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At least 433 records · Page 24Linked to original sources

Radiofrequency versus injection snoreplasty in simple snoring.

OBJECTIVE: To compare the efficacy and tolerance of controlled temperature radiofrequency (RF) and injection snoreplasty (IS) for the treatment of simple snoring. STUDY DESIGN: The study was a nonrandomized, prospective study conducted on 70 simple snorers. Efficacy of the operations was subjectively evaluated by the bed partners and after 6 weeks of the last treatment. Tolerance was evaluated by the patient during first 10 postoperative days. Postoperative pain and discomfort level were assessed. RESULTS: Satisfaction in terms of snoring severity was reported by 87.5% of the cases with RF and by 76.7% of the patients with IS. Discomfort levels also were similar for both groups CONCLUSIONS: Controlled-temperature RF and IS were both effective on snoring and well tolerated by the patients. This allows retreatments if necessary.

Female↗

Patient selection and efficacy of pillar implant technique for treatment of snoring and obstructive sleep apnea/hypopnea syndrome.

OBJECTIVE: Pillar implant (PIT) is a simple, office-based procedure with minimal morbidity that was introduced in 2003 to treat snoring and mild/moderate obstructive sleep apnea/hypopnea syndrome (OSAHS). We studied the: (1) success rate using subjective symptoms and objective polysomnographic improvement; (2) success rate based on BMI, OSAHS severity and Friedman tongue position (FTP); and (3) its value as an adjunctive or revision procedure. STUDY DESIGN AND SETTING: Retrospective review of 125 patients who underwent the PIT for snoring and OSAHS. Patients were grouped: Group I had PIT only (n = 29); Group II received adjunctive nasal procedures (n = 37), Group III received adjunctive oropharyngeal procedures (n = 55); and Group IV had failed previous UPPP (n = 4). RESULTS: Overall subjective and objective "cure" rates were 88.0% and 34.4%, respectively. Group IIb had the best objective cure rate of 46.7%. Neither AHI nor BMI correlated with outcome measures, whereas FTP did correlate. (FTP I and II had improved success vs FTP III and IV). Ten patients had partial extrusion of the PIT. These were removed and new PIT were carried out at a later date. CONCLUSIONS: Based on a short-term study, the Pillar implant is an effective treatment for snoring and OSAHS in selected patients and can be combined with adjunctive procedures to treat OSAHS.

Adolescent↗

The management of simple snoring.

Simple snoring is a very common problem that presents a number of different challenges. The initial difficulty is in confirming the presence of snoring, next one must exclude any other nocturnal respiratory pathology and finally a decision as to an appropriate treatment must be made. There are many different ways of achieving these objectives, but no one-way has a clear advantage in terms of both accuracy and cost effectiveness. In this review the authors do not intend to give a didactic method for the management of simple snoring but to discuss the pros and cons of various different options in order to help physicians make a choice based on local priorities.

Diagnosis, Differential↗

Resolution of nocturnal enuresis in snoring children after treatment with nasal budesonide.

Nocturnal enuresis has been associated with obstructive sleep apnea-hypopnea and may resolve after adenotonsillectomy. Nasal corticosteroids have improved symptoms and polysomnography findings in children with snoring. Two children with primary nocturnal enuresis, chronic nasal obstruction, and loud snoring underwent polysomnography. The apnea-hypopnea index was 4.9 and 7.3 episodes/hr, and the oxygen desaturation of hemoglobin index was 4.6 and 5.2 episodes/hr. After administration of budesonide, the frequency of snoring decreased, the polysomnography findings improved, and the enuresis resolved completely. Six months after treatment, both children were still dry at night. Administration of nasal corticosteroids is associated with resolution of enuresis in children with mild obstructive sleep-disordered breathing.

Administration, Intranasal↗

[Somnoplasty: treatment of chronic snoring using radiofrequency irradiation of the palate].

The goal of this study is to evaluate the efficacy and the safety of tissue reduction of the palate by means of radiofrequency for the treatment of snoring. Fifty-three patients were evaluated. Eight of them (15%) met criteria for mild OSAS. All of them underwent RF energy treatment with several ablation sites and the mean total energy administered was about 2500 J per treatment session. 40 patients (75%) underwent an additional RF treatment and the energy administered in the second session was the same as in the first one. We evaluated postoperative pain, snoring and the satisfaction of the patient and his enviroment. After a mean follow-up of 20 months no adverse effect was reported. The success diminishes with time as happens other surgical procedures (UPPP or LAUP) but the absence of serious adverse side-effects and the minimal postoperative pain support the use of RF as an effective procedure for reducing snoring.

Adult↗

Effects of electrical stimulation to the soft palate on snoring and obstructive sleep apnea.

Obstructive sleep apnea (OSA) is a disorder and has been associated with social and physical problems. Many treatments of OSA have been proposed with various levels of success. Seven patients with histories of snoring and OSA participated in this pilot study to evaluate the effects of electrical stimulation to the soft palate. Each patient slept with a palatal appliance that delivered a weak electrical stimulus to the soft palate on activation. A 3 milliampere stimulus in the range of 9 to 10 volts was found to be effective in terminating snoring without causing patient arousal. The effects of the stimulus on OSA were variable. The results of this study indicated that electrical stimulation of the soft palate may be effective as a treatment for snoring and OSA and warrants further investigation.

Adult↗

Digital signal processing of stridor and snoring in children.

Stridor and snoring are common signs of upper airway obstruction. The nature and characteristics of the stridor and snoring depend upon the site of obstruction. Sophisticated analysis of these sounds may provide important information concerning the source of the sound helping to assess the patient more objectively. The preliminary results of computerized digital analysis of stridor and snoring sounds are presented in 5 children. Two main programs were applied to analyse the signal: the Power Spectral Density (PSD) function and the Estimated Cross-sectional Area (ECSA). A consistent pattern according to the site of the produced sound was seen. Further acoustical analyses are needed to standardize this method and to program the computer to indicate the various sites of lesions.

Child, Preschool↗

Palatoplasty for snoring: a randomized controlled trial of three surgical methods.

In a randomized, controlled trial, 62 patients (47 men and 15 women) with severe antisocial snoring, but no sleep apnea, were allocated to one of three surgical treatments. These were uvulopalatopharyngoplasty, laser palatoplasty, and diathermy palatoplasty. Postoperative morbidity was measured on a visual analogue scale of severity of pain, dysphagia, and nasal regurgitation at 1, 2, and 7 days after the operation. Efficacy of each procedure was measured by asking the sleeping partner to record the severity of snoring before and after the operation, again on a visual analogue scale. Measurements were taken at 1, 3, and 6 months. There were no significant differences in early postoperative morbidity among the treatment groups. Diathermy palatoplasty is a new technique for the relief of snoring that is associated with low morbidity and requires little in the way of expensive equipment.

Adult↗

Can snoring induce or worsen obstructive sleep apnea?

Snoring and sleep apneas are breathing disorders intimately associated during sleep. Most snorers are 'simple' or 'nonapneic', as the prevalence of snoring is much higher than that of sleep apneas. The vibrations transmitted to the pharyngeal structures by snoring span a large range of frequencies, while the energy transmitted may reach high values. A deleterious effect of these vibrations can therefore be considered. In 1983 a group of investigators from Bologna described five cases of heavy snorers of increasing severity, suggesting that they correspond to the natural history of 'heavy snorers' disease'. The present article reviews the data published since 1983 in favor of this hypothesis: anatomic lesions of the upper airway mucosa, pharyngeal muscles and nerves, and clinical observations in snorers. The conclusion stresses the absence of ultimate proof in favor of this attractive hypothesis: we lack the demonstration of a significant increase of the incidence of sleep apnea in a group of nonapneic snorers in a longitudinal follow-up study.

Female↗

Does 2 years' nocturnal treatment with a mandibular advancement splint in adult patients with snoring and OSAS cause a change in the posture of the mandible?

The aim of this pilot study was to investigate the effects of 2 years' nocturnal treatment with a mandibular advancement splint in adult patients with snoring and obstructive sleep apnea syndrome with respect to possible development of a forward position of the mandible or other dentofacial changes. Thirty snoring and sleep apnea patients, mean age 55.3 years (SD, 8.61; range, 46.5 to 79.8 years), referred from the Ear, Nose, and Throat Department, were treated with an acrylic splint with full tooth coverage that advanced the mandible 5 to 8 mm (70% of maximal protrusion) and used 5 mm opening vertically. The splint was used 6 to 8 hours per night and 5 to 7 nights per week. Two lateral head radiographs were taken in centric occlusion, 1 before and 1 after 2 years of treatment. A small but statistically significant forward and downward change in mandibular position was found after treatment; mean was 0.4 mm (SD, 0.53; range, 0.0 to 2.0 mm; P <.001) and 0.3 mm (SD, 0.43; range, 0. 0 to 1.5 mm; P <.001), respectively. The forward and downward movement of the mandible was accomplished by a statistically significant increase in mandibular length-mean was 0.4 mm (SD, 0.62; range, 0.0 to 2.5 mm; P <.01)-and a significant decrease in overjet (P <.001) and overbite (P <.05). However, none of the patients reported any permanent sense of altered occlusion, and the anteroposterior distance between habitual occlusion (intercuspal position) and centric relation (retruded position) did not exceed 1. 0 mm in any of the patients either before or after the treatment. The change in mandibular position might be a result of a condylar and/or glenoid fossa remodeling or condylar position changes within the fossa as a compensatory reaction to the advancement of the mandible (bite jumping). However, to visualize and analyze such possible changes in detail, additional studies using lateral tomography of the temporomandibular joints or magnetic resonance imaging are required. Furthermore, because the treatment of snoring and OSAS patients is considered to be lifelong, long-term studies are needed to analyze if the small change in mandibular position will continue with further treatment.

Adaptation, Physiological↗

Symptoms related to snoring and sleep apnoea in subjects with chronic bronchitis: report from the Obstructive Lung Disease in Northern Sweden Study.

To assess the relationship between chronic bronchitis and obstructive sleep apnoea, a postal survey was performed. A postal questionnaire was sent to 523 subjects identified as having chronic bronchitis or long-standing cough and sputum production in the Obstructive Lung Disease in Northern Sweden Study I (OLIN I). In 1986-88, all 6610 adults born in 1919-20, 1934-35 and 1949-50 living in representative areas in Northern Sweden were screened for airway diseases according to different methods. A random sample of healthy adults identified in the screening were chosen as references (n = 625). Subjects were asked about a variety of airway symptoms, smoking habits and symptoms related to obstructive sleep apnoea syndrome (OSAS). In the bronchitic group, 20% did not report bronchitic symptoms in the present study, and 26% of the formerly healthy reference group reported at least one bronchitic symptom in the present study. Snoring, apnoea and liability to 'nod off' during activity were much more common in the bronchitic group in both men and women, and most common in men, as expected. Snoring was reported by 29% of the men in the bronchitic group and by 14% in the reference group. In women, the corresponding figures were 14 and 8%, respectively, and for apnoea, the figures were 25 vs. 11% in men and 6 vs. 4% in women. The prevalence of OSAS symptoms was similar in subjects with attacks of breathlessness, long-standing cough, sputum production and recurrent wheezing. Bronchitic symptoms may influence quality of sleep and contribute to daytime tiredness, but this does not fully explain the high prevalence of snoring and apnoea reported by subjects in this cohort. This study indicates a positive correlation between chronic bronchitis and OSAS, but sleep studies are required to confirm this.

Adult↗

Snoring and myocardial infarction: a 4-year follow-up study.

The association between snoring and myocardial infarction was studied in 1453 people of both sexes aged 20-70 years. The study was carried out in a population of 92,364 residents and the subjects were recruited using the Electoral Census. A questionnaire was sent to all participants, asking about snoring and cardiovascular risk factors. Hospital records were checked for the next 4 years to establish how many of them developed myocardial infarction. At the beginning of the follow-up study 39 patients were diagnosed with ischaemic heart disease. Of the other 1414 participants, 571 (40.4%) were snorers and 843 (59.6%) non-snorers. Twenty-one developed myocardial infarction in the snorer group and four in the non-snorer group. The snorer group presents an adjusted relative risk of myocardial infarction of 3.08 (95% CI 1.01-9.46) with respect to non-snorers. We conclude that snoring seems to be a potential risk factor for myocardial infarction.

Adult↗

Snoring and obstructive sleep apnoea in children: why should we treat?

Frequent and loud snoring is a very frequent condition in prepubertal children affecting approximately 10% of all 2-8 year old children. If polysomnographical evaluations are performed in these snoring children, approximately 10% will be diagnosed with obstructive sleep apnoea (OSA). The pathophysiology of OSA in children is still poorly understood. Indeed, while adenotonsillar hypertrophy is certainly a major contributor to OSA, other factors need to be implicated for OSA to develop. In recent years, it has become apparent that OSA and snoring are not as innocuous as previously thought. Indeed, epidemiological and pre-post treatment analyses have identified substantial morbidities that primarily affect cardiovascular and neurobehavioural systems, namely pulmonary hypertension, systemic elevation of arterial blood pressure, nocturnal enuresis, reduced somatic growth, behavioural problems that resemble attention deficit-hyperactivity disorder, as well as learning and cognitive deficits. These problems are associated with marked increases in healthcare-related costs. More importantly, if timely diagnosis and intervention are not implemented, some of these morbid complications may not be completely reversible, leading to long-lasting residual consequences.

Behavior↗

Snoring and oral submucous fibrosis.

Forty patients above the age of 40 years with oral submucous fibrosis were studied to determine the frequency and severity of snoring. The results were compared with a controlled group of similar sex and age for presence of snoring. The present study indicates that patients with oral submucous fibrosis having a short and fixed uvula and scarred soft palate are less likely to develop snoring. Thus it is suggested that in laser surgery or in classical uvulopalatopharyngeal surgery, the uvula and soft palate should be reduced in size and volume to the extent of that found in oral submucous fibrosis.

Adult↗

Ear protection as a treatment for disruptive snoring: do ear plugs really work?

BACKGROUND: In the absence of surgical treatments with demonstrable long-term efficacy, conservative treatments for snoring remain appropriate. Only limited evidence evaluating the use of ear protection by partners has been published. METHODS: Eligible couples were invited to participate in a two-month trial, with each partner using custom-moulded ear plugs. Five questionnaires were completed by patients and their partners, at baseline and after two months: the snoring outcomes survey (SOS) or the spouse/bed partners survey (SBPS), the Epworth sleepiness scale (ESS), the general health questionnaire-12 (GHQ-12), the Nottingham health profile (NHP) and the Golombok-Rust inventory of marital status (GRIMS). RESULTS: After two months, there was a significant improvement in the SOS score for patients (p = 0.005), the SBPS score for partners (p = 0.001) and the ESS for partners (p = 0.004). CONCLUSIONS: For selected couples, ear plugs represent an effective short-term treatment for some of the social effects of disruptive snoring, as determined by the SOS, SBPS and ESS questionnaires.

Ear Protective Devices↗

[Is snoring a health risk?].

Snoring is a marker for sleep apnea. Additionally, snoring per se is a cause of excessive vascular morbidity and an excessive risk for accidents. These health risks of snoring could be lowered by using CPAP (continuous positive airway pressure). Despite this evidence, CPAP-therapy is still limited to patients with hypersomnolence (excessive daytime sleepiness), due to conflicting results in the literature and the well-known lack of compliance in patients without hypersomnolence.

Arousal↗

Aerobic exercise and snoring in overweight children: a randomized controlled trial.

OBJECTIVE: To determine whether regular aerobic exercise improves symptoms of sleep-disordered breathing in overweight children, as has been shown in adults. RESEARCH METHODS AND PROCEDURES: Healthy but overweight (BMI > or =85th percentile) 7- to 11-year-old children were recruited from public schools for a randomized controlled trial of exercise effects on diabetes risk. One hundred children (53% black, 41% male) were randomly assigned to a control group (n = 27), a low-dose exercise group (n = 36), or a high-dose exercise group (n = 37). Exercise groups underwent a 13 +/- 1.5 week after-school program that provided 20 or 40 minutes per day of aerobic exercise (average heart rate = 164 beats per minute). Group changes were compared on BMI z-score and four Pediatric Sleep Questionnaire scales: Snoring, Sleepiness, Behavior, and a summary scale, Sleep-Related Breathing Disorders. Analyses were adjusted for age. RESULTS: Both the high-dose and low-dose exercise groups improved more than the control group on the Snoring scale. The high-dose exercise group improved more than the low-dose exercise and control groups on the summary scale. No group differences were found for changes on Sleepiness, Behavior, or BMI z-score. At baseline, 25% screened positive for sleep-disordered breathing; half improved to a negative screen after intervention. DISCUSSION: Regular vigorous exercise can improve snoring, a symptom of sleep-disordered breathing, in overweight children. Aerobic exercise programs may be valuable for prevention and treatment of sleep-disordered breathing in overweight children.

Body Mass Index↗

Upright and supine cephalometric evaluation of obstructive sleep apnea syndrome and snoring subjects.

Specific craniofacial characteristics are reported to occur with obstructive sleep apnea syndrome (OSAS). The purpose of this study was to determine whether craniofacial morphology differs between subjects with OSAS and heavy snorers, and to investigate how change in posture from upright to lying down affects the upper airway passage. Lateral head radiographs of ten persons diagnosed with OSAS(AHI > 50) and ten snorers matched for age, height and weight without any history of daytime sleepiness, doctor-diagnosed OSAS, and no evidence of significant desaturation on overnight oximetry were obtained in both upright seated and awake supine positions. The posterior superior pharyngeal space in both the OSAS and snorers was reduced when changing from upright to supine posture (p < or = 0.05). Significant differences in cranial base alignment, ramus width relative to the middle-cranial fossa, position of the maxilla relative to the cranial base in the seated position (P < or = 0.01) were noted between subjects with OSAS and subjects with snoring and less severe apnea. In addition, differences in the posterior superior pharyngeal space, tongue length, tongue to intermaxillary area ratio and hyoid position (p < or = 0.05) were demonstrated both in the upright and in the supine positions (p < or = 0.05) in the OSAS compared to the snoring group. These results suggest that anatomic factors may predispose some snorers to develop OSAS. Measurements made from awake supine position lateral head radiographs revealed no additional differences between OSAS and snoring subjects when compared to measurements made on radiographs taken in the upright position.

Cephalometry↗