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PubMed1999

Influence of gas density on simulated snoring.

According to a recent theoretical model, snoring is related to instability of the upper airway (UA). Factors promoting UA instability include increased gas density. The aim of this study was to test the influence of gas density on simulated snoring production and supraglottic resistance. Supraglottic pressure and flow rate (V') were measured in 10 healthy seated subjects during simulated snoring. Subjects breathed three different gas mixtures: Helium-oxygen, He 79%-O2 21% (He-O2); air; and sulphur hexafluoride-oxygen, F6S 79%-O2 21% (F6S-O2) administered in a random order. Supraglottic resistance (Rsg) was measured on its linear range during quiet breathing and V' was measured at the onset and middle of snoring. Linear Rsg increased and V' conversely decreased with gas density. These data are in agreement with predictions of a mathematical model of the upper airway showing that snoring occurs at lower flow rates when gas density is increased.

Adult↗
PubMed2002

Medium-term outcome of palatal surgery for snoring using the Somnus unit.

The aim of this study was to retrospectively survey patients who had undergone radiofrequency ablation of the soft palate for snoring complaints. Fifty-nine patients who had undergone radiofrequency ablation were sent an anonymous questionnaire to assess snoring (using visual analogue scales), pain and satisfaction with the procedure. Sixty-one per cent of the group returned the questionnaire. The mean time since operation was 17.5 months. Taking an improvement in snoring of 50 per cent or greater as a successful operation, snoring improvement occurred in 22 per cent. Post-operative pain was minimal with a median pain score of zero. Information was requested on whether the patient would undergo this procedure again, 50 per cent responded that they would and 44 per cent would advise a friend in the same situation to have this procedure. Radiofrequency ablation of the soft palate, as in other forms of surgery for snoring, seems to have a relapse rate over the long-term.

Catheter Ablation↗
PubMed2004

Portable method for the determination of snoring site by sound analysis.

It has been shown that computerized sound frequency analysis can be used to distinguish between different snoring sites. The aim of this study was to investigate whether a portable recording method using audiotapes and digital minidisc formats could produce waveforms similar to a computer recording. The snores of 12 subjects in their natural sleep were recorded onto audiotape, minidisc and directly onto a computer. For each snorer and recording method 30 snore samples were analysed and their power ratio was calculated indicating the relative amount of sound below and above a set frequency. It was found that the power ratios from audiotape recordings were significantly different to those from computer recordings for all snoring sites (p = 0.0007), whereas there was no significant difference between minidisc and computer recordings (p = 0.41). These results indicate that it would be possible to base a portable snore analysis system for site determination on minidisc, but not on audiotape recordings.

Adult↗
PubMed1989

Surgery for snoring.

Snoring is a common obnoxious disturbance in human society. Although considered a mere nuisance by most, it can have significant social and medical effects. Snoring has caused marriage breakdown and murder. It can lead to hypertension, heart failure, and the obstructive sleep apnea syndrome. Since Ikematsu developed palatopharyngoplasty (PPP) in 1952 and Fujita introduced it to North America in 1981, numerous reports have alluded to its efficacy in the management of snoring. From June 1986 to February 1988, 110 PPP operations were performed at The Wellesley Hospital, University of Toronto. Of these, 58 patients responded to review and questionnaire. Elimination or improvement of their snoring was reported by 75.9% of patients. Complications encountered are discussed. We conclude that palatopharyngoplasty (PPP) is a safe and effective technique in the treatment of problematic snoring.

Female↗
PubMed1995

UPPP for habitual snoring: a 5-year follow-up with respiratory sleep recordings.

Fifty-six men who underwent uvulopalatopharyngoplasty (UPPP) because of habitual snoring without preoperative obstructive sleep apnea (OSA), according to respiratory sleep recordings, were interviewed concerning persistent snoring and excessive daytime sleepiness (EDS). Renewed recordings were made in 53 of them at a median time of 63 months postoperatively. Median preoperative oxygen desaturation index (ODI) was 0; the median postoperative index was 1. Median duration of the preoperative obstructive respiratory pattern was 8% of total sleeping time, and the median duration postoperatively was 17%. (Significant individual increases were P = .0005 and P = .004, respectively.) Six patients answered to OSA criteria postoperatively. Weight increases were significantly correlated to increases in both ODI and obstructive respiratory pattern and to persistent snoring. Preoperatively 51 of 56 patients reported EDS, and 73% of the patients were improved or cured. From snoring, 87% reported improvement or cure. No patient had any serious sequelae of UPPP. Uvulopalatopharyngoplasty is a safe and effective treatment for habitual snoring, but it does not give absolute protection from development of OSA.

Body Mass Index↗
PubMed1995

Inability of clinical history to distinguish primary snoring from obstructive sleep apnea syndrome in children.

STUDY OBJECTIVE: To determine whether primary snoring (PS) could be distinguished from childhood obstructive sleep apnea syndrome (OSAS) by clinical history. DESIGN: Retrospective study of clinical history of 83 children with snoring and/or sleep disordered breathing who were referred for polysomnography. SETTING: Tertiary referral center; pediatric pulmonary sleep apnea clinic. MEASUREMENTS: We evaluated the ability of a clinical obstructive sleep apnea (OSA) score and other questions about sleep, breathing, and daytime symptoms to distinguish PS from OSAS in children. Parents were asked about the child's snoring, difficulty breathing, observed apnea, cyanosis, struggling to breathe, shaking the child to "make him or her breathe," watching the child sleep, afraid of apnea, the frequency and loudness of snoring, and daytime symptoms such as excessive daytime sleepiness (EDS). RESULTS: Based on polysomnography results, 48 patients were classified as PS and 35 as OSAS. Peak endtidal CO2 (49 +/- 3.2 vs 55 +/- 8.2 [SD] mm Hg); lowest arterial oxygen saturation measured by pulse oximetry (95 +/- 1.9 vs 82 +/- 14%); and apnea/hypopnea index (0.27 +/- .3 vs 8.4 +/- 6 events/h) indicated that the diagnostic criteria for PS versus OSA were reasonable. There were no differences between PS and OSA patients with respect to age, sex, race, failure to thrive, obesity, history of EDS, snoring history, history of cyanosis during sleep, or daytime symptoms except for mouth breathing. There were no significant differences in sleep variables between PS patients and those with any severity of OSAS. The OSA score misclassified about one of four patients. Comparing PS and OSA patients, significant findings were daytime mouth breathing (61 vs 85%; p = 0.024); observed apnea (46 vs 74%; p = 0.013); shaking the child (31 vs. 60%; p = 0.01); struggling to breathe (58 vs 89%; p = 0.003); and afraid of apnea (71 vs 91%; p = 0.028). However, none of these were sufficiently discriminatory to predict OSAS. CONCLUSION: We conclude that PS in children cannot be reliably distinguished from OSAS by clinical history alone.

Case-Control Studies↗
PubMed1999

Evaluation of variable mandibular advancement appliance for treatment of snoring and sleep apnea.

OBJECTIVE: To evaluate an adjustable mandibular positioning appliance for treatment of snoring and sleep apnea. METHODS: One hundred thirty-four patients with baseline apnea/hypopnea index (AHI) of 37 +/- 28 events/h (mean +/- SD) received the appliance. The efficacy of the appliance was assessed by the following investigations, performed at baseline and with the appliance: polysomnography, Epworth sleepiness scale, bedpartners' assessment of snoring severity, patients' assessment of side effects, and overall satisfaction. RESULTS: Thirteen patients were lost to follow-up. An additional 46 patients had no follow-up polysomnography, but answered the questionnaires. A total of 75 patients had polysomnography at baseline and with the appliance. We found a significant reduction in AHI from 44 +/- 28 events/h to 12 +/- 15 events/h (p < 0.0005) and a reduction in the arousal index from 37 +/- 27 events/h to 16 +/- 13 events/h (p < 0.05). Epworth scores fell from 11 +/- 5 to 7 +/- 3 (p < 0.0005). Bedpartners' assessment revealed marked improvement in snoring. For example, at baseline 96% of patients were judged to snore loudly "often" or "always" by their bedpartners, whereas only 2% were judged so while using dental appliance. The most frequent side effect was teeth discomfort, present "sometimes" or "often" in up to 32% of patients. Follow-up clinical assessment in 121 patients conducted on the average 350 days after the insertion of the appliance revealed that 86% of patients continued to use the appliance nightly; 60% were very satisfied with the appliance, 27% were moderately satisfied, 11% were moderately dissatisfied, and 2% were very dissatisfied. CONCLUSION: We conclude that the adjustable mandibular positioning appliance is an effective treatment alternative for some patients with snoring and sleep apnea.

Evaluation Studies as Topic↗
PubMed1984

Positive nasal airway pressure eliminates snoring as well as obstructive sleep apnea.

Nine men who were habitual snorers were studied during a control and a treatment night (in random order) to assess the effect of nasal continuous positive airway pressure (CPAP) on snoring, sleep-disordered breathing, and nocturnal oxygen desaturation. Four subjects had symptoms suggestive of the sleep apnea syndrome, but the other five were asymptomatic. Polysomnography and recordings of snores were obtained on both nights. On the treatment night, the subjects wore a customized infant anesthesia mask over their noses, and CPAP was applied and adjusted upward from 4 cm H2O to a level that obliterated snoring. Nasal CPAP (range 4 to 13 cm H2O) reduced the mean number of snores per night from 1,015 per subject to 23 per subject (p less than 0.01). Mean numbers of episodes of apnea, hypopnea, and desaturation were also significantly reduced. Analysis of sleep structure showed no significant differences in sleep period time, total sleep time, or the percentages of stages 3 and 4 sleep. The percentage of stages 1 and 2 was significantly greater on control nights, and the percentage of REM sleep was greater on treatment nights. On the control nights, snoring was common in stages 3 and 4 and least common during REM sleep.

Adult↗
PubMed1988

Snoring and upper airway properties.

Habitual snoring in adults may be related to upper airway dysfunction, although the precise relationship has never been studied. We quantitatively measured snoring and correlated it with upper airway properties in 50 apneic and 59 nonapneic adult male patients. Both groups were similar in terms of nasal airflow resistance and pulmonary function tests. We found a significant correlation between the severity of snoring and nasal airflow resistance in both groups, and between the severity of snoring and pharyngeal and glottic areas in the apneic group. We conclude that snoring may be associated with abnormalities in upper airway properties.

Adult↗
PubMed2000

Snoring in Portuguese primary school children.

OBJECTIVE: To determine the prevalence of snoring and its potential associations with sleep problems, such as daytime symptoms, medical conditions, school performance, and behavioral disturbances in Portuguese children attending primary school. METHODS: A previously validated questionnaire was sent to the parents of 1381 children attending primary schools in a parish of Coimbra, Portugal. To assess behavioral disturbances, the Portuguese version of Rutter's Children's Behavior Questionnaire for completion by teachers was used. RESULTS: Of the 988 questionnaires returned (71.5%), complete information concerning snoring was obtained for 976 children (496 girls and 480 boys; mean age: 8.1 +/- 1.5 years). Loud snoring during sleep was reported as frequent or constantly present (LSn) in 84 children (8.6%), as occasionally present in 299 children (30.6%), and as never present (NSn) by 593 children (60.8%). The LSn and NSn groups did not differ with respect to age, gender, sleep duration, time to fall asleep, frequency of night wakings, bedwetting, daytime tiredness, and school achievement. However, LSn was significantly associated with increased bedtime problems (fears and struggles), increased need for comforting activities to fall asleep, behaviors suggestive of parasomnias (sleep talking, teeth grinding, and night terrors), increased daytime sleepiness and irritability, and behavioral disturbances. Children in the LSn group were also more likely to report recurrent medical problems particularly those involving infections of the respiratory tract. CONCLUSIONS: Snoring is a common symptom in Portuguese children that is associated with behavioral daytime and sleep time disturbances. Children with loud snoring may benefit from early evaluation and intervention.

Achievement↗
PubMed2001

Snoring in 9- to 15-year-old children: risk factors and clinical relevance.

OBJECTIVE: Our objective was to investigate the occurrence of snoring in a general population sample of children and to evaluate the association with anthropometric data and clinical findings of oropharynx and nasal airways. METHODS: A cross-sectional study was conducted with children from primary and secondary schools in Civitavecchia and Viterbo in the Latium region in central Italy. The total sample of the survey included 2439 schoolchildren. A total of 2209 children who were ages 10 to 15 years were selected (response rate: 90.5%) according to their snoring frequency during sleep: never, only with colds, occasionally apart from with colds, often. Children in the last category were defined as habitual snorers. Data were collected by means of questionnaires and clinical examination. A blood sample was collected to determine the concentration of hemoglobin in the blood. Logistic regression was used to calculate odds ratios (OR) and 95% confidence intervals. RESULTS: The prevalence of habitual snorers was 5.6%. Boys who were older than 15 years and had a body mass index greater than the 90th percentile were significantly more likely to be snorers. Habitual snoring was strongly associated with decreased nasal patency (rhinitis OR: 2.13; septal deviation OR: 2.75; nasal obstruction OR: 2.20). Children who had undergone adenoidectomy or had markedly enlarged tonsils were at greater risk of being habitual snorers (OR: 4.28 and 5.07, respectively). Last, habitual snorers had a significantly higher concentration of hemoglobin in the blood compared with other children. CONCLUSION: Body weight and nasal and pharynx patency seem to be the main determinants of snoring. The finding of higher values of blood hemoglobin concentration in snorers than in nonsnorers suggests that these children could be experiencing oxyhemoglobin desaturation during sleep. Taking into consideration the relationship between these different risk factors could lead to a better clinical approach to the snoring child.

Adolescent↗
PubMed2005

Level of proinsulin in association with cardiovascular risk factors and sleep snoring.

AIM: To explore the relationship between the level of proinsulin with cardiovascular risk factors and sleep snoring. METHODS: Based on the random stratified sampling principle, 1 193 Chinese residents in Pizhou City, Jiangsu Province (530 males and 663 females, aged 35-59 years with an average age of 46.69 years) were recruited. Their sleep snoring habits were investigated. Biotin-avidin based double mAbs ELISA was used to detect specific insulin and proinsulin, and a risk factor score was established to evaluate the individuals according to the number of their risk factors. RESULTS: The results of Spearman correlation analysis and covariate ANOVA analysis after age and sex were controlled, indicated that not only the level of proinsulin (r = 0.156, P = 0.000, F = 5.980 P = 0.000), but also cardiovascular risk factors score (r = 0.194, P = 0.000, F = 11.135, P = 0.000) significantly associated with the frequency of sleep snoring, and the significant relationship between true insulin and frequency of sleep snoring was only shown in the covariate ANOVA analysis (F = 2.868, P = 0.022). The result of multivariate stepwise logistic regression after age, sex, body mass index, waist circumference and true insulin were controlled showed that proinsulin (division by interval of quartile) was an independent risk factor for sleep snoring (OR = 1.220, 95%CI: 1.085-1.373, P = 0.001). CONCLUSION: The interaction of cardiovascular risk factors clustering, high proinsulin level and sleep breathing disorder may be a syndrome, which has not been recognized in human beings so far.

Adult↗
PubMed1999

The effect of snoring and obstructive sleep apnea on the sleep quality of bed partners.

OBJECTIVE: To measure the effect of snoring and obstructive sleep apnea (OSA) on the sleep of snorers' bed partners and to determine whether a bed partner's sleep improves when snoring and OSA are treated. MATERIALS AND METHODS: We studied 10 married couples in which 1 member was undergoing polysomnography to evaluate suspected OSA. The patients and their spouses underwent simultaneous polysomnography. Midway through the 1-night study, the patients received nasal continuous positive airway pressure (CPAP) with the pressure adjusted to eliminate snoring and obstructive breathing events. Apnea-hypopnea index (episodes/hours of sleep time), arousal index (arousals/hours of sleep time), and sleep efficiency (percent time asleep) were calculated to measure sleep quality. RESULTS: The patients (all male) demonstrated a median (range) apnea-hypopnea index of 26 (3-75) that decreased to 7 (0-34) during the trial of nasal CPAP therapy (P < .05). During the CPAP trial, the median (range) arousal index of the spouses decreased from 21 (14-34) to 12 (4-27) (P < .01), and the spouses' median (range) sleep efficiency increased from 74% (56%-80%) to 87% (64%-95%) (P < .01). CONCLUSION: The elimination of snoring and OSA in these patients was associated with an improvement in the quality of their bed partners' sleep, as indicated by improved sleep efficiency and continuity, even when the spouses had been habitually exposed to snoring and OSA. Assuming that 480 minutes were spent in bed for sleep, a 13% improvement in sleep efficiency (i.e., from 74% to 87%) translates to an additional 62 minutes of sleep per night for the spouses of snorers with OSA.

Adult↗
PubMed1999

Snoring surgery: which one is best for you?

Excessive snoring is a common problem that is frequently treated surgically. In the early 1980s, uvulopalatopharyngoplasty was introduced to the United States as the first surgical treatment for excessive snoring. It remains in common use, but its limitations created an incentive to develop a procedure that is as effective, but safer and more economical. Several other surgical procedures for snoring were developed, including laser-assisted uvulopalatoplasty, palatal stiffening operations, and radiofrequency ablation. Each of these procedures has its own advantages and limitations; which procedure is the best treatment for excessive snoring is controversial. We present our experience with each of these procedures, along with a thorough review of the literature, to help the otolaryngologist determine which is the best snoring surgery for the individual patient.

Catheter Ablation↗
PubMed2000

[Treatment of snoring with controlled temperature radiofrequency: short- and mid-term tolerance and efficacy].

UNLABELLED: Uvulopalatopharyngoplasty and laser pharyngotomy can provide effective and definitive cure of snoring. These methods are however very painful. The ideal treatment would be not only effective but also pain free. MATERIAL AND METHODS: We assessed prospectively the efficacy and tolerance to temperature controlled radiofrequency (somnoplasty). This technique was applied to the velar palate in 15 snoring patients. Self assessment was used to evaluate outcome. The patients daily recorded: uneasiness, pain, drug use, and food intake. Their spouse scored snoring for 6 to 8 weeks after the end of treatment and more than 6 months after the last treatment session. RESULTS: We achieved 80% success after 2.1 sessions. Pain was minimal. A sensation of uneasiness was frequent and led to minimal drug use. After a mean 13 months, half of the patients experienced a recurrence or an aggravation of their snoring level. Overall satisfaction rate was 69%. CONCLUSION: These preliminary results suggest that radiofrequency is well tolerated and effective in the short- and mid-term for the treatment of snoring.

Adult↗
PubMed2001

A review of oral devices in the treatment of habitual snoring and obstructive sleep apnoea.

With recent interest in sleep apnoea, oral devices have been proposed and used increasingly to treat patients suffering from snoring and obstructive sleep apnoea (OSA). Numerous case reports have been published and studies have been carried out to determine the efficiency and mechanism of action as well as evaluate side effects, complications and costs of different oral devices in the treatment of habitual snoring and OSA. A summary of the scientific basis and current opinions regarding oral devices in the treatment of habitual snoring and obstructive sleep apnoea is presented in this article. The selection of papers was based on a computerised search of published clinical and associated studies identified by MEDLINE from 1980 to November 2000. Although there is not yet enough scientific evidence for the clinician to determine which appliance is most likely to improve symptoms for a given patient, it appears from the literature that dental devices may have a place in the treatment of habitual snoring and mild and moderate cases of OSA. However, most of the studies are case series, raising questions on validity, and few studies use appropriate control groups. The general opinion is that these patients should not be treated without a sleep study as the OSA must be diagnosed before beginning treatment with oral devices to identify patients at risk and to provide a baseline to establish the effectiveness of the treatment. The main advantages of oral devices is the relative simplicity of the treatment, its reversibility and cost-effectiveness, and the fact that they can be used as an alternate treatment in patients who are unable to tolerate nasal continuous positive airway pressure (nCPAP) or who are poor surgical risks. Side effects occur in a significant proportion of patients using the MAD. In most cases these are minor and their importance must be balanced against the efficacy of the MAD in treating snoring and OSA. n.

Adult↗
PubMed2002

Effect of nasal valve surgery by open-septorhinoplasty and lateral cartilage grafts (spreader grafts) on snoring among a population of single snorers. Preliminary report.

Snoring is traditionally considered more of a social nuisance than disease. The observation that nasal obstruction may modify breathing during sleep and daytime behavior and our clinical observations suggesting that some single snorer patients who had undergone surgery of the nasal valve for nasal obstruction complaints had presented a decrease in their snoring, led us to make a retrospective study on twenty nine patients. Eight of them were simple snorers. They underwent a surgery of the nasal valve under general anesthesia through an open septorhinoplasty during which lateral graft cartilages (modified spreader grafts) were set in place between septolateral cartilage and the anterior and superior edge of the nasal septum. Active anterior rhinomanometry (AAR), posterior active rhinomanometry (PAR) and a self-assessment of the nasal patency by the patient himself on a visual analog scale (VAS) were compared before and one year after surgery. Snoring was assessed by both bed partners according to a four step scale (none, slight, moderate and severe). No significant differences were found between AAR or between PAR. But significant differences were measured with VAS (for the left (p < 0.0001) and the right sides (p < 0.001). All patients but one demonstrated substantially decreased snoring. As there is no clear cut evidence of changes in nasal resistances measured by rhinomanometry, we suggest that the observed decrease in snoring may be induced by changes in the direction of the nasal airflow against the nasal mucosa which may produce by a reflex between mecanoreceptors of the nasal mucosa and muscles of the pharynx, an increased tonus of the muscles of the pharynx.

Adult↗
PubMed2002

UPPP for snoring: long-term results and patient satisfaction.

We retrospectively survey 57 patients who underwent uvulopalatopharyngoplasty (UPPP) because of habitual snoring over a five-year period. A total of 100 patients were sent questionnaires concerning persistent snoring, excessive daytime sleepiness (EDS), body mass index (BMI) and postoperative complications. After 5 years the success rate was 53%. The mean snoring score was 16.7 preoperatively and decreased to 10.6 postoperatively. There was a relationship between the body mass index (BMI) preoperatively and the efficiency of the surgery. The mean EDS score was 11.1 before and 9.4 after surgery. UPPP in patients complaining of snoring is quite successful but the results decline significantly with time and patients should be warned of the possibility of snoring remaining or returning.

Body Mass Index↗