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PubMedDate not supplied

The association of self-reported sleep duration, difficulty sleeping, and snoring with cognitive function in older women.

We examined the association of sleep duration, snoring, and difficulty sleeping with cognitive function in a cohort of community-dwelling women. Women (n = 1844), aged 70 to 81 years at initial cognitive interview in 2000, are members of the Nurses' Health Study cohort. Women completed six tests of cognitive function encompassing general cognition, verbal memory, category fluency, and attention. We repeated the assessment 2 years later. We used linear regression models to obtain multivariate-adjusted mean differences in initial test performance, and in cognitive decline over time, across categories of sleep duration (< or =5,6,7,8,9+ hours/night), frequency of snoring (never, occasionally, regularly), and sleep difficulties (rarely/never, occasionally, regularly). In analyses of initial test performance, women sleeping < or =5 hours/night scored worse than women sleeping 7 hours/night (mean difference on global score combining all cognitive tests = 0.15 standard units, 95% CI: -0.28, -0.02). Women who regularly had difficulty falling or staying asleep scored 0.11 units lower on the global score (95% CI: -0.22, 0.01) compared with those who rarely had difficulty sleeping. These differences were equivalent to the mean differences in score observed between participants who were 4 to 5 years apart in age. We found no associations with snoring or with any of the sleep variables and cognitive decline over 2 years. Associations between sleep patterns and initial cognitive function may be clinically relevant given that diminished cognition is a risk factor for dementia. However, the lack of an association with prospective cognitive decline warrants further investigation.

Adult↗
PubMed1991

Obstructive sleep apnoea in adults presenting with snoring.

Snoring is a common disorder, and may be associated with obstructive sleep apnoea, although there is little published information on the incidence of apnoea in snorers. This study aimed to assess the upper airway and to relate the findings to sleep study data in a population of patients referred by their general practitioners with loud snoring. Each patient had a full history, weight and height measurements, nasal examination, rhinomanometry, peroral grading of the oropharyngeal features, and fibreoptic pharyngoscopy with a modified Muller manoeuvre, followed by a sleep study. The results in our group of 35 patients demonstrate a high incidence of obstructive sleep apnoea (46%). Factors which correlated well with apnoea were excessively loud snoring, a narrow oropharynx, and marked obesity; 94% of patients with one or more of these features had evidence of sleep apnoea.

Adult↗
PubMed1995

Observation of the mechanism of snoring using sleep nasendoscopy.

We have performed sleep nasendoscopy on 54 adult snorers in whom obstructive sleep apnoea had been excluded by an overnight sleep study. The purpose of the study was to identify the site or sites of noise production in each case. This was successfully achieved in 50 of the 54 and 70% showed palatal flutter snoring only. In a further 20%, palatal flutter snoring was combined with evidence of noise generation at another site. The second site was supraglottic in 10%, tonsillar in 8% and tongue base in 2%. The tongue base was also the sole site of noise generation in 8% and the epiglottis was the sole site in 2%. This study suggests that sleep nasendoscopy can identify different mechanisms of snoring in individual patients. This information is likely to be of use in formulating a logical surgical treatment plan.

Adult↗
PubMed2004

A prospective single-blind randomized-controlled trial comparing two surgical techniques for the treatment of snoring: laser palatoplasty versus uvulectomy with punctate palatal diathermy.

The aim of this study was to compare laser palatoplasty with uvulectomy with punctate palatal diathermy as treatment modalities for snoring. The study design was a prospective, single-blind, randomized-controlled trial. Eighty-three patients entered the trial. After a mean follow-up period of more than 18 months there was no statistically significant difference between the two groups regarding the patient perception of benefit from surgery or the subjective improvement in snoring. However, there was a statistically significant difference in the degree of pain in the immediate postoperative period (mean difference = 22.14, 95% CI = 7.98-36.31, P = 0.003), with the pain being worse in the laser palatoplasty group. Relative risk of complications for laser palatoplasty was 1.42 (95% CI = 0.93-2.17). The snoring scores and Glasgow Benefit Inventory scores decreased with time in both the groups but there was no statistically significant difference between the two groups.

Adult↗
PubMed1997

A survey of habitual snoring in centenarians.

OBJECTIVE: To ascertain whether centenarians in the surveyed group would be nonhabitual snorers. DESIGN AND SETTING: A cross-sectional survey of centenarians residing in the Aichi Prefecture of Japan. PARTICIPANTS: A total of 103 centenarians (21 men and 82 women). MEASUREMENTS: Questionnaire on sleep habits, breathing, and snoring. RESULTS: Nineteen centenarians (18.4%; 5 men and 14 women) were habitual snorers and two (1.9%) were suspected of having sleep apnea syndrome because of the presence of heavy snoring and nocturnal respiratory arrest. CONCLUSION: Most centenarian subjects were nonsnorers and without breathing pauses during sleep; their snoring rates were no different from those of younger aged older adults in the same population.

Adolescent↗
PubMed1989

Prevalence of every night snoring and obstructive sleep apnoeas among 30-69-year-old men in Bologna, Italy.

An epidemiological survey of the prevalence of snoring and sleep apnoeas was performed on 3479 30-69-year-old men living in Bologna, north-east Italy. First a postal questionnaire was sent. It was returned with appropriate answers by 1170. A 20% random sample of those who did not answer were invited by telephone to return the questionnaire. Among these groups 119 (10%) and 19 (5.6%) respectively answered that they always snored. A random sample of 40 every-night snorers were studied by polysomnography. Based on the frequency of every-night snoring and the results of polysomnography we estimated that the minimal prevalence of sleep apnoea among 30-69-year-old men was 2.7% considering an apnoea + hypopnoea index of 10 or more pathological. According to the Lugaresi classification we had a 2.5% prevalence of heavy snorers' disease (HSD) Stage 1 or higher. These figures indicate that obstructive sleep apnoea during sleep is a major public health problem.

Adult↗
PubMed1994

Natural evolution of snoring: a 5-year follow-up study.

INTRODUCTION: The natural evolution of snoring was studied in a middle-aged population in Finland. MATERIAL AND METHODS: A questionnaire was mailed to a stratified random sample of 1600 people aged 36-50 years in 1985 with a response rate of 75.2%; 53% of them completed also the 5-year-follow-up questionnaire. Clinical examinations (N = 36) and whole-night polygraphic recordings (N = 22) were made to habitual (every or almost every night) snorers and daily sleepy persons. RESULTS: A total of 626 persons completed the 5-year-follow-up questionnaire. The prevalence of habitual snoring among men was 28.3-43.8% and among women 6.3-18.8%, increasing with age. Sleepiness was common: doze-off at the wheel was reported by 23% of snorers and traffic accidents because of sleepiness by 4.5%. Hypertension was clearly more common (p = 0.002) among habitual snorers, but the self-reported rates of strokes and coronary heart disease were not increased in this study. None of the snorers had been investigated because of their snoring or sleepiness during the five years. In polygraphic recordings 11/22 showed an oxygen desaturation index (ODI4) more than 5/h; active treatment was started for 8 of them. The observed prevalence of sleep apnea syndrome with ODI4 > 10 was 1.1% in this study. CONCLUSIONS: Snorers, even with clear sleepiness, are passive in seeking help for their symptoms. Physicians should actively diagnose this treatable condition impairing the quality of life and increasing the risk of traffic accidents and vascular diseases.

Accidents, Traffic↗
PubMed1995

Mechanical modeling of palatal snoring.

The mechanism of human snoring caused by vibration of the soft palate and the characteristics of the noise are investigated. The soft palate becomes unstable and vibrates violently once the inspiratory flow exceeds a critical speed. The physiological phenomenon is modeled by studying flow over a flexible plate. In determining the stability of this flow, the trailing edge conditions are crucial. It is found that the noise generated in the simple experimental configuration has distinct characteristics found in human snores. For example, there is an antiphase relation between unsteady pressures from the oral and nasal channels and this provides a feature that distinguishes snoring by vibration of the soft palate from that caused by other parts of the human airway.

Acoustics↗
PubMedDate not supplied

Laser-assisted uvulopalatoplasty for habitual snoring without sleep apnea: outcome and complications.

Thirty patients suffering from habitual snoring were subjected to laser-assisted uvulopalatoplasty with a KTP/532 laser under local anesthesia. The patients selected for the present study had no complaints of severe sleep apnea. The surgical procedure included bilateral vertical incision through the palate at the base of the uvula with or without removal of the lower half of the uvula. Ninety-three percent of the patients showed apparent improvement of snoring following the operation. However, other sleep-related symptoms such as sleep quality and daytime sleepiness were not significantly improved. No major or critical complications such as massive bleeding and asphyxia occurred. Post-operative pain on deglutition disappeared in most patients 2 weeks after the operation. This procedure is safe, minimally invasive and effective for habitual snoring without apnea.

Adult↗
PubMed2001

Role of snoring and daytime sleepiness in occupational accidents.

To establish whether snoring and excessive daytime sleepiness (EDS), the main symptoms of obstructive sleep apnea syndrome, influence the risk of occupational accidents a population-based, prospective study was performed. In 1984, 2,874 men aged 30-64 answered questions on snoring and EDS. Ten years later 2,009 (73.8% of the survivors) responded to a follow-up questionnaire including work-related questions and potential confounders. Information on occupational accidents during 1985-1994 was obtained from national register data. A total of 345 occupational accidents were reported by 247 of the men (12.3%). Multivariate analysis revealed that men who reported both snoring and EDS at baseline were at an increased risk of occupational accidents during the following 10 yr, with an adjusted odds ratio of 2.2 (95% CI 1.3-3.8) after adjusting for age, body mass index, smoking, alcohol dependence, years at work, blue-collar job, shift work, and exposure to noise, organic solvents, exhaust fumes, and whole-body vibrations. However, no significant increased risk was found for snorers without EDS or nonsnorers with EDS. We conclude that sleepy, male snorers have an increased risk of occupational accidents. The results indicate that early identification and treatment of sleep-disordered breathing may reduce the number of injuries at work.

Accidents, Occupational↗
PubMed1993

Digital monitoring of sleep-disordered breathing using snoring sound and arterial oxygen saturation.

A new portable digital recorder (SNORESAT) that uses the sound of snoring and arterial oxygen saturation (SaO2) to monitor breathing abnormalities during sleep was constructed and compared in the laboratory with standard overnight polysomnography (PSG). The device digitally records sound from a transducer applied to the chest and SaO2 from a commercially available ear oximeter. A snore is identified when the moving time average of the sound exceeds a threshold voltage level longer than 0.26 s. The stored data are transferred to a personal computer for poststudy analysis. An analysis algorithm identifies a respiratory disturbance event when a quiet period of 10 to 120 s separates two snores and is associated with a fall in SaO2 exceeding 3%. The respiratory disturbance index (RDI), mean apnea duration, mean lowest SaO2, and number of desaturations > 3% are computed. A total of 129 referrals to the sleep apnea outpatient clinic underwent simultaneous all-night recording of PSG and SNORESAT. Using the computed RDI recorded by the SNORESAT, the sensitivity and specificity of the monitor in detecting sleep apnea syndrome (SAS) ranged between 84 and 90% and 95 and 98%, respectively, depending on the PSG value of RDI used to define SAS (range, > or = 7 to > or = 20 events/h). Using a PSG value of RDI > or = 10, or > or = 20 RD/h as the definition for SAS, the prevalence of SAS in the referral population was 45 and 31%, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1991

Laser uvulopalatoplasty in treatment of habitual snoring.

Velopharyngeal sonorous snoring is best treated with uvulopalatopharyngoplasty (UPPP). To reduce surgical risks and minimize the morbidity, a simplified carbon dioxide laser uvulopalatoplasty (LUPP) was performed under local anesthesia. Among a total of 146 patients who had a LUPP performed, there was no significant bleeding or postoperative episodes of asphyxia. The procedure was well tolerated even by those patients with strong vomiting reflexes. The operation time was halved, as was the convalescence. Two patients (1.4%) developed scarring with nasal obstruction, but the impact of factors other than the laser approach itself seemed to be the cause. By scored questionnaires the effect on snoring, family complaints, and daytime somnolence was evaluated in two comparable random groups of patients. Sixty-three patients had LUPP procedures, and 37 had UPPP. The short-term results showed that about 90% of the patients considered themselves essentially improved as regarded snoring and that most patients felt more alert, irrespective of the surgical method used.

Adult↗
PubMed2000

Omission of polysomnography in treatment of snoring: common reasons and medico-legal implications.

Although polysomnography (PSG) is an important investigation in the treatment of snorers, it was observed that a large number of patients did not have pre-operative PSG assessment in a tertiary hospital in Singapore. Of the 118 Asian patients who underwent surgery for snoring from January 1997 to December 1998, 36 (30.5 per cent) of patients did not have pre-operative PSG and only 21 (17.8 per cent) of patients had post-operative PSG. In this cohort, 43 (36.4 per cent) patients presented with snoring as their only complaint and not associated with symptoms indicative of obstructive sleep apnoea syndrome (OSAS). Thirty-one of these 'simple snorers' underwent sleep studies with the following outcome: two (6.5 per cent) true simple snorers, two (6.5 per cent) upper airway resistance syndrome, nine (29 per cent) mild OSAS, seven (22.6 per cent) moderate OSAS and 11 (35.5 per cent) severe OSAS. Our study showed that without the aid of PSG, it would be difficult to predict the severity of sleep apnoea based on clinical history alone. In an increasingly litigation-conscious society such as Singapore, there is therefore little justification in omitting PSG in the treatment of snoring. The common reasons for omission of pre-operative PSG and the medico-legal implications are also discussed.

Adult↗
PubMed2000

Retrospective survey of long-term results and patient satisfaction with uvulopalatopharyngoplasty for snoring.

The aim of this study was to retrospectively survey patients who had undergone the uvulopalatopharyngoplasty (UPPP) operation over a two-year period, assessing loudness of snoring, sleep quality and patient satisfaction. A total of 271 patients were sent questionnaires to assess snoring and sleeping habits, with additional questions about pain and satisfaction with surgery. Those who did not reply were contacted by telephone. Seventy-four per cent of the target population were surveyed. Taking an improvement in snoring level of 50 per cent or greater, immediately post-operatively the overall success rate was 76 per cent; however, after two years the success rate fell to 45 per cent. Variables such as alcohol consumption and smoking were not found to influence results. On a post-operative pain scale of 1-10 the average was 7.5 and on a satisfaction scale of 1-10 the average satisfaction with surgery was five, 61 per cent of patients stating that they would not have this operation again. This study shows that the UPPP operation is successful in only 45 per cent of patients after long-term follow-up, that the majority of patients experience severe pain and that the overall satisfaction with surgery is low.

Adult↗
PubMed2001

Mandibular advancement prosthesis: first-line alternative to surgery in snoring.

Mandibular advancement prosthesis (MAP) is infrequently used in the UK at present for snoring. First-line measures include dietary and weight modification for those that require it. Where such measures are unlikely to be useful or have already failed, surgery is sometimes utilized as a second-line treatment modality. We evaluate the use of MAP as an adjunct to first-line measures, with emphasis on efficacy, side-effects and patient compliance. Case notes of 30 snorers were reviewed and followed up with a questionnaire. Despite being useful in alleviating snoring, the prosthesis was poorly tolerated. Side-effects include increased salivation, temporomandibular joint pain, intra-oral and myofacial discomfort. Patients who persevered with the prosthesis found the early side-effects resolved after a few weeks and snoring reduced. MAP can be used in the initial management of snorers but patients need to be educated and encouraged, especially in the first few weeks.

Humans↗
PubMed2003

Celon radiofrequency thermo-ablative palatoplasty for snoring - a pilot study.

A prospective non-randomized study was designed to investigate the effects of Celon radio-frequency thermo-ablation (RFTA) of the soft palate in patients with snoring/mild obstructive sleep apnoea. Ten patients, fulfilling various inclusion/exclusion criteria, underwent single operator sub-mucosal RFTA palatoplasty as an office procedure. Two separate procedures six weeks apart involved each patient receiving six distinct sub-mucosal lesions on each visit. Questionnaires including visual analogue scales (VAS) were used to evaluate post-operative pain and subjective snoring (scored by patient/partner). Polysomnography (PSG) was performed pre-operation and three months following the second procedure. Using non-parametric statistical analysis, a significant reduction in VAS snoring was noted from initial levels to those scored at six and 16 weeks in nine of 10 patients (p = 0.013 and p = 0.007 respectively). (Five of these nine showed a greater than 50 per cent reduction in score). Objectively, six of 10 patients had a reduction in the apnoea-hypopnea Index between the two PSGs, (four of these six showed a greater than 50 per cent reduction) however, this was not statistically significant. Subjective assessment of the PSG snoring signal by the senior author showed eight of 10 patients had either a reduced or much reduced signal at four months. VAS pain confirmed both procedures are well tolerated with minimal analgesia requirements. Minor complaints of transient mild palatal swelling, dry throat, catarrh and referred otalgia were noted and one patient developed mucosal ulceration following both procedures that healed within three weeks. Swallowing and speech were unaffected. These results confirm similar findings using the Somnus Unit, although the Celon device provides additional advantages including inherent safety in a bipolar electrode tip, auto-stop energy application and reduced procedure time.

Adult↗
PubMed2001

Snoring, sleep apnoea and the role of dental appliances.

This article describes the problems of snoring and obstructive sleep apnoea, together with an outline of treatment options. The Glasgow approach, whereby patients are investigated at a sleep clinic and a custom-made mandibular advancement device is made in semi-soft material, is also described. We have demonstrated the acceptability and effectiveness of a simple appliance in patients with varying dental states, some with simple snoring and some with mild to moderate sleep apnoea. Our experience relates to around 260 patients, extending over a period of 4 years with good success. The simple intraoral device is recommended as a first line of approach for patients with problem snoring.

Equipment Design↗
PubMed1993

Snoring, hypertension, and the sleep apnea syndrome. An epidemiologic survey of middle-aged women.

The lower limit of the prevalence of sleep apnea syndrome (SAS) was estimated among women 40 to 59 years old by a two-stage procedure. In the first stage 2,016 questionnaires were mailed. The response rate was 75.6 percent. Daytime sleepiness was reported by 8.2 percent, habitual snoring by 11.2 percent, and intermittent snoring by 21.7 percent. There were altogether 128 women described with systemic hypertension and these women were more than twice as often habitual snorers. Logistic multiple regression analyses showed almost a threefold increase in the predicted prevalence of hypertension among intermittent and habitual snorers compared with nonsnorers in the age group 40 to 49 years old and a 60 percent increase in the 50- to 59-year-old age group. In the second stage, a group of 97 women highly suspected of SAS were selected because of their habitual snoring and daytime sleepiness. Eventually, 35 of these came for night studies and 14 were found to have SAS. Among the 35 women, 12 were hypertensive and nine of these had SAS. We estimated the lower limit of the prevalence of SAS to be 2.5 percent for women 40 to 59 years old. It is concluded that SAS is a relatively common occurrence among women, especially postmenopausal ones, and it is strongly related to hypertension.

Adult↗