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PubMed2004

Laser-assisted uvulopalatoplasty in the management of snoring and obstructive sleep apnea syndrome.

Laser-assisted uvulopalatoplasty (LAUP) was initially proposed as an alternative method to treat habitual snoring. Throughout the years the indications for LAUP have broadened, however, it has also remained an area of controversy. LAUP is a staged office-based procedure involving removal of excessive uvular mucosa and creation of transpalatal vertical troughs to effectively widen the retropalatal airway. Since postlaser treatment mimics the palatal appearance after uvulopalatopharyngoplasty (UPPP), similar surgical outcomes can be expected in properly selected patients. Although still an area of controversy, the medical literature has supported the cost effectiveness, safety, and comparable efficacy to the standard of UPPP in the treatment of snoring and obstructive sleep apnea syndrome (OSAS). In select patients, LAUP is a viable option for the management of not only snoring, but also OSAS.

Humans↗
PubMedDate not supplied

Etiopathogenesis, prevention and therapeutic strategies of snoring pathologies.

The sleep of adults and childrens is often disturbed from obstructive respiratory desorders evidenced from snoring. Scientific literature agrees in considering that as a dangerous pathology called roncopathy. Statistics show that about 50% of adult population over 50 yrs snores (exspecially males) and some of that has a dangerous period of prolonged and frequent obstructive sleep apneas. Results of polisomnographic tests show that 4% of total population suffer of apneas extremely severe and dangerous for life. Roncopathy is often associated to a lot of troubles: pulmonary, gastroenterologic, endocrinologic, of behaviour and especially cardiovascular and neurologic and this could explain the motif of high nocturnal percentage of myocardial infarction, ictus and sudden death. In this work we evidence the anatomical and functional etiology of snoring and sleep apneas and expose the surgical and medical therapeutic options up to day available.

Adult↗
PubMed2001

[Application of plasma radio frequency at low temperature in treatment of snoring and obstructive sleep apnea syndrome: a pilot study].

OBJECTIVE: To explore the effect of plasma radiofrequency at low temperature in treatment of snoring and obstructive sleep apnea syndrome (OSAS). METHODS: Plastic surgery of uvula and soft palate was performed by plasma radiofrequency at low temperature under local anaesthesia in out-patient department among 12 patients with simple snoring and 47 patients with OSA (42 males and 17 females with the average age of 40.2 +/- 7.2 years). Nocturnal polysomnography was performed before and after operation. The patients were followed up for 4 to 8 weeks after operation. RESULTS: Clinical symptoms improved significantly after four to eight weeks. The free margin of soft palate was elevated, the uvula was shortened, and the volume of tonsils was reduced remarkably. The pharyngeal space was expanded significantly. No bleeding, choke, open rhinolalia and cicatricial stricture occurred during and after operation. Mean AHI of 47 OSA patients decreased from 18.1 +/- 7.3 to 6.9 +/- 5.4 (P < 0.02), mean lowest SaO2 increased from 82.1% +/- 6.7% to 86.7% +/- 3.3% (P < 0.05). The percentage of slow wave sleep in total sleep time increased from 3.0 +/- 2.7% to 10.4 +/- 3.6% ( P < 0.05). In general, 49 patients were with excellent curative effect, 8 with good effect, and 2 needed oral appliance to release the base of tongue. Conclusion Snoring and mild and moderate obstructive sleep apnea can be significantly improved by using radiofrequency ablation at least on a short-term basis. This treatment can be administered as an outpatient procedure without complications related to speech, taste or swallowing.

Adult↗
PubMed1991

[Pulmonary artery blood pressure and snoring].

Snoring is an extrathoracic inspiratory airway obstruction during sleep, accompanied by more or less intense noise. The inspiration volume being limited at the same time, this can produce additional blood gas changes. Epidemiological studies have shown an increased risk of myocardial infarction or cerebral ischaemia during night for snorers. Little is known, however, about acute effects of snoring on the haemodynamics of heart and circulation. The present study presents data of the pulmonary artery blood pressure during sleep-related upper airway obstruction. Pulmonary arterial pressure during sleep was examined with five patients via Swan-Ganz catheter. When an upper airway obstruction occurred, the inspiratory pulmonary arterial pressures rose in all the five patients. Two patients showed a clinically significant decrease in arterial oxygen saturation during snoring so that in these cases, a hypoxic vasoconstriction can be discussed as a possible cause. The other three patients did not produce significant decreases in oxygen saturation, so that in these cases mechanical factors (negative inspiratory intrathoracic pressure oscillations) should be regarded as the most probable cause for increases in the pulmonary arterial blood pressure.

Blood Gas Analysis↗
PubMed1991

Quantification of sleep disordered breathing by computerized analysis of oximetry, heart rate and snoring.

Intermittent snoring and cyclic oscillations of heart rate and oxyhaemoglobin saturation (Sao2) are characteristic features of the obstructive sleep apnoea syndrome (OSAS). Thus, overnight recordings of laryngeal sounds and heart rate by a portable device (MESAM) and of Sao2 by oximetry are applicable to screen outpatients for the presence of OSAS. Computerized analysis for time intervals of constant heart rate and intervals between snoring sounds is used by MESAM to quantify respiratory disturbances during sleep. Rapid increases in Sao2 during the postapnoeic hyperventilation period together with the number of desaturations are used by a new software for quantitative analysis of oximetry. To elucidate reliability of results from automatically scored MESAM and oximetry recordings, we compared the four computer calculated respiratory disturbance indices from heart rate (RDIH), snoring (RDIS), resaturations (RDIR) and desaturations (RDID) with the apnoea plus hypopnoea index (AHI) from simultaneously performed polysomnography. The study population consisted of 53 snorers with an AHI of 19.0 +/- 2.6 (median +/- SEM; range 0.7-87.8). Whereas both RDI's from MESAM correlated rather weakly with the AHI from polysomnography (RDIH: r = 0.32, p less than 0.05; RDIS: r = 0.33, p less than 0.05), this correlation was much better for the RDI's from oximetry (RDIR: r = 0.951, RDID: r = 0.93; p much less than 0.0001). Accepting a plus/minus 30 percent difference from the AHI, the RDIR classified 77% of patients correctly, the RDID 62%, the RDIS 32% and the RDIH 23%. In conclusion, results from computerized analysis of oximetry for desaturations and rapid resaturations correlate more closely with polysomnography than those from automatic scoring of MESAM recordings.

Heart Rate↗
PubMedDate not supplied

[Pathophysiologic mechanisms of functional disorders of the cardiorespiratory system in snoring].

Disturbances in the function of cardio-respiratory system due to nasal obstruction, accompanied by snoring, are described. Obstructions to other levels, oropharynx, pharynx and larynx, also inducing such disturbances are mentioned, with particular reference to snoring which may lead to the development of apnea during sleep. The need of a multidisciplinary approach to such patients is underlined, with a very specific role of the otorhinolaryngologist, especially when obstruction of the nose has caused such a disturbance. The act of snoring can be eliminated or diminished, and the development of obstructive apnea during sleep prevented or interrupted by accurate indications for and properly performed reconstructive surgery of the nose.

Adolescent↗
PubMed1988

Pathogenic aspects of snoring and obstructive apnea syndrome.

Snoring (inspiratory noise related to narrowing of the upper airways) and obstructive sleep apnea (OSA) are two aspects of the same basic disorder: sleep-related narrowing of the upper airways. Patients with OSA have been heavy snorers for years and even decades. Lying supine induces snoring and mild OSA in heavy snorers due to hypotonia of pharyngeal dilator muscles, decreasing waking neural drive and recumbent position, which contribute to functional narrowing of the upper airways. Functional factors in obstruction during sleep include (a) respiratory instability prevalent in the male sex, (b) increased extensibility of the lax tissues surrounding the oro-pharynx and (c) deficient contraction of the pharyngeal dilator muscles during inspiration. These effects are worsened by sleep deprivation and fragmentation, alcohol intake and sedatives. Anatomical factors favoring narrowing of the upper airways in snorers and OSA patients are (a) abnormally narrow airways as well as (b) increased thickness and length of the velum palatinum in snorers and OSA patients, (c) tonsillar and adenoid hypertrophy, micro- and retrognathia, and nasal insufficiency, (d) obesity with fat infiltration of the soft tissues and in particular of the oropharynx, (e) relatively open mandibular angle, hypertrophy and thickness of the tongue, and lowered hyoid bone (as shown by MRI imaging). It is possible that many anatomical abnormalities may be the consequence of snoring and obstructive apnea. During NREM sleep the ineffective inspiratory efforts progressively increase with worsening hypoxia and hypercapnia. The upper airways become patent again when arousal induces phasic activation of the dilator pharyngeal muscles.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1988

The effects of a mixture of surface-active agents (Sonarex) on upper airways resistance and snoring in anaesthetized dogs.

We measured upper airways resistance from the trachea and from the pharynx to the atmosphere, EMG of the genioglossus muscle and the sound of snoring, in anaesthetized greyhounds, breathing spontaneously through the upper airways. Using extra-corporeally produced continuous flow we determined flow/pressure curves for the upper airways and resistances from the trachea and from the pharynx. We tested the effects of 0.9% saline and of Sonarex (a proprietary mixture containing sodium chloride, glycerol, polysorbate 80 and benzalkonium chloride). Both saline and Sonarex decreased upper airways resistance, but the latter did so more consistently. With Sonarex, genioglossus activity increased and the sound of snoring decreased. Flow/pressure curves 5-20 min after Sonarex showed a decrease in upper airways resistance and a smoother curve, whereas those with saline showed an increase in resistance. The sound produced by continuous flow through the upper airways was decreased by Sonarex but increased by saline. Thus, both Sonarex and saline decrease upper airways resistance, but Sonarex also reduces the sound of snoring and the resistance and sound of continuous airflow through the upper airways.

Airway Resistance↗
PubMed1986

[Sleep apnea syndrome, snoring and uvulopalatopharyngoplasty].

Sleep-related closure of the upper airways is the key feature of the obstructive sleep apnoea syndrome (OSAS). Excessive daytime sleepiness and loud snoring are the major signs. It is not possible to differentiate patients with the single complaint of habitual snoring from patients with sleep apnoea by their history alone; polysomnography is a mandatory procedure. Recently, uvulopalatopharyngoplasty (UPPP) has been introduced as a surgical procedure to treat OSAS and excessive snoring. This paper presents the results of UPPP in eleven patients evaluated by means of postoperative polysomnography.

Adult↗
PubMed1986

Snoring: not funny--not hopeless.

Snoring means obstructive breathing during sleep, and its most exaggerated form is obstructive sleep apnea. Mild snoring may respond to simple self-help remedies. Heavy snoring responds well to the surgical removal or reconstruction of obstructive elements in the hypopharynx, nasopharynx or nasal passages.

Adult↗
PubMed1995

[Obstructive snoring--diagnosis and therapy].

Obstructive snoring belongs to the sleep-related breathing disorders. The characteristics of this disorder is described, following the case report about two young snorers, complaining of excessive day-time sleepiness, involuntary falling asleep in monotoneous situations. Ambulatory monitoring using the four-channel system MESAM-IV showed a Respiratory Disturbance Index of < 5 during a predominantly continuous snoring episode without significant drops in oxygen saturation. Clinical cardio-respiratoric polysomnographic monitoring showed a normal architecture of sleep interrupted by respiratory arousals. Under nasal CPAP treatment these arousals, as well as the complained excessive daytime sleepiness disappeared. The latter fact becomes evident, when comparing the sleep latencies before therapy to those under CPAP-treatment, estimated by the Multiple Sleep Latency Test (MSLT). Thus, this therapy proved to be very effective in patients suffering from obstructive snoring.

Adult↗
PubMed1995

[Role of ENT surgery in the assessment and treatment of snoring and of obstructive sleep apnea syndrome in adults and children].

The otolaryngologist is increasingly involved in the evaluation and management of sleep-related respiratory disorders. Main symptoms of intermittent obstruction in adults and children are snoring and stridulous breathing. Important factors causing pharyngeal obstruction are functional and structural narrowings in the upper airways leading to increased upstream resistance. The ENT's examination has two principal aims: 1. habitual snoring must be separated from an obstructive sleep-apnea syndrome (OSAS), as the later is associated with cardiovascular diseases and an increased mortality; 2. a functional or structural cause of the obstruction must be sought. Flexible nasopharyngoscopy is a valuable diagnostic tool to determine the nature of obstruction. OSAS patients need a differentiated evaluation in a sleep laboratory, and an attempt of therapy with continuous positive airway pressure (CPAP) should be undertaken in most of these cases. Today the otolaryngologist is equipped with a whole range of conservative and surgical therapeutic possibilities. The introduction of compact lasers as well as the endoscopic/microscopic endonasal surgery have revolutionized surgical treatment in patients with habitual snoring and OSAS. In contrast to adults, OSAS in children has still received poor attention and leads often to impaired thriving. Most frequently, hypertrophied tonsils are present, and tonsillectomy eliminates obstruction in nearly all of these cases.

Adolescent↗
PubMed1994

Outpatient treatment of snoring with CO2 laser: laser-assisted UPPP.

The usual treatment of snoring in the absence of sleep apnea has been uvulopalatopharyngoplasty (UPPP). Patients are often reluctant to undergo this painful procedure, which must be performed under general anaesthesia. A new procedure, introduced 5 years ago by the author, called LAUP (laser-assisted uvulopalatoplasty), can be used to treat the pharyngeal airway obstruction that produces snoring during sleep. LAUP is performed with CO2 laser under local anaesthesia. LAUP produces a progressive enlargement of the oropharyngeal airspace that reduces or eliminates airway collapse during sleep, and it allows surgery for the relief of snoring to be performed in the office under local anaesthesia. LAUP has many advantages over the traditional UPPP. It is simple, reliable, hemostatic, and less painful. It is also less expensive, as it can be performed on an outpatient basis. This makes the LAUP more accessible to patients. Our experience with LAUP in 741 patients treated from December 1988 to December 1993 (121 women and 620 men) is described. Good results were obtained in 95% of patients, and there were no complications. This new technique can be easily performed by other otolaryngologists after suitable training. LAUP provides a simple alternative for many patients who do not wish to undergo a traditional UPPP. The method and its results are discussed.

Ambulatory Care↗
PubMed1993

[Evaluation of velopharyngeal function using an aerophonoscope before and after surgery for snoring].

Following surgery for snoring, regardless of the technique used, velopharyngeal insufficiency remains an infrequent but disabling complication. In an attempt to assess the risk of velopharyngeal insufficiency, we used a new, simple, rapid, and noninvasive method of evaluating palatal function, the aerophonoscope. Pre and postoperative aerophonoscopic studies were carried out in 25 chronic snores undergoing a single step uvulopalatoplasty with a laser under local anesthesia. The aerophonoscope revealed signs of palatal dysfunction in 2 patients (8%) preceding surgery and confirmed the absence of palatal dysfunction in all patients following our technique of uvulopalatoplasty. We also present the aerophonoscopic findings in 3 patients with nasopharyngeal stenosis and 2 patients with velopharyngeal insufficiency following surgery for snoring.

Humans↗
PubMed1993

Significance and treatment of nonapneic snoring.

Snoring has been associated with an increased risk of vascular morbidity and mortality and with the complaint of excessive daytime sleepiness. Much of this risk may be attributable to concomitant sleep apnea or hypopnea. Recent work suggests that in certain individuals, snoring without apnea or hypopnea can lead to sleep disruption. This appears to be due to augmented ventilatory effort in response to an increased "internal" resistive load that results in repetitive arousals from sleep. This condition has been termed the upper airway resistance syndrome (UARS). Identification of load-related arousals in patients with the UARS may require the addition of esophageal pressure monitoring to the diagnostic polysomnogram. Nasal continuous positive airway pressure (CPAP) effectively eliminates snoring, hypopnea and apnea and therefore may be useful in treating this form of sleep-disordered breathing. The diagnostic criteria and indications, if any, for chronic treatment of these nonapneic snorers with nasal CPAP as well as long term compliance remain to be determined.

Adult↗
PubMed1993

Snoring and anxiety dreams.

In a group of elderly males who had been exposed to excessive stress during World War II, 56% of whom suffered from current post-traumatic stress disorder, a significant association was found between snoring and the occurrence of anxiety dreams, independent of the use of sedatives, antidepressants, smoking and alcohol and coffee consumption. Anxiety dream incidence was highest when snoring was accompanied by respiratory pauses. The underlying pathophysiologic mechanisms are thought to be hypercapnia and autonomic-vegetative arousal, resulting from obstructive sleep apneic episodes in heavy snoring. Polysomnographic sleep studies are needed to confirm this hypothesis.

Aged↗
PubMed1993

Snoring, asthma and sleep disturbance in Britain: a community-based survey.

A questionnaire was sent to a random sample of adults in eight locations throughout Britain, to investigate the prevalence of snoring, asthma and sleep complaints in community-based British adult. Of the 1,478 respondents (831 females, 647 males; mean +/- SD age 45 +/- 18 yrs), 37% reported snoring at least occasionally, and 11% reported snoring on at least four nights per week (frequent snorers). Frequent snorers reported spending less time asleep at night, falling asleep accidentally during the day more often, taking planned daytime naps, and falling asleep whilst driving or operating machinery more often than the other respondent. Using ordinal logistic regression analysis to allow for the age and sex of the respondents, both accidental daytime sleep and planned daytime naps were commoner in frequent snorers than other respondents. Six percent of all respondents and 6% of those aged under 40 yrs reported that they had asthma (asthmatics). Seven percent of respondents aged less than 40 yrs reported wheezing on three or more occasions per year, and had been prescribed oral or inhaled bronchodilators (young wheezers). More than 80% of the asthmatic respondents of all ages, and young wheezers, reported waking at night with wheeze at least occasionally, and more than 30% of each group reported this symptom frequently. A larger proportion of asthmatics and young wheezers reported that their night-time sleep was unrefreshing, and that they had too little sleep at night than the other respondents.(ABSTRACT TRUNCATED AT 250 WORDS)

Asthma↗
PubMed1996

[Medical treatment of snoring and obstructive sleep apnea syndrome].

Although snoring may have deleterious effects by itself, its only clearly identified hazard is that of a social nuisance; therefore, treatment of snoring should before all make no harm. Conversely, the potential hazards of obstructive sleep apnea are well established, and it is clearly important to eliminiate sleep apneas. The medical treatments which may improve snoring and obstructive sleep apneas are basically the same. They include avoidance of risk factors such as obesity, alcohol and hypnotics as well as active treatments such as positional treatment, dental appliances and by nasal continuous positive airway pressure. Nasal continuous positive airway pressure has become the treatment of choice for obstructive sleep apnoea, since it is both efficient and safe. Its only limitation is related to variable acceptance by patients.

Dental Prosthesis↗