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PubMed1995

Snoring, apneic episodes, and nocturnal hypoxemia among children 6 months to 6 years old. An epidemiologic study of lower limit of prevalence.

STUDY OBJECTIVE: To identify a lower limit of the prevalence of sleep-related breathing disturbances among preschool children. DESIGN: A cross-sectional epidemiologic study in two stages, first by questionnaires and second by whole-night investigation of children symptomatic of the sleep apnea syndrome. SETTING: Gardabaer, a small town, 10 km south of Reykjavìk, Iceland. PARTICIPANTS: All children in Gardabaer, 6 months to 6 years old (n = 555). MEASUREMENTS: Symptom score estimated by questionnaire and respiratory events based on overnight oximetry, thermistors, and a static charge sensitive bed. RESULTS: The response rate was 81.8%. Snoring was reported as often or very often among 14 (3.2%) and occasionally by 73 (16.7%). Apneic episodes were reported often or very often among seven (1.6%). Altogether 18 children were highly suspected of the sleep apnea syndrome because of habitual snoring or apneic episodes. The girls (n = 9) were older than the boys (mean age: 46 +/- 21 months vs 20 +/- 12 months, p < 0.001). Eventually 11 children came for a whole-night investigation and 8 of them showed more than three respiratory events per hour of sleep, associated with > or = 4% oxygen desaturation. The lower limit of the sleep apnea syndrome prevalence among these children was thus 2.9% (SE, 0.5%). CONCLUSIONS: Among children, symptoms such as snoring and apneic episodes are reported relatively seldom, but a high proportion of the children with these symptoms have hypoxic respiratory events.

Child↗
PubMed1991

Treatment of snoring and obstructive sleep apnea with a dental orthosis.

A dental orthosis, designed to increase the size of the upper airway by advancing the mandible, was used in 68 patients to treat snoring and varying degrees of obstructive sleep apnea. The orthosis increased the posterior airway space, as assessed by lateral cephalograms. Seven months (range 2 to 25) after beginning use, 75 percent of patients were using the orthosis regularly. Snoring, by report, was improved in all patients but one (p less than 0.001) and was eliminated in 42 percent (95 percent confidence interval 30 to 55 percent). Sleep quality and sleepiness were also reported improved. Apneas and hypopneas, measured before and after use in 20 patients with obstructive sleep apnea, were reduced from an average of 47 to 20 events per hour (p less than 0.001). Oxygenation and sleep disturbance were also improved. Apnea-hypopnea frequency was reduced with treatment to less than 20/h in 13 patients. Residual frequencies greater than 20/h were associated with higher initial frequencies of apneas and hypopneas. Side effects of orthosis use were minor, and no serious complications were observed. The dental orthosis is an effective treatment for the symptom of snoring and can also effectively treat obstructive sleep apnea of moderate severity.

Adult↗
PubMed2004

Habitual snoring, intermittent hypoxia, and impaired behavior in primary school children.

OBJECTIVES: Sleep-disordered breathing is associated with impaired behavior and poor academic performance in children. We aimed to determine the extent of behavioral problems in snoring children, clarify the role of intermittent hypoxia, and test the reversibility of impaired behavior and poor academic performance. METHODS: In 1144 children, habitual snoring (HS; snoring frequently or always) and impaired behavior were assessed using parental questionnaires. Intermittent hypoxia (ie, presence of > or =5 arterial oxygen desaturations by > or =4% or > or =1 desaturation to < or =90%) was investigated with pulse oximetry. Poor academic performance (grade 4-6 on a 6-point scale in mathematics, science, or spelling) was based on the last school report. HS, impaired behavior, and academic performance were reevaluated after 1 year. Adjusted odds ratios (ORs) were calculated using unconditional logistic regression. RESULTS: HS was significantly associated with hyperactive (OR: 2.4) and inattentive behavior (OR: 4.0), daytime tiredness (OR: 7.1), and sleepiness (OR: 2.6-4.8). These associations were independent of intermittent hypoxia. HS was also significantly associated with bad conduct (OR: 2.8), emotional symptoms (OR: 5.5), and peer problems (OR: 9.7). At follow-up, hyperactive and inattentive behavior but not academic success had significantly improved in children in whom HS had ceased. CONCLUSIONS: We suggest that impaired behavior is a key feature of HS independent of intermittent hypoxia and improves when HS ceases.

Affective Symptoms↗
PubMed2005

Obesity rather than severity of sleep-disordered breathing as the major determinant of insulin resistance and altered lipidemia in snoring children.

OBJECTIVE: Sleep-disordered breathing (SDB) is associated with insulin resistance and dyslipidemia in adults and in obese children. However, the prevalence of such metabolic abnormalities among snoring children is unknown. This study was done to prospectively assess the relative contribution of SDB and obesity to metabolic disturbances in a large cohort of snoring children. METHODS: Measurements of fasting serum glucose, insulin, and lipids were obtained after polysomnographic evaluation in 116 snoring children and in 19 control subjects. Insulin resistance was assessed using the insulin/glucose ratio (I/G ratio) and homeostasis model assessment (HOMA). RESULTS: A total of 135 children (79 boys; mean age: 8.9 +/- 3.5 years) were studied. Sixty-four children had moderate to severe SDB (AHI = 5 per hour of total sleep time [TST]), 52 had mild SDB (AHI = 1 but <5 per hour of TST), and 19 were control subjects (AHI <1 per hour of TST). Seventy of these children were obese. No significant correlations were found between AHI, lowest arterial oxygen saturation, or arousal index and serum insulin, serum glucose, I/G ratio, HOMA, or serum lipids for either the whole group or the obese children only. However, significant positive correlations were found between I/G ratio and relative BMI (relBMI; r = 0.58), HOMA and relBMI (r = 0.52), triglycerides and relBMI (r = 0.30), and high-density lipoprotein and relBMI (r = 0.50). No significant differences were found in relBMI, I/G ratio, and lipid levels between boys and girls. CONCLUSIONS: Among children with suspected SDB, insulin resistance and dyslipidemia seem to be determined primarily by the degree of body adiposity rather than by the severity of SDB.

Adolescent↗
PubMed2003

Oral appliance therapy for snoring and sleep apnea: preliminary report on 86 patients fitted with an anterior mandibular positioning device, the Silencer.

There has been a great deal of interest recently in snoring and obstructive sleep apnea (OSA) by both dental and medical professions, as well as the media. Oral appliance therapy has been recognized by many sleep disorder specialists as the primary treatment of choice for snoring and mild to moderate OSA. Continuous positive airway pressure (CPAP) is the gold standard treatment for severe OSA, with oral appliance therapy reserved for CPAP failures. CPAP therapy has a compliance rate of 50 to 70%. The author has had experience with anterior mandibular positioning devices, in particular, Dr. Wayne Halstrom's Silencer for approximately 2 years. All patients are thoroughly investigated to include a polysomnogram (PSG) to assess the degree of snoring and OSA. Patients who are suitable candidates for oral appliance therapy are offered a temporary appliance with a follow-up PSG prior to fitting with the permanent appliance or initially with a more comfortable, custom-fitted permanent appliance. In either case, attempts are made to convince the patients of the necessity for a follow-up PSG to evaluate the efficacy of the device. The results, as well as potential harmful side effects and complications, are presented and are compared with the results of other recent studies.

Follow-Up Studies↗
PubMed2006

Uvular edema secondary to snoring under deep sedation.

A 57-year-old male with a documented history of obstructive sleep apnea with loud snoring received deep intravenous sedation with midazolam, fentanyl, ketamine, and propofol infusion and a left interscalene brachial plexus nerve block for a left biceps tendon repair. Loud snoring during the case was noted. On the second postoperative day, he was observed to have significant uvular edema. After due consideration of the various elements in the differential diagnosis, it was concluded that negative pressure trauma from deep snoring during the sedation was the most likely etiology.

Anesthetics, Dissociative↗
PubMed1993

Snoring and nightmares.

To test the conclusion of a recent study that snoring and disturbing dreams are strongly associated, 199 university undergraduates responded to a questionnaire that assessed their level of snoring and the frequency with which they experienced fantastic nightmares. Contrary to data provided by this recent study, we did not find a significant relationship between snoring and disturbing dreams. Some possible reasons for the discrepancy between these data sets were considered.

Adult↗
PubMed1998

[Effective nasal CPAP therapy for heavy snoring and paradoxical respiration during sleep in a case of multiple system atrophy].

A 64-year-old man with multiple system atrophy complained of daytime sleepiness, fatigue, and snoring. Neurological examination revealed severe autonomic failure, mild cerebellar ataxia and akinesia. Daytime blood gas analysis showed respiratory acidosis with hypoxia and hypercapnia. MR imaging of the brain showed atrophy of the pons, cerebellum and bilateral frontal lobes. Although paralysis of the vocal cord abduction was not found by laryngoscopy during daytime examination, polysomnography (PSG) showed heavy snoring with paradoxical respiration associated with severe desaturation during sleep as well as reduced slow wave sleep and REM sleep. He was diagnosed as having sleep-related upper airway obstructive breathing disorder probably due to Gerhardt syndrome. Tracheostomy was considered, but we performed nasal CPAP therapy during sleep because this therapy is non-invasive and would not impair his daily life. After nasal CPAP therapy, daytime sleepiness, fatigue, and snoring with desaturation improved, and PSG showed increased slow wave sleep. These results demonstrate that nasal CPAP therapy improves the quality of sleep and should be considered in patients with early stages of multiple system atrophy who exhibit sleep-related breathing disorders.

Humans↗
PubMed2000

Uvulopalatopharyngoplasty versus sequential uvulopalatoplasty for surgical treatment of snoring.

Military personnel serving on active duty suffering from loud, bothersome snoring often require surgical treatment. This elective treatment should not disrupt the command and should have minimal impact on military readiness. Major drawbacks of the standard procedure, uvulopalatopharyngoplasty, include postoperative pain requiring convalescent leave, postoperative bleeding, and velopharyngeal incompetence. In addition, the surgery consumes limited operating room time for what many consider elective surgery. Sequential uvulopalatoplasty was developed as an alternative. This is performed with a carbon dioxide laser under local anesthesia in a clinic setting, but it requires cumbersome laser precautions and expensive laser equipment. Standard electrocautery can be used instead of a laser for this procedure. This avoids additional expense, special precautions, and equipment but is equally safe and effective. We compare time lost from work, duration and level of pain experienced, number of days until regular diet resumed, and effectiveness between uvulopalatopharyngoplasty and sequential uvulopalatoplasty. We found sequential uvulopalatoplasty to have less impact on military readiness while being as effective as uvulopalatopharyngoplasty for snoring. This makes it an ideal treatment modality for patients desiring surgical correction of snoring.

Adult↗
PubMed2000

[Surgical treatment of severe snoring. Long-term effects].

AIM: The long-term results of uvulopalapharyngoplasty (UPPP) reported by patients who had been operated for severe snoring but without clinically significant obstructive sleep apnoea were explored. METHODS: Median three years (one to eight years) after the operation follow-up results were obtained from 80 of 85 patients (94%), using a questionnaire. RESULTS: In nine patients (11%) the operation had been without any effect. Eleven patients (14%) indicated that they were completely cured of snoring. In sixty patients (75%) snoring was reduced. In about half of these the initial effect had been more pronounced than the present. About 60% of the patients felt better during daytime, were less tired or sleepy than before the operation. Slight or temporary side effects were present in 30% of the patients. Eighty percent of the patients would recommend the operation to others. CONCLUSION: This study confirms that UPPP is effective in relieving the symptoms in non-apnoeic snorers, without significant side effects. A certain reduction of the positive effect occurs during the first two years in about half of the patients. Nevertheless most patients are satisfied with the operation and would recommend it to others.

Female↗
PubMed2000

[Short term evaluation of a new treatment method for primary snoring: radiofrequency energy].

The usual treatments for primary snoring are uvulopalatopharyngoplasty (UPPPP) and laser assisted uvulopalatoplasty, their morbidity is known, particularly considerable postoperative pain. We have performed a prospective study on a population of 23 patients with primary snoring (respiratory disturbance index =6 +/- 1) to 1) evaluates by means of questionnaires the short term (2 month) efficacy of the application of radiofrequency energy at the level of the soft palate, and 2) assess the morbidity associated with this treatment in this population. In the group of patients receiving treatment at three sites in a maximum of three sessions, the short term satisfaction rate was 75 %. The postoperative pain was of minor importance and the use of major analgesics was necessary in 2 cases only. We conclude that this treatment with radiofrequency energy seems to be an effective treatment for primary snoring at short term. The morbidity, specially the pain seems to be distinctly inferior compared to UPPP or laser treatment. Further prospective studies on a larger number of patients and with a longer follow-up are absolutely necessary to confirm these results.

Catheter Ablation↗
PubMed1999

From snoring to sleep apnea in a Singapore population.

We have no information on snoring and obstructive sleep apnea (OSA) in our population, which is predominantly Chinese. Our perception is that sleep apnea syndrome is more common than the 2-4% prevalence (Young et al., 1993) often quoted, judging from the experience in our sleep disorder unit. We studied the snorers in an adult population in Singapore and then went on to see how many snorers suffer pathological apnea and sleep apnea syndrome. Room partners, 220 of them aged 30-60 years, were interviewed for their observation of snoring among each other. 106 consecutive habitual loud snorers of a similar age group in the same population were studied with polysomnography in our sleep laboratory. An apnea index greater than 5 was considered pathological. 24.09% were loud habitual snorers. 87.5% of loud habitual snorers had significant obstructive apneas on the polysomnogram and 72% of these apneics complained of excessive daytime sleepiness (EDS). Given the clinical observation that all apneics snored, by extrapolating these figures, we guess that sleep apnea syndrome affects about 15% of the population. Multiple Sleep Latency Tests validated EDS in our cases with clinical hypersomnia. Hypersomnolence was significantly related to the poor delta wave sleep. Contrary to what was believed, OSA occurred predominantly in stage 1 and 2 non-rapid eye movement (NREM) sleep rather than in REM sleep. The frequent arousals prevented sleep going beyond stage 1 and 2.

Adult↗
PubMed2001

[Snoring and excessive daytime somnolence and risk of cardiovascular diseases].

Snoring and excessive daytime somnolence (EDS) are very common in middle-age adults. The goal of the investigation was to assess links between those symptoms and risk for cardiovascular diseases (CVD). The population studied included 1186 inhabitants of Warsaw (mean age 52 years), participants of the international multicentre study of cardiovascular disease MONICA II, who completed the sleep disordered breathing (SDB) questionnaire. Snoring was reported by 78% of males (48% habitual and 30% occasional) and 59% of females (27% habitual and 32% occasional). Every fourth (26.8%) subject declared observed apnoeas, in 9.2% apnoeas were observed every night. EDS was declared by 28.7% of studied sample. The results of the questionnaire were compared to the results of MONICA study. Snorers had significantly higher systolic and diastolic blood pressure (133.2 +/- 23/84.6 +/- 13 mm Hg) compared to non-snorers (126.4 +/- 22/80.4 +/- +/- 12 mm Hg) (p < 0.0001). The high total serum cholesterol (> or = 200 mg%) and triglycerides (> or = 200 mg%) concentration, and also obesity (BMI > or = 30 kg/m2) were more prevalent in snorers. Subjects reporting apnoeas more often had coronary artery disease (p < 0.001) or history of stroke (p = 0.002) compared to non-apnoeics. There was no relationship between EDS and risk of cardiovascular disorders, and also between diabetes and SDB. In conclusion, snoring was strongly associated with hyperlipidaemia, obesity or hypertension, well known risk factors for development of cardiovascular disorders. Reported apnoeas were related to risk of coronary artery disease.

Adult↗
PubMed2001

[Snoring--when is etiological assessment necessary?].

Snoring is more than a social problem. Snoring is a sound produced by the vibrating structures of the upper airway. If clinical signs like sleepiness, fatigue, hypertension or vascular disease are present or if a surgical procedure for the treatment of snoring is considered, further investigations (respiratory polygraphy or full nocturnal polysomnography) should be performed. If sleep apnea is demonstrated, non-surgical approaches may be more promising.

Diagnosis, Differential↗
PubMedDate not supplied

Orofacial complications associated with forward repositioning of the mandible in snore guard users.

Snoring and obstructive sleep apnea (OSA) result from a collapse of the tongue, soft palate, and pharynx, causing temporary airway blockage. Acrylic mandibular advancement splints and Herbst appliances are used to relieve snoring and mild OSA. Repositioning the mandible forward may have an adverse effect on the orofacial and dentoalveolar structures of susceptible individuals. This article reports two cases in which orofacial complications developed following the utilization of snore guard appliances.

Dental Occlusion, Traumatic↗
PubMed2004

[Dependence of severity of obstructive sleep apnoea syndrome on body mass gain in patients after emergence of snoring symptom].

AIM: To search for simple clinical criteria for prediction of obstructive sleep apnoea syndrome (OSAS). MATERIAL AND METHODS: Case histories of 389 patients with uncomplicated snoring and OSAS (321 males and 68 females, mean age 55.2 +/- 10.9 years) were analysed retrospectively. The OSAS diagnosis was made according to polysomnographic evidence using somnological systems Minisimno (Sefam, France) and Compumedix S-series (Compumedix, Australia). Correlations between OSAS severity and some clinical parameters were studied. RESULTS: It was found that gain in body mass after onset of snoring significantly correlates with apnea/hypopnea index and with OSAS severity. If the body mass gain was > 10 kg, there is a 95% probability of the existence of moderate or severe OSAS. If the gain was > 20 kg, severe OSAS is highly probable. CONCLUSION: Body mass gain after onset of snoring can help in prediction of OSAS severity.

Body Mass Index↗
PubMed2004

Snoring, sleep quality, and sleepiness across attention-deficit/hyperactivity disorder subtypes.

STUDY OBJECTIVES: To characterize the relationship between pediatric attention-deficit/hyperactivity disorder (ADHD) subtypes, chronic snoring, and indexes of sleep quality and daytime sleepiness. DESIGN: A cross-sectional design with planned comparisons of ADHD (all subtypes) versus general community controls; ADHD Predominantly Inattentive Type (ADHD-I) versus a group with both ADHD Predominantly Hyperactive/Impulsive Type (ADHD-HI) and ADHD Combined Type (ADHD-C); and ADHD-HI versus ADHD-C. SETTING: Subjects recruited from a pediatric clinic, a university psycholgy clinic, and the general community. PARTICIPANTS: Caretakers of 74 children (45 with ADHD, 29 community controls; 53 boys, 21 girls; mean age, 9.6 years; age range, 6 to 16 years). Thirty-two (71.1%) of the children with ADHD were taking stimulant medication and 7 (15.5%) were taking hypnotic medication. INTERVENTIONS: N/A. MEASUREMENTS AND RESULTS: Caretakers completed the Pediatric Sleep Questionnaire (PSQ) and the Children's Sleep-Wake Scale (CSWS). Only the ADHD-HI diagnosis was associated with an increased likelihood of chronic snoring. Sleep quality was poorer among children with ADHD than controls; however, there were no differences in sleep quality across ADHD subtypes. Sleepiness was greater in children with ADHD, especially the ADHD-I Type. CONCLUSIONS: Chronic snoring may be a correlated feature in only a subgroup of the ADHD population, possibly those more likely to be diagnosed with ADHD-HI. Although children with ADHD have poorer sleep quality and greater daytime sleepiness, these 2 features of ADHD are not closely related.

Adolescent↗