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PubMed1997

Comparison of the effectiveness of uvulopalatopharyngoplasty and laser palatoplasty for snoring.

We present the surgical management of 51 patients with a primary diagnosis of snoring. Patients with sleep apnoea syndrome were eliminated from the study. Four procedures were used: the classical uvulopalatopharyngoplasty, a limited uvulopalatoplasty, laser palatoplasty with tonsillectomy; and laser palatoplasty alone. Fifty-one of the 67 patients (76.1%) responded to a telephone questionnaire with a mean follow-up period of 18.2 months, 78.4% of patients reported improved or absent snoring. There was almost equal patient satisfaction between the conventional technique and the laser technique. The improvement in snoring was not influenced by the type of operation performed.

Adult↗
PubMed1999

A new acoustic method of differentiating palatal from non-palatal snoring.

Palatal snoring produces explosive peaks of sound at very low frequency (approximately 20 Hz). Using a digital sound trace a ratio of peak amplitude to root mean square amplitude can be calculated. This Peak Factor Ratio is significantly higher for palatal snores than non-palatal snores (P < 0.01). This acoustic method will be useful for selecting patients for palatal surgery as it is non-invasive and could be used in a home monitor.

Acoustics↗
PubMed1999

Psychometric performance before and after laser palatoplasty for non-apnoeic snoring.

Psychometric tests are an objective way of examining cognitive functioning, and have shown impairment in patients with obstructive sleep apnoea. Non-apnoeic snoring may cause reduced concentration, but psychometric tests have been used rarely in this population. We investigate whether their use can demonstrate an improvement in cognitive performance in 20 non-apnoeic snorers following Laser Palatoplasty (LPP). The subjects completed psychometric tests, Beck Anxiety and Depression Inventories and an Epworth Sleepiness Scale on two occasions before LPP and once postoperatively. The only index to show any significant change with LPP was the Beck Depression Inventory (P < 0.005), which was reduced by a mean of 1.6 units following surgery. There was also a highly significant improvement in information processing between the preoperative tests, for which no explanation could be found. Our results suggest that commonly applied psychometric tests are unable to demonstrate significant improvements following surgery for non-apnoeic snoring. However, we have demonstrated for the first time a significant reduction in depression following surgery, which is evidence that snoring is more than a social nuisance.

Cognition↗
PubMed2003

Surgery for snoring: are partners satisfied in the long run?

Patients seek surgery for snoring, essentially for the sake of their partners. Few studies have looked into the long-term results from this angle. We herein report the findings of a study of partner satisfaction, following laser-assisted uvulopalatoplasty (LAUP) and uvulopalatopharyngoplasty (UVPP). This was a questionnaire-based survey, with a minimum follow-up of 1 year. A total of 91 procedures (LAUP = 50 and UVPP = 41) were evaluated. Response rate was 65.93%. Both groups were matched for age, gender and duration of the follow-up. Residual snoring was even more frequently following LAUP than it was following UVPP (Mann-Whitney U = 244, P = 0.012). After UVPP, partners were less likely to have trouble falling asleep (Mann-Whitney U = 255, P = 0.041). There was a highly significant reduction in the disturbance of sleep and need to wake up after both types of surgery (McNemar test, chi2 = 25.037, P < 0.001). Both groups reported improvements in quality of life. We propose a grading system to record partner satisfaction. The long-term results show that surgery for snoring is justified in the National Health Service (NHS) in the new millennium.

Adult↗
PubMed1990

[Anamnesis and polysomnography in patients who snore and in obstructive apnea syndrome: a comparative study in 140 patients].

Results of a questionnaire comprising 23 questions concerning general data, snoring, and daytime sleepiness were compared with polysomnographic data. 140 consecutive patients, 89 of them chronic snorers and 51 with obstructive sleep apnea syndrome (OSAS) were included in the study. The results show that ten questions, four about snoring and six about daytime sleepiness, are sufficient cause to suspect of OSAS in a snoring patient. This patient should be diagnosed and treated immediately.

Age Factors↗
PubMed2001

Follow-up of primary snoring in children.

We reevaluated 13 children with primary snoring 3 years after their original polysomnograms were performed and compared them with healthy control subjects. As a group, the patients' snoring and polysomnographic findings did not change. There was no difference in any sleep-disordered breathing of the patients and control subjects. Only the youngest individual in the study developed frank obstructive sleep apnea. Children with primary snoring are not likely to develop polysomnography-confirmed obstructive sleep apnea, and it is safe to defer treatment.

Adolescent↗
PubMed1997

Snoring and obstructive sleep apnea: does head posture play a role?

The aim of this article is to present scientific and clinical evidence to support the role of proper head and neck posture in the management of snoring and obstructive sleep apnea. Obstruction of the upper-airway during sleep is a serious medical condition often associated with severe daytime somnolence, morning headache, and a host of cardiopulmonary complications, including but not limited to systemic and pulmonary hypertension, nocturnal cardiac dysrhythmias, myocardial infarction, and stroke. Though anti-snoring pillows are occasionally mentioned in the literature, the role of proper head-neck support during sleep has been largely neglected. In this article the effect of head-neck position on upper-airway obstruction during sleep is discussed from the perspective of both causation and treatment. Based on the evidence presented by the author, it is recommended that the use of cervical-support pillows be considered as an adjunctive treatment modality in patients suffering from snoring and obstructive sleep apnea.

Aged↗
PubMed2001

Variable site of oropharyngeal narrowing and regional variations of oropharyngeal collapsibility among snoring patients during wakefulness and sleep.

The oropharynx shows rhythmic caliber changes in accordance with the respiratory cycle. Dynamic imaging of the oropharynx is required to evaluate airway changes associated with snoring and obstructive sleep apnea. The purpose of this study was to determine the sites of narrowing/obstruction and to measure the regional collapsibility of the oropharynx during respiration during the sleep and awake cycles in snoring patients. Seven snoring patients were included for this study. Electron Beam Tomograms of the oropharynx were taken while the patient was awake and asleep, and dynamic views were reconstructed. The site of narrowing or obstruction varied widely among patients and differed from awake to asleep. The mean of smallest minimum cross-sectional area of the oropharynx was 60.38+/-42.97 mm2 in the awake state and 16.90+/-20.43 mm2 in the asleep state. Although the collapsibility of the oropharynx showed considerable regional variations, it increased during sleep at the overall oropharynx. The low retropalatal region showed the smallest minimum cross-sectional area and the highest collapsibility; however, the most prominent changes in the minimum cross-sectional area and collapsibility during sleep were observed in the high retroglossal region.

Adult↗
PubMed1999

Palatal snoring identified by acoustic crest factor analysis.

The differentiation of palatal from non-palatal snoring is very important for ENT surgeons trying to determine whether palatal surgery would be curative. At present sleep nasendoscopy is the accepted method. Palatal vibration produces marked modulation of sound loudness at low frequency (below approximately 100 Hz). We calculate a crest factor for the sound waveform (ratio of peak to root mean square (rms) value in any given epoch), as a measure of the degree of modulation. Free-field snore sounds were recorded from 11 supine adult patients under intravenous sedation (midazolam), using a digital tape recorder. Recordings were transferred to a PC (sampling frequency 11 kHz), and analysed using code written by us. Direct visual confirmation of the site of snoring was gained from simultaneous sleep nasendoscopy, taken as the gold standard. In six patients the dominant site was the soft palate. The non-palatal group (five patients) comprised one epiglottic, two hypopharyngeal and two tongue base snorers. The crest factor was found to be significantly higher for palatal snorers (p < 0.01, Student-t or Mann-Whitney tests). Furthermore, palatal could be distinguished from non-palatal snorers on the basis of crest factor alone in all 11 cases, making this a promising non-invasive diagnostic technique.

Acoustics↗
PubMed2000

A cephalometric comparison of subjects with snoring and obstructive sleep apnoea.

This prospective study analysed the upright lateral cephalometric radiographs of 115 dentate, Caucasian males. Forty-five subjects exhibited proven obstructive sleep apnoea (OSA), 46 were simple snorers, and the remaining 24 subjects, who had no history of respiratory disease and did not snore, acted as controls. Radiographs were traced and digitized, and comparisons were made of the dento-skeletal, soft tissue, and oropharyngeal features of the three groups. Differences were also sought between the snoring and OSA subjects. Of the hard tissue measurements, only the cranial base angle and mandibular body length showed significant inter-group differences (P < 0.001 and P < 0.05, respectively). When the airway and associated structures were examined, both snorers and OSA subjects exhibited narrower airways, reduced oropharyngeal areas, shorter and thicker soft palates, and larger tongues than their control counterparts. Comparison of the two sleep disordered breathing groups showed no differences in any of the skeletal or dental variables examined. However in OSA subjects, the soft palate was larger and thicker (P < 0.05), both lingual and oropharyngeal areas were increased (P < 0.01 and P < 0.05, respectively) and the hyoid was further from the mandibular plane (P < 0.05). Thus, whilst the dento-skeletal patterns of snorers resembled those of subjects with OSA, some differences in soft tissue and hyoid orientation were apparent. There was not, however, a recognizable gradation in size of the airway and its associated structures from control through snoring to OSA subjects. This suggests that there may be a cephalometrically recognizable predisposition towards the development of sleep disordered breathing, but that this is only one facet of the condition.

Adult↗
PubMed1993

Cognitive function and snoring.

The relationship between self-reported snoring, headache and cognitive complaints (memory and concentration problems) was evaluated in an epidemiologic survey including 3,323 males, with a mean age of 63 (53-75) years. Fourteen potential confounders were examined. A strong association between snoring and headache was found, persisting after correction for potential confounders. An association was found between snoring and cognitive complaints only in those who reported good sleep quality without insomnia.

Adult↗
PubMed1995

Oral appliances for the treatment of snoring and obstructive sleep apnea: a review.

This paper, which has been reviewed and approved by the Board of Directors of the American Sleep Disorders Association, provides the background for the Standards of Practice Committee's parameters for the practice of sleep medicine in North America. The 21 publications selected for this review describe 320 patients treated with oral appliances for snoring and obstructive sleep apnea. The appliances modify the upper airway by changing the posture of the mandible and tongue. Despite considerable variation in the design of these appliances, the clinical effects are remarkably consistent. Snoring is improved and often eliminated in almost all patients who use oral appliances. Obstructive sleep apnea improves in the majority of patients; the mean apnea-hypopnea index (AHI) in this group of patients was reduced from 47 to 19. Approximately half of treated patients achieved an AHI of < 10; however, as many as 40% of those treated were left with significantly elevated AHIs. Improvement in sleep quality and sleepiness reflects the effect on breathing. Limited follow-up data indicate that oral discomfort is a common but tolerable side effect, that dental and mandibular complications appear to be uncommon and that long-term compliance varies from 50% to 100% of patients. Comparison of the risk and benefit of oral appliance therapy with the other available treatments suggests that oral appliances present a useful alternative to continuous positive airway pressure (CPAP), especially for patients with simple snoring and patients with obstructive sleep apnea who cannot tolerate CPAP therapy.

Evaluation Studies as Topic↗
PubMed1995

Practice parameters for the treatment of snoring and obstructive sleep apnea with oral appliances. American Sleep Disorders Association.

These clinical guidelines, which have been reviewed and approved by the Board of Directors of the American Sleep Disorders Association (ASDA), provide recommendations for the practice of sleep medicine in North American with regards to the use of oral appliances for the treatment of snoring and obstructive sleep apnea. Oral appliances have been developed for the treatment of snoring and have been applied to the treatment of obstructive sleep apnea, a syndrome associated with morbidity. Based on a review of the relevant scientific literature, the Standards of Practice Committee of the ASDA has developed guidelines describing the use of oral appliances for the treatment of snoring and obstructive sleep apnea in adults.

Activator Appliances↗
PubMed1996

Critical analysis of the results of surgery in the treatment of snoring, upper airway resistance syndrome (UARS), and obstructive sleep apnea (OSA).

Surgery is widely considered to be the first-line therapy for "simple" snoring and moderate sleep apnea syndrome. Surgical treatment of severe obstructive sleep apnea (OSA) is currently generally considered to be second-line therapy after continuous positive airway pressure (CPAP) treatment. Many patients, however, find difficulty in complying with the continued long-term demands of CPAP treatment and seek a more definitive one-off solution to their sleep-related problem. Surgical therapy has been found useful for snoring, at least on subjective grounds; this has incited patient demand and led surgeons to expand its use for upper airway resistance syndrome (UARS) and possibly OSA. In this paper the surgical procedures of uvulopalatopharyngoplasty (UPPP), nasal surgery, and maxillofacial surgery are discussed and analyzed as they relate to the resolution of snoring, UARS, and OSA. There are many methodological problems in the published literature that make this analysis difficult. We feel that surgical therapy should be comparable to CPAP therapy, fulfilling the same analytical criteria in regard to measurement of severity and improvement of the disorder, as well as an equally sustained effect. Operative risk and side effects need to be clearly stated. Guidelines for future data collection and clinical trials of surgical procedures are proposed, and we recommend randomized prospective multicenter protocols and a registry of patients undergoing surgery for OSA so that long-term follow-up can be achieved.

Airway Obstruction↗
PubMed2004

Sleep pressure score: a new index of sleep disruption in snoring children.

STUDY OBJECTIVES: Excessive daytime sleepiness (EDS), as measured by objective criteria, is infrequent in snoring children despite a high prevalence of EDS-related behavioral manifestations. We hypothesized that sleep architecture and arousal indexes may be altered relative to the severity of sleep-disordered breathing (SDB). DESIGN: Retrospective and prospective study. SETTING: Questionnaires were distributed through sleep clinic or school program; polysomnograms were performed at Kosair Children's Hospital in Louisville, Kentucky. PARTICIPANTS: To examine this issue, 182 children with SDB, 163 children with primary snoring, and 214 control children with a mean age of 6.9 +/- 2.6 years underwent polysomnographic evaluation in the laboratory. MEASUREMENTS AND RESULTS: Significant increases in slow-wave sleep (percentage of total sleep time) and decreases in rapid eye movement sleep (percentage of total sleep time) occurred in the SDB group (P < .0001). Spontaneous and respiratory arousal indexes and the apnea-hypopnea index (AHI) displayed negative and positive correlations, respectively, suggesting reciprocal interactions. Based on these observations, a sleep pressure score (SPS) was derived as a surrogate numeric measure for disrupted sleep homeostasis. The SPS exhibited linear increases relative to AHI, reaching a plateau at an AHI of 30 to 40 per hour of total sleep time. Furthermore, SPS values were significantly higher among African American and obese children (P < .0001). CONCLUSIONS: Sleep architecture is not preserved in children with SDB. An algorithm allowing for calculation of sleep propensity and disturbed sleep homeostasis in children who snore is proposed and may be of practical value in the assessment of sleepiness.

Body Mass Index↗
PubMed2002

Treatment of simple snoring using radio waves for ablation of uvula and soft palate: a day-case surgery procedure.

OBJECTIVE: Uvulopalatoplasty, performed with high-frequency radio waves, was evaluated as a treatment for social snoring. METHODS: Forty male social snorers were included in this prospective, nonrandomized study. Patients' subjective complaints before, during, and 3 months after radio-assisted uvulopalatoplasty were recorded on a visual analogue scale. RESULTS: Complications were negligible. Snoring sounds and daytime tiredness reduced significantly. Considering effect and suffering during and after surgery, a high number of patients (93%) were willing to undergo the procedure again if necessary. CONCLUSIONS: The results of radio-assisted uvulopalatoplasty (RAUP) seem to be similar to other surgical methods used to reduce snoring. The relative small investments needed and its simplicity makes RAUP a good alternative to known treatment strategies.

Ambulatory Surgical Procedures↗
PubMed2003

Postoperative pain and side effects after uvulopalatopharyngoplasty, laser-assisted uvulopalatoplasty, and radiofrequency tissue volume reduction in primary snoring.

OBJECTIVES: We compared, in a prospective study, the side effects and the postoperative complications of three procedures commonly used for the treatment of primary snoring. METHOD: Forty-nine patients underwent velopharyngeal surgery for primary snoring (17 for uvulopalatopharyngoplasty [UPPP]; 15 for laser-assisted uvulopalatoplasty [LAUP], and 17 for radiofrequency tissue volume reduction [RFTVR]). Preoperative full polysomnographic studies ruled out obstructive sleep apnea syndrome. Each patient's evaluation encompassed postoperative pharyngeal pain (as measured by a 5-point visual analogue scale) and use of narcotic drugs in the early postoperative period as well as a subjective evaluation of late postoperative complaints. A surgeon's examination was performed to report postoperative complications in the oropharynx. RESULTS: Postoperative pharyngeal pain was less important in the RFTVR group than in the UPPP and LAUP groups. Mean scores at days 3, 7, 16 were as follows: 4.2, 4.0, and 2.4, respectively, for UPPP; 4.6, 3.8, and 1.6 for LAUP; and 2.4, 2.0, and 0.7 for RFTVR. Mean duration of pain with a score greater than 2 was calculated as follows: UPPP, 21.3 days; LAUP, 15.1 days; and RFTVR, 6.1 days. Mean duration of narcotic drug use for the patients who needed this medication was 10.1 days for UPPP, 7.2 days for LAUP, and 1.3 for RFTVR. Postoperative side effects (trouble with smell and taste, pharyngeal dryness, globus sensation, voice change, and pharyngonasal reflux) were more present in the UPPP and LAUP groups than in the RFTVR group. Surgeon's assessment for postoperative complications reported more wound infection, dehiscence, and posterior pillar narrowing in the UPPP and LAUP groups than in the RFTVR group. CONCLUSION: RFTVR is a safer and less painful procedure than UPPP and LAUP for the treatment of primary snoring. Postoperative discomfort after LAUP and after UPPP appears to be very similar.

Adult↗
PubMed2006

Use of Er,Cr:YSGG versus standard lasers in laser assisted uvulopalatoplasty for treatment of snoring.

OBJECTIVES: The aim of this study was to compare the effectiveness of the Er,Cr:YSGG (Waterlase) laser with KTP and CO2 lasers in laser assisted uvulopalatoplasty (LAUP) for treatment of snoring. STUDY DESIGN: This is a prospective study of 63 patients who were treated for snoring by LAUP either with Er,Cr:YSGG (n = 21) or with KTP (n = 21) or CO2 lasers (n = 21). Histologic analysis was performed, and the effects of KTP and Waterlase on soft tissue were compared. METHODS: Patients were examined by an ENT surgeon and tested with polysomnography. Probands who suffered from obstructive sleep apnea or had an apnea-hypopnea index of 15 or greater were excluded from the study. The remaining patients were assigned to either Er,Cr:YSGG, KTP, or CO2 laser therapy. The three lasers were compared from a postoperative recovery point of view by immunohistochemical examination. RESULTS: Pain medications were used on average for 4.1, 6.5, and 10.1 days, and the times to return to normal diet were on average 4.5, 6.8, and 8.6 days in the Er,Cr:YSGG, KTP, and CO2 groups, respectively. Two cases of bleeding were observed in the CO2 group. Foreign body sensation occurred in 14%, 19%, and 19% of subjects in the Er,Cr:YSGG, KTP, and CO2 groups, respectively. Velopharyngeal insufficiency was noticed in one KTP treated patient; however, it was transient. Snoring and apnea-hypopnea index was significantly reduced in all groups. Significantly larger coagulation of soft tissue was found in the KTP group than in the Waterlase group. CONCLUSIONS: Patients treated with Waterlase recovered more quickly in comparison with patients in the KTP and CO2 groups, which was confirmed by immunohistochemical findings. The laser techniques did not differ in effectiveness.

Adult↗