Adenoids↗
PubMed2000

Snoring, noisy breathing in sleep and daytime behaviour in 2-4-month-old infants.

UNLABELLED: The study aimed at evaluating possible associations between snoring and/or noisy breathing in sleep and daytime behaviour in 2-4-month-old infants using the Early Infancy Temperament Questionnaire (EITQ) as a tool. It covered the period from 1997 to 1998 and comprised 200 randomly selected clinically healthy infants aged 2-4 months from the community who were singletons and born in St. Petersburg within the chosen period. The mothers were asked to complete the questionnaires addressing infant, maternal, and major demographic characteristics, some infant care practices as well as the infant's habitual breathing symptoms during sleep. As a part of interview, the mothers answered the EITQ consisting of 76 items which describe different aspects of infant behaviour. Groups of questions were added according to a scoring sheet to produce total scores describing nine different aspects of infant temperament: activity, rhythm, approach, adaptability, intensity, mood, persistence, distractibility and threshold. In 129 cases (64.5%), mothers reported no respiratory disturbances during sleep in their infants. Mothers of ten infants (5.0%) described their babies as habitual snorers; 48 babies (24.0%) were characterised as having other than snoring noisy breathing during sleep, and 13 (6.5%) habitually had both snoring and noisy breathing. Symptomatic infants were rated as being moodier when awake compared with asymptomatic ones and most moodiness was the feature of those infants who had both snoring and noisy breathing during sleep. These associations remained after adjustment had been made for major potential confounders. CONCLUSION: Snoring and noisy breathing during sleep, rather common symptoms in young infants, may be associated with specific behavioural disturbances, and moody infants should be investigated carefully for possible obscure respiratory problems.

Affect↗
PubMed2000

[Radiofrequency ablation of the soft palate (somnoplasty). A new method in the treatment of habitual and obstructive snoring].

Twenty-nine patients (26 male and 3 female) with habitual or obstructive snoring and socially disturbing character were followed over a ten week period. All patients were treated with radiofrequency volumetric tissue reduction (RFVTR) of the soft palate. In 21 patients this operation was combined with other surgery of the upper airway, eight patients had soft palate reduction with RFVTR exclusively. With this method an electrode is positioned in the musculature of the soft palate submucosally. RFVTR may be performed under local anesthesia and has to be repeated if necessary. Ten weeks postoperatively 24 of 29 patients, respectively their social-partners, reported subjective reduction of snoring after the first treatment. Markable improvement of snoring was seen in 20 of 29 patients postoperatively and reduction of the respiratory-disturbance-index (RDI) for more than 10 was noticed in 7/29 patients polysomnographically. 5/8 patients who were treated with RFVTR exclusively, showed reduction of snoring and 3/8 patients had RDI-reduction for more than 10. We conclude, that RFVTR of the soft palate is successful in the treatment of snoring and may be helpful in the treatment of mild obstructive-sleep-apnea-syndrome (OSAS).

Aged↗
PubMed2003

Effects of a mandibular protruding device on the sleep of patients with obstructive sleep apnea and snoring problems: a 2-year follow-up.

OBJECTIVES: To evaluate subjective discomfort and somnographic measures of patients with obstructive sleep apnea and snoring problems who had been treated for 2 years with a mandibular protruding device (MPD). METHODS: The study population comprised 65 patients with a pretreatment diagnosis of obstructive sleep apnea (OSA) ( n = 44) or habitual snoring without apnea (n = 21). After a baseline medical and somnographic examination, a functional examination of the stomatognathic system, and a questionnaire focused on sleep-related qualities, each patient received an MPD. Two follow-ups were made 6 months and 2 years after MPD treatment had been initiated, and all initial examinations were repeated. RESULTS: At the 2-year follow-up, significant subjective improvements were registered in 90% of the patients regarding a reduction of snoring and apneas, in 76% regarding a reduction in daytime tiredness, and in 84% regarding an improvement in the quality of the night sleep (change of > or = 50% from baseline data). At the 2-year follow-up of the OSA group, the oxygen desaturation index (ODI) had dropped significantly from a mean value of 14.7 (SD, 12.7) to 3.1 (SD, 4.2) ( P < 0.001), and the mean SaO2 nadir rose from 78.2% (SD, 8.1) to 89.0% (SD, 4.7) ( P < 0.001). Only one of the snorers increased his ODI value; the others retained their initial healthy values. The OSA patients significantly reduced the amount of time they snored during their sleep. CONCLUSION: MPD treatment is associated with a significant reduction in subjective complaints such as disturbing snoring, apneas, daytime tiredness, and poor quality of night sleep, and with a significant reduction in ODI values in the OSA group. In addition, favorable 6-month results were unchanged after 2 years.

Adult↗
PubMed1994

Snoring may be linked to culture.

The estimates of the incidence of snoring in adults that have been provided by four epidemiological studies vary from 16-89% of the population. Collectively, these data are completely confounded by country of origin and thus may reflect cultural differences that contribute to snoring. While the etiology of snoring is not fully known, speculation has focused on gender and age as primary factors that contribute to this behavior. Within the limitations imposed by the designs of these four studies, we compared the relative strength of the relationships between snoring and gender, age, and culture. These analyses suggest that certain variables associated with cultures appear to be more salient than both gender and age, as determinants of snoring.

Adult↗
PubMed2005

Neuropsychological and psychosocial function in children with a history of snoring or behavioral sleep problems.

OBJECTIVES: To compare neuropsychological and psychosocial function in children with a history of snoring, children with a history of behavioral sleep problems (BSP), children with both a history of snoring and BSP, and a group of control subjects. STUDY DESIGN: Families awaiting consultation for "sick" visits in 5 general practice clinics completed the Sleep Disturbance Scale for Children. A subset of children were categorized into groups: Snorers (n = 11), BSP (n = 13), Snorers+BSP (n = 9), and controls (n = 31). Children underwent psychological (Wechsler Abbreviated Scale of Intelligence, Children's Memory Scale; Test of Everyday Attention and Auditory Continuous Performance Test) and psychosocial assessment (Child Behavior Checklist). RESULTS: With analysis of variance, it was revealed that, compared with children in the BSP and control groups, those in the Snorers+BSP and Snorers groups showed reduced intelligence and attention scores. By contrast, compared with children in the Snorers and control groups, children in the Snorers+BSP and BSP groups reported reduced social competency, increased problematic behavior, and reduced memory scores. Children in the combination of Snorers+BSP group showed more deficits than children in all other groups. CONCLUSION: In children, snoring and BSP, separately and together, are associated with impaired neuropsychological and psychosocial functioning. Furthermore, snoring and BSP are related to performance in disparate ways. Snoring was associated with intelligence and attention deficits, whereas BSP was associated with memory and behavioral deficits.

Adolescent↗
PubMed2004

Radiofrequency soft palate procedure in snoring: influence of energy delivered.

OBJECTIVE: We conducted a retrospective study to evaluate the influence of amount of energy delivered during radiofrequency procedure for soft palate reduction in snoring, to improve the cure rate. METHODS: Consecutive patients with chronic disruptive snoring presenting to our department were successively treated in an outpatient procedure. A visual analog scale was used to assess the severity of snoring by the bed partner and the pain by the patient, before treatment and after each treatment session. The soft palate was divided into 3 treatment sites: middle, lateral right, and lateral left. Any mucosal injury of the soft palate was classified as a complication. RESULTS: Forty-3 patients were classified into 2 groups according to energy assignment. The total amount of energy delivered was 1250 J in group 1 (n = 15) and 1500 J in group 2 (n = 28). Energy was predominantly distributed in the middle of the soft palate in group 1 (550 J) and group 2 (800 J). After each treatment session, the 1500-J delivery of radiofrequency energy (total per session) led to a better snoring grading reduction in comparison with the 1250-J delivery with a significant difference after 2 treatment sessions (P < 0.05). The mean pain score and the incidence rate of complications per treatment were not statistically different in comparing both groups. CONCLUSION: Better snoring scores can be expected by increasing radiofrequency energy applied to the soft palate. Further randomized long-term investigations are required to confirm that the cure rate can be improved when increasing energy with a suitable distribution and good clinical tolerance.

Adult↗
PubMed2006

The development of a snoring symptoms inventory.

OBJECTIVE: To develop a patient-derived snoring questionnaire, the Snoring Symptoms Inventory (SSI), and explore its structure and relationship to the Epworth Sleepiness Scale (ESS); and to assess the sensitivity of the SSI to change. STUDY DESIGN AND SETTING: The SSI was developed from an open-ended questionnaire given to 120 habitual snorers. The 25 symptoms reported compose the SSI. This study examines 261 subsequent snorers assessed between April 1998 and August 2002, who completed both the SSI and the ESS. Fifty-five of them underwent laser uvulopalatoplasty and their preoperative and postoperative SSI results were compared. RESULTS: The total SSI score is the key outcome derived. Principal component analysis identified two further dimensions, one contrasting family/social with work-related problems and another comparing physical problems with embarrassment. The total score correlated weakly with the ESS. Laser uvulopalatoplasty significantly reduced patients' overall symptom severity and family and socially related problems. CONCLUSION: The SSI is a comprehensive and sensitive measure for assessing snoring, making it a useful clinical outcome tool for snoring treatment. SIGNIFICANCE: The SSI is a new, useful snoring questionnaire. EBM RATING: B-2b.

Adult↗
PubMed2006

Consequences of increased rigidity in palatal implants for snoring: a randomized controlled study.

OBJECTIVE: Palatal implants have seen an increased role in the treatment of snoring. In this study, we evaluate the safety and possible treatment effect of adding further stiffness to the palate through the use of a more rigid implant. STUDY DESIGN: Randomized double-blind study of 20 patients with primary snoring. Three polyethylene teralphate implants were placed in the soft palate with the patient under local anesthesia. Ten patients received regular implants (rigidity 1.0) and 10 patients received stiffer implants (rigidity 1.8). The patients and their bed partners were followed for 6 months with questionnaires and office visits. A sleep study was performed preoperatively and at the last follow-up. RESULTS: Four of the 10 patients with stiffer implants had 5 partial extrusions in the observation period. There was a nonsignificant reduction in snoring intensity from 8.1 to 6.1 evaluated by the bed partner on a visual analogue scale in this group. No extrusions were seen in the group with regular implants. This group showed a significant reduction in snoring intensity from 7.7 to 4.7. No other major adverse events were observed. CONCLUSIONS AND SIGNIFICANCE: Rigid implants cause short time extrusions with loss of treatment effect. Regular implants reduce palatal snoring intensity with high patient and bed partner satisfaction. EBM RATING: A-1b.

Adult↗
PubMed2006

Evaluation of potential predictors of outcome of laser-assisted uvulopalatoplasty for snoring.

OBJECTIVE: Laser-assisted uvulopalatoplasty (LAUP) is a common treatment for snoring, but up to 50% of patients obtain little or no sustained benefit. We investigated whether pre-operative measurements from lateral cephalometry, acoustic rhinometry, analysis of snoring sounds, and body mass index (BMI) could predict which snorers benefited from LAUP. STUDY DESIGN AND SETTING: Fifty-five snoring patients were assessed pre- and 6 months post-LAUP. Snoring severity was assessed by objective sound level recorded during polysomnography, and a Snoring Symptoms Inventory (SSI) questionnaire. RESULTS: The outcome of surgery was assessed by changes in objective sound measurements and in SSI, 6 months after LAUP. CONCLUSIONS: Relationships between the predictive measurements and outcome were at best only weak and none had sufficient predictive value to be useful in clinical practice.

Adult↗