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Treatment of snoring--with and without carbon dioxide laser.

Thirty patients with bedpartners complaining of their heavy snoring which had resulted in separate bedrooms were treated surgically. Three different methods were used, each group consisted of 10 patients. In group A conventional scalpel excision was used for uvulopalatopharyngoplasty including tonsillectomy. In groups B and C, patients with small tonsils were selected and therefore the tonsils were saved. Group B was operated with carbon dioxide laser under a microscope and using micromanipulator. The same kind of excision was used as in group A but the tonsils were saved. Group C was operated as group B but using conventional scalpel excision technique. With a starting-point of snoring score 3 preoperatively in all groups, the mean postoperative snoring score in Group A was 1.0, in Group B 0.2 and in Group C 1.1. Patients with postoperative snoring scores of 0 and 1 were regarded as successful responders to surgery. No serious side effects were noted due to treatment.

Airway Obstruction↗

Nocturnal asthma: snoring, small pharynx and nasal CPAP.

We studied two populations of patients who snored and had frequent nocturnal asthma attacks: ten overweight men presenting with typical obstructive sleep apnoea syndrome, and a group of five adolescents with regular snoring and an increase in negative inspiratory oesophageal pressure during stage II non-rapid eye movement (NREM) and rapid eye movement (REM) sleep. All subjects presented cranio-mandibular abnormalities at cephalometric evaluation, with a narrow space behind the base of the tongue. Both populations were treated with nasal continuous positive airway pressure (CPAP) during sleep. Snoring and partial or complete airway obstruction were eliminated, as were the nocturnal asthma attacks. Two adolescents treated with upper airway surgery after nasal CPAP showed no nocturnal asthma at short-term follow-up. Nasal CPAP had no effect on daytime asthma. One hypothesis is that a subgroup of asthmatic patients with small pharynxes may have enhanced vagal stimulation during sleep compared with other asthmatic patients. This enhancement would be related to the repetitive Müller manoeuvres noted with airway obstruction during sleep. Combined with the local effects of snoring, this extra vagal stimulation would be a precipitating factor in nocturnal asthma attacks.

Adolescent↗

[Sleep apnea syndrome and morbid snoring].

Regular, continuous snoring usually does not have any sleep disturbing effects; however, discontinuous snoring may be associated with increased upper airway resistance and leads to recurrent arousals, sleep fragmentation and excessive daytime sleepiness. Loud snoring, recurrent obstructive apneas and oxygen desaturation during sleep with excessive daytime sleepiness are the hallmarks of the obstructive sleep apnea syndrome (OSAS). A tentative diagnosis of disturbed breathing during sleep can be made from a careful history and confirmed by a sleep study. Continuous positive airway pressure (CPAP) applied by a nasal mask is the primary treatment for OSAS and for snoring associated with increased upper airway resistance and symptoms of sleep disruption. CPAP may improve sleep quality, excessive daytime sleepiness, and potentially vascular morbidity and mortality among patients with severe OSAS.

Airway Obstruction↗

Surgical relief of snoring due to palatal flutter: a preliminary report.

We describe our experience in the surgical treatment of 32 patients with severe snoring. In the first 16 patients we used the standard surgical procedure of uvulopalatopharyngoplasty (UPP) but found this unsatisfactory because of its radical nature, complications and uncertain outcome. We therefore investigated the mechanics of snoring in the laboratory as a help in devising a more effective operation. These studies have shown that there are several methods by which snoring can be generated but that palatal flutter is probably the most important. The dominant parameters in the generation of flutter of the palate are its length and stiffness. Any removal of tissue to shorten the palate as in UPP inevitably risks impairing its function, so we chose the stiffening alternative. Using the laser, a central longitudinal strip of mucosa was removed from the surface of the soft palate which healed by fibrosis, producing the required stiffening. The early results of this new procedure show that snoring has been eliminated or greatly reduced in 14 of 16 patients and that apart from local pain there have been no complications.

Adult↗

[Surgical treatment of snoring and sleep apnea].

Twenty-one patients (four females and 17 males) greatly inconvenienced by snoring were subjected to UPP with CO2-laser technique. All patients were overweight (body-mass index average 30 kg/m2). Narrowing was found at the naso/oropharyngeal border in 71%. All had either abnormal uvula or soft palate. Snoring was reduced to a degree no longer socially troublesome in 17 patients. Three patients were still inconvenienced to some extent. Snoring was completely unchanged in only one patient. UPPP is not very difficult to perform, and we did not notice any sequelae of importance. We think that UPPP is an effective operation for severe snoring, although it does not eliminate the symptom.

Adult↗

Snoring, apnea, and nasal resistance.

OBJECTIVE: To understand the impact of the nose in relation to snoring, to increased and decreased nasal resistance and sleep, to nasal anatomy and physiology in snorers and apneic patients, and to nocturnal episodes of respiratory obstruction in relation to nasal obstruction. DESIGN: A select group of patients, in whom nasal reconstruction and uvulopalatopharyngoplasty (UPPP) were combined, were studied. A review of the literature is included. METHODS: A questionnaire was given to all patients. MAIN OUTCOME MEASURES: Patients' snoring improvement was evaluated postoperatively. RESULTS: Overall, 174 of the 180 patients (97%) believed their snoring to be improved postoperatively after combined nasal reconstruction and UPPP were done. CONCLUSION: A review of the literature, a review of snorers' pathophysiology, and the results of this study show that nasal surgery and UPPP combined are effective in improving snoring.

Airway Resistance↗

Magnetic therapy is ineffective for the treatment of snoring and obstructive sleep apnea syndrome.

Snoring and the obstructive sleep apnea syndrome are common and chronic ailments with potentially serious medical complications. There are several accepted treatments, but these can be uncomfortable, inconvenient, and expensive. A number of alternative treatments have been reported to be beneficial in the treatment of obstructive sleep apnea and snoring. They are advertised in magazines, on the radio and television, and on the Internet. The lay press is reporting about the effectiveness of these treatments without the benefit of clinical trials or scientific studies. Among the therapies currently being promoted for the treatment of snoring and sleep apnea is biomagnetic therapy. Unlike many of the other treatments which have not undergone scientific evaluation, biomagnetic therapy has been evaluated in the past. In fact, the evaluation of biomagnetic therapy is one of the first controlled scientific investigations found in the literature. This report showed that magnet therapy had no medicinal value. Despite this clear evidence, magnetic therapy continues to be utilized today and currently is being promoted for the treatment of snoring and sleep apnea. At out Sleep Disorder Center, we have had the opportunity to evaluate a patient with severe obstructive sleep apnea both before and after treatment with magnetic therapy, as well as with conventional therapy. Our study clearly indicates there was no benefit from magnetic therapy in this case. While alternative therapy may be helpful in the treatment of certain medical conditions, extreme care must be exercised to prevent inappropriate treatment or undertreat-ment of significant medical problems. Close clinical follow-up and controlled studies are important in determining the effectiveness of therapies.

Complementary Therapies↗

Validation of the snore outcomes survey for patients with sleep-disordered breathing.

OBJECTIVE: To develop and validate a self-reported outcomes measure for patients with sleep-disordered breathing-the Snore Outcomes Survey. DESIGN: Item areas of the SOS were developed by an expert panel. Consecutive patients were enrolled into the study in a prospective manner. Patients received the SOS, the Epworth Sleepiness Scale, the Pittsburgh Sleep Quality Index, the Medical Outcomes Study 36-Item Short-Form Health Survey, and standard overnight polysomnography at baseline and after 4 months of continuous positive airway pressure therapy. SETTING: A tertiary care, academic otolaryngology and sleep disorders referral center. PATIENTS: One hundred fifty-six adult patients presenting with a chief complaint of snoring or sleep-disordered breathing to the Massachusetts Eye and Ear Infirmary, Boston. MAIN OUTCOME MEASURES: Test-retest reliability, intrasurvey reliability, internal consistency, validity, and standardized response means of the SOS. RESULTS: Overall, reliability of the SOS was excellent (test-retest reliability r = 0.86; P<.001; Cronbach alpha coefficient, 0.85). The SOS index significantly correlated with the Epworth Sleepiness Scale (r = - 0.42; P<.001) and the global Pittsburgh Sleep Quality Index score (r = - 0.38; P<.001), as well as with the number of recorded arterial oxygen saturation levels below 85% (r = - 0.46; P =.02). The SOS index was sensitive to clinical changes after intervention (standardized response mean, 0.57). CONCLUSION: The SOS is a reliable and valid instrument for assessing sleep-related health status for patients with snoring and sleep-disordered breathing and for measuring change in health status following therapy.

Adult↗

The use of essential oils to treat snoring.

Snoring is a very common social inconvenience. This double-blind study suggests a significant reduction in snoring reported by bed partners in a group of snoring volunteers using either an essential oil spray or gargle formulation. Possible modes of action of the essential oils are discussed.

Administration, Inhalation↗

[Use of an intraoral snoring therapy device of thermolabile plastic].

Oral appliances are used to treat snoring and sleep apnea. Yet, their success cannot be predicted without a therapeutical trial. This uncertainty and the high prices of the appliances are the reasons for their limited use. We tested a cheap, custom fit mandibular advancement device (SnorBan) for the treatment of sleep disordered breathing in order to assess its efficacy. 39 consecutive patients (51.1 +/- 9.2 years, BMI = 27.4 +/- 4.5 kg/m2) with different degrees of sleep disordered breathing (AHI = 16.6/h +/- 15.6/h) received the device after a thorough clinical examination. After getting used to the device a second polysomnography was performed. The AHI improved significantly from 16.6/h to 8.2/h (P < 0.01) in the whole group. The only patient who became worse could not get used to the device. Time with snoring dropped significantly from 16.3% to 6.6%, 59.1% of the sleep apnea patients were successfully treated as their RDI dropped below 10/h. The sleep efficiency remained unchanged. Slow wave sleep and REM-sleep increased significantly from 12% to 16% (P < 0.05). The overall compliance was 75%. The custom fit mandibular advancement device Snorban is a cheap and effective treatment for a number of patients with snoring and sleep apnea. The oral appliance is proven to be a useful and simple, non-surgical treatment option. Polysomnographic follow-up is mandatory as breathing may worsen with the device while asleep.

Adult↗

Soft palate implants: a new option for treating habitual snoring.

One hundred six patients with proven habitual snoring were each treated with three implants consisting of a cylindrical-shaped segment of braided polyester filaments (18 mm in length with an outer diameter of 1.5 mm) in the soft palate. The implants, pre-loaded in a single-use delivery tool, were inserted into the soft palate under local anesthesia. Along with the initial examination, follow-up exams were done after the treatment to test the safety and efficacy of the procedure. Snoring post treatment was reported as "no snoring" or "slight/occasional" in the majority of the cases after treatment. The results indicate there were no serious adverse events reported. The most frequent minor adverse events were partial extrusions in which the patient often presented a minor foreign body sensation along with mild transient pain. This data has demonstrated the procedure as a minimally invasive, relatively painless, simple procedure that has been shown to be safe and effective.

Adult↗

Available techniques for objective assessment of upper airway narrowing in snoring and sleep apnea.

A number of techniques are available to determine the level of obstructive predominance in snoring and in the obstructive sleep apnea hypopnea syndrome (OSAHS): lateral cephalography, awake endoscopy, awake endoscopy with the Müller maneuver, endoscopy during sleep, endoscopy with nasal continuous positive airway pressure during sleep, fluoroscopy, CT scanning, MR scanning, manometry, and acoustic reflections. Data from different studies using various methods suggest that different patients have different patterns of narrowing or collapse of the pharynx. No reference standard exists for the determination of the predominant obstructive level during obstructive events, so further investigations are necessary to improve and validate existing methods and develop new techniques. These would improve our understanding of the pathophysiology of OSAHS and snoring and help to select the correct treatment option for different patients. This article lists criteria that must be used to assess the available techniques for diagnosis of obstruction level in snoring and OSAHS. The advantages and limitations of each diagnostic technique are summarized, with emphasis on the acoustic reflectometry technique.

Endoscopy↗

Digital signal analysis of snoring sounds in children.

Snoring sounds of 5 children with sleep-dependent compromised breathing were recorded. Underlying diseases were large adenoids, adeno-tonsillar hyperplasia, hemangioma of the tongue-base and Rubinstein-Taybi's syndrome associated with micrognathia. For comparison snoring sounds of a 42-year-old chronic snorer were analyzed. Time series of the power spectral density of the breath sounds were calculated as well as the mean power spectra of the recordings. The results show that the frequency spectrum reflects the pathomechanism responsible for the production of the abnormal breath sound. In adults, simple snoring is due in large part to vibrations of the soft palate. This can be identified in the frequency spectrum as a low-frequency component with a large number of harmonics. In children with enlarged adenoids and tonsils the soft palate is impeded in its movement which can be demonstrated in the frequency spectrum as a lack of low-frequency components and harmonics. Craniofacial anomalies are characterized by special spectral patterns.

Adenoids↗

Current treatment practices in obstructive sleep apnea and snoring.

PURPOSE: To determine current management strategies of otolaryngologists involved in the treatment of sleep-disordered breathing. MATERIALS AND METHODS: Survey of practitioners regarding their workup and treatment of patients suspected of obstructive sleep apnea. RESULTS: Of 305 respondents, 280 actively treated patients with obstructive sleep apnea or snoring, form the basis for this study. Respondents were from assorted practice settings, from a diverse geographic background, and varied length of time in practice. Although 48% see more than 3 new outpatients a week for snoring or obstructive sleep apnea, only 46% routinely ask their patients about sleep problems, and 49 % fail to ask all of their patients with sleep apnea about sleep-related automobile accidents. Although most regularly use nasopharyngoscopy, a significant proportion seldom uses the Müller maneuver. Most tend to rely predominantly on whole-night polysomnography, rather than split night or home testing. Half of respondents offer their patients with simple snoring more than 1 method of treatment. Although many different surgical procedures are offered by most, only 28% of respondents offer patients any procedure aimed at airway obstruction at the base of tongue level. CONCLUSIONS: Otolaryngologists, with their unique expertise in airway management, need to be more vigilant for patients with sleep-disordered breathing. The hypopharynx fails to be frequently addressed by the respondents and could lead to inadequate treatment of obstructive sleep apnea. Further research should seek to develop an evidence-based standard of care such that this disorder might be most effectively managed in the future.

Adult↗

[Snoring in children].

Only snoring loud enough to be heard behind a closed door have to be investigated and treated. Snoring is severe when associated with sleep apneas. The 3 most frequent causes of snoring in children are enlarged adenoids, enlarged tonsils and blocked nose due to allergic rhinitis.

Adenoidectomy↗

Blocked nose and snoring in a 6-year-old boy.

Nasal obstruction, mouth-breathing, snoring and deafness are common symptoms seen in children presenting to the otorhinolaryngology clinic. The aetiopathologies are frequently due to adenotonsillar hypertrophy and otitis media with effusion. Rarely however, nasal obstruction and snoring may be associated with more sinister pathology. We report a case of a child with nasopharyngeal B-cell Non-Hodgkin's lymphoma whose initial symptoms were of nasal obstruction and snoring.

Burkitt Lymphoma↗

Snoring associated with Ondine's curse in a patient with brainstem glioma.

UNLABELLED: Ondine's curse is an uncommon type of sleep apnea syndrome characterized by failure of automatic respiration. We present an adult patient with brainstem glioma who presented with snoring and Ondine's curse as the only symptoms. CASE REPORT: A 52-year-old female was brought to the hospital by a fellow resident due to exceptionally loud snoring. During the hospitalization, Ondine's curse was diagnosed after monitoring using Apnomonitor 5 (Chest Co., Tokyo), a cheap, non-invasive respiratory monitoring procedure. MRI and MR spectroscopy revealed a brainstem glioma. After radiation therapy, clinical response was documented using repeat apnomonitoring. CONCLUSION: Exceptionally loud snoring in non-obese adult patients with sleep apnea may be an early feature of a brainstem space-occupying lesion. Overnight sleep respiratory evaluation and neuroimaging should be considered in such instances.

Brain Stem Neoplasms↗

Mitochondrial dysfunction in muscle cells induced by snoring vibrations.

Snoring-related vibrations have been proposed as a pathogenic factor contributing to upper airway muscle dysfunction in patients with obstructive sleep apnea (OSA). To investigate whether exposure to snoring vibration is linked to muscle weakness, we used an in vitro vibration model to examine its effects on mitochondrial homeostasis in L6 muscle cells at 8, 12, 24, and 48&#xa0;h. The findings were then compared with mitochondrial alterations in the upper airway muscles from snorers and patients with OSA. Proteomic analysis of L6 myoblasts revealed extensive remodeling of the mitochondrial proteome at 8&#xa0;h, affecting pathways involved in oxidative phosphorylation, protein import, ribosome biogenesis, and RNA processing. Respiratory chain remodeling was subunit-specific, with increased abundance of selected components of Complexes I, IV, and V, including NDUFS4, COX5A, and ATP5PD. However, reductions in spliceosome-associated factors, such as SRSF2 and DDX46, along with alterations in mitochondrial ribosomal proteins, indicated impaired RNA processing and protein synthesis. Furthermore, both proteomic and transcriptomic analyses revealed activation of a mechanosensing-mechanotransduction axis, with early upregulation of integrin subunits and mechanosensitive ion channels, followed by transient activation of focal adhesion signaling. Despite transcriptional upregulation of selected Complex IV subunits Cox5a and Cox6a2, this response was accompanied by accumulation of unspliced pre-mRNA, indicating impaired RNA processing efficiency and a decoupling between transcript and protein levels. Real-time Seahorse assay revealed a collapse of mitochondrial respiration and glycolytic reserve at 8&#xa0;h. Although mitochondrial oxygen consumption recovered after 48&#xa0;h, the ability to dynamically upregulate glycolysis remained impaired. In patients, muscle capillarization was impaired, COX activity was reduced, and mitochondrial organization was disrupted. Moreover, transcription of Complex IV subunits COX5A and COX6A2 was, as in vibrated L6 cells, upregulated, suggesting a mismatch between transcript levels and protein expression. We conclude that snoring-induced vibrations are an unrecognized stressor that disrupts mitochondrial homeostasis in muscle by impairing RNA processing, protein synthesis, and mechanotransduction-driven mitochondrial remodeling, leading to transcript-protein uncoupling and likely muscle dysfunction.

Humans↗