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PubMed2004

Treatment of snoring and obstructive sleep apnea with mandibular repositioning appliances.

Snoring and obstructive sleep apnea form part of a spectrum of sleep disordered breathing affecting a significant proportion of the general population and particularly the middle aged. The consequences can be severe and even life threatening for both the individual directly affected and those more remotely involved. Adverse sequelae can manifest themselves acutely or in the longer term as a result of obstructive breathing induced hypersomnolence, neurocognitive deficits and cardiovascular abnormalities. The combination of anatomical and neuromuscular risk factors in the pathogenesis of OSA has resulted in a varied approach to its management. One such treatment option is mandibular repositioning appliances (MRA), which mechanically stabilize the airway. Whilst the efficacy of this simple intervention has been rigorously proven quite recently in a significant proportion of patients with varying disease severity, individual patient selection in its application remains uncertain. Short-term side-effects are common but usually transient, whilst in the long-term minor permanent adverse developments on the dentition and occlusion have been reported. Considering both the medicolegal implications of snoring and OSA and the increasing popularity of MRA, it is recommended that skilled multidisciplinary respiratory and dental personnel form the primary care team.

Critical Pathways↗

PubMed1990

Nasal influences on snoring and obstructive sleep apnea.

Although the relationship between nasal obstruction and sleep disturbance is variable, either partial or total obstruction of the nasal passages can cause snoring, obstructive sleep apnea, and the sequelae of alveolar hypoventilation. In addition, nasal obstruction can cause sleep fragmentation, sleep deprivation, and the known sequelae of disturbed sleep architecture, including associated daytime tiredness and alterations in normal behavior patterns. Nasal obstruction may produce greater physiologic effects during sleep than during the awake state. A complete examination of the upper respiratory tract should be done in all patients with obstructive sleep apnea and snoring. The degree of nasal obstruction is not directly correlated with the severity of symptoms and findings.

Humans↗

PubMed1995

Outpatient uvuloplasty: an inexpensive, single-staged procedure for the relief of symptomatic snoring.

Outpatient uvulopalatoplasty is an inexpensive alternative to laser-assisted uvulopalatoplasty for relief of symptomatic snoring. This single-stage procedure successfully reduced snoring in properly selected patients. Patients reported improvement in most cases, with 55% indicating great improvement or complete resolution. Spouses reported 83% of the patients were significantly improved or resolved. To date we have had no complications, including bleeding, infection, or velopharyngeal insufficiency or stenosis.

Adult↗

PubMed1997

Correlation between anthropometric measurements of the oropharyngeal area and severity of apnea in patients with snoring and obstructive sleep apnea.

The aim of this study was to investigate the relationship between severity of apnea and anthropometric oropharyngeal measurements in patients with snoring and obstructive sleep apnea. A total of 22 patients complaining of snoring and apneic spell during sleep were evaluated by polysomnographic and anthropometric measurements of the oropharyngeal area. The horizontal width of the uvula at the mid-point and the length of the uvula were measured using a T-shaped ruler. The distance between the anterior pillars, posterior pillars and retromolar raphes were also measured. The correlation between these anthropometric measurements and polysomnographic parameters including the respiratory disturbance index (RDI) and the lowest arterial O2 saturation level (lowest SaO2) of the patients were analyzed. Of the anthropometric measurements, the horizontal width of the uvula showed a significant correlation with RDI and lowest SaO2. The results of the present study indicate that patients with broader uvula may have severer sleep apnea and that anthropometric oropharyngeal measurements may give additional information to polysomnographic findings for selecting surgical candidates.

Adult↗

PubMed1989

Snoring as a presenting feature of the Shy-Drager syndrome.

A 67-year-old man with a progressive snoring habit is presented. Fluctuant bilateral abductor vocal cord paralysis was later recognized together with autonomic features suggesting a diagnosis of Shy-Drager syndrome. Snoring as a presenting feature of this condition has been infrequently described. This case highlights the importance of careful assessment of snorers.

Aged↗

PubMed1997

Complications of palatoplasty for snoring or sleep apnoea.

A questionnaire was sent to consultant Otolaryngologists (483) throughout the UK to identify any mortality associated with uvulopalatoplasty and other forms of palatoplasties for snoring and/or obstructive sleep apnoea. The response rate was 76.8 per cent (371). Six intra- and post-operative deaths were reported and four were known to have obstructive sleep apnoea. Life-threatening morbidity occurred in at least seven patients (three known apnoeic), two required immediate tracheostomy and two were managed in the intensive care unit. This suggests that the apnoeic patients undergoing palatoplasties experienced significant mortality and morbidity. Pre-operative sleep study should be performed in all snoring patients to identify the apnoeic subgroup. Continuous positive airway pressure, management of excessive obesity, elective tracheostomy and other strategies should be first considered before palatoplasties in these patients.

Humans↗

PubMed2006

Long-term outcomes of laser-assisted uvulopalatoplasty in 168 patients with snoring.

Laser-assisted uvulopalatoplasty (LAUP) is an established treatment for snoring. Our institution has been using a modification of the Kamami technique since 1995. Between January 1995 and December 2001, 469 patients underwent LAUP for snoring. A telephone survey of these patients and their partners was conducted retrospectively. One hundred and sixty-eight patients and their partners were interviewed and the findings analysed.Of the 168 patients, 122 had LAUP alone, 42 had LAUP and tonsillectomy and four had LAUP and septoplasty. The median follow-up time was 59 months (range 19 to 98 months).Seventy-four per cent reported improvement at six weeks, 69 per cent reported improvement at nine months and 55 per cent reported improvement at the time of interview. To assess the degree of improvement, patients and their partners were asked to grade any improvement in percentage terms. The mean subjective improvement scores were 57 per cent at six weeks (95 per cent confidence interval (CI) 50-64 per cent), 45 per cent at nine months (95 per cent CI 38-59 per cent) and 30 per cent at the time of interview (95 per cent CI 23-35 per cent). Patients who reported weight gain since surgery did not have a poorer outcome than those who reported no weight change or weight loss. Neither did weight loss predict a better outcome. The procedure was generally well tolerated, with only 30 patients (18 per cent) reporting complications (mainly minor). The benefits of LAUP wane with time and the results are best in the first 12 months following surgery. Our study suggests that 55 per cent of patients selected after sleep studies and sleep nasendoscopy will enjoy long-term benefit.

Adult↗

PubMed1999

Hypersomnia following uvulopalatopharyngoplasty for snoring.

This report describes three cases who underwent uvulopalatopharyngoplasty for severe snoring and who subsequently developed progressive excessive daytime sleepiness. All three cases were shown to have sleep fragmentation as a result of non-apnoeic episodic upper airway narrowing. These cases raise the possibility that increased upper airway resistance during sleep may be exacerbated or even caused by uvulopalatopharyngoplasty. Ideally, sleep-disordered breathing should be carefully excluded before this surgery is offered as treatment for severe snoring.

Adult↗

PubMed1997

Comparing the outcome of two surgical treatments for snoring using a patient-orientated measure of benefit.

Many different surgical techniques are currently used to treat simple snoring and their outcomes are difficult to compare. We used the Glasgow Benefit Inventory (GBI) to examine the outcome of two different surgical procedures. Thirty patients had been treated by uvulopalatopharyngoplasty (UPPP) and fifty-six by laser palatoplasty. The GBI scores showed close agreement with other subjective outcome measures. The two groups gave similar scores at 15 months postoperatively, and there was no deterioration in score with time. The GBI could be used to evaluate new surgical techniques for snoring, and could be useful in research and audit in this field.

Adult↗

PubMed1996

Sleepiness, snoring and driving habits.

A self-report postal questionnaire was sent to 5000 (3612 male) drivers randomly selected from the policy holders of an insurance company which insures only motorists who have achieved a maximum 'no-claims bonus'. The questionnaire sought demographic and physical details (sex, age, height, weight and collar size), driving history (number of years, average mileage), accident history (number, number of 'near misses'), frequency of events due to sleepiness (accidents, pulling off the road, falling asleep at the wheel), frequency and severity of snoring and sleep pattern and severity of EDS. Of the 2247 (44.9%) responses received, 1609 (44.5%) were male and 638 (46%) female. Snorers were more likely to report daytime sleepiness than non-snorers and were more likely to have had to pull off the road due to sleepiness. Despite this increased sleepiness there were no significant differences in overall accident rate. These results were obtained from a population with a maximum 'no-claims bonus' which would have excluded any subjects who had already had a recent accident due to sleepiness. Thus the results probably underestimate the problem. It is concluded that snorers tend to be sleepier than non-snorers and are more likely to have modified their driving habits as a result. Snoring and daytime sleepiness should be further investigated as contributory factors to road traffic accidents.

Adult↗

PubMed2000

[Snoring and postoperative pulmonary edema].

After uneventful ENT surgery, two male patients developed acute upper airway obstruction following extubation which progressed into negative pressure pulmonary edema (NPPE). One of these two patients suffered from known obstructive sleep apnoea syndrome, the other admitted to heavy snoring only after the incident. The pathophysiology of NPPE and the anaesthesiological implications of a patient's history of snoring are discussed.

Airway Resistance↗

PubMed2004

Single-visit hypnotic cure of stentorian snoring: a brief communication.

This is a report of a single-visit hypnotic cure of a woman who snored so loudly that she had to sleep in a back room at home. Her snoring recurred a year later when her orthopedist prescribed a muscle relaxant drug, and it again responded to a suggestion to "let it be impossible" to make that sound. There was no recurrence in a 4-year follow-up.

Female↗

PubMed1999

A simple audio data logger for objective assessment of snoring in the home.

We have developed a portable device for patient use in logging snoring loudness in the home, for guiding treatment decisions and measuring the clinical effectiveness of treatment. The device uses a free field microphone and is positioned on a bedside table. The prototype devices contain no inherently expensive components and are simple to operate (producing only 5% patient error to date). They are portable, battery powered, rugged and produce digital data which are easily and automatically analysed, and these design parameters enable the devices to be used for first line patient assessment. Of the 75 recordings made so far from 30 patients, 85% were successful, yielding clinically useful data. Because it is sound levels which are recorded and not replayable sounds, patient privacy is maintained, resulting in excellent patient acceptance (to date no patient has refused). The device has a dynamic range of 45-90 dB sound pressure level and a frequency range of 30 Hz-5 kHz. Because snoring intensities often vary significantly throughout the night the device can measure continuously over 8 h.

Calibration↗

PubMed1998

Effect of two types of mandibular advancement splints on snoring and obstructive sleep apnoea.

Snoring and obstructive sleep apnoea (OSA) both seem at least to be associated with narrowing of the upper airway and sleep-induced loss of muscle-tone. Mandibular advancement splints (MAS) have been proposed as a relatively simple method to increase oro- and hypo-pharyngeal dimensions thereby increasing the size of the airway. However, data on their effectiveness are conflicting and there are no clear indications as to which design is most effective or when they should be used. The effects of two designs of splint (types A and B) have been evaluated in 14 and nine subjects, respectively, using the Epworth Sleepiness Score (ESS) and domiciliary sleep monitoring on separate nights. Both splints reduced the median ESS (type A from 12 to 4.5; P = 0.003, type B from 7 to 4; P = 0.005). The apnoea-hypopnoea index was not affected by type A, but was reduced from 7.1 to 0.8; P = 0.005 by type B splints. There was evidence of a small improvement in overnight oxygen saturation for type B splints (P = 0.02). The splints were well tolerated and continued to be used nightly by 18 subjects. Mandibular advancement splints may offer a simple and effective alternative for the treatment of snoring and mild OSA in selected patients. Splint design may have considerable bearing on efficacy.

Adult↗

PubMed2001

Orthodontic side-effects of mandibular advancement devices during treatment of snoring and sleep apnoea.

The aims of this study were to investigate possible orthodontic side-effects following the use of mandibular advancement devices (MAD) in adults with snoring and sleep apnoea. A second objective was to analyse the effect of the appliance design. Seventy-five patients treated with MAD and 17 reference patients were studied at follow-up after 2.5 +/- 0.5 years. In the test group, 47 patients were provided with soft elastomeric devices, while the remaining 28 patients received hard acrylic devices. The treatment induced a change in overjet of -0.4 +/- 0.8 mm (mean +/- SD) and a change in overbite of -0.4 +/- 0.7 mm (mean +/- SD). These changes were larger than those found in the reference group (P < 0.01). The odds ratio (OR) for the largest quartile of reduction in overjet was 3.8 in patients using hard acrylic devices compared with those using soft elastomeric devices (P < 0.05). A large reduction in overjet in patients using the hard acrylic devices was unrelated to the degree of mandibular protrusion by the device. The OR for a large reduction in overjet in patients using the soft elastomeric devices with a protrusion of 6 mm or above was 6.8 compared with smaller mandibular protrusions (P < 0.05). The results indicate that the orthodontic side-effects are small during the treatment of adult subjects with MAD for snoring and sleep apnoea, especially in patients using soft elastomeric devices with mandibular protrusions of less than 6 mm. The follow-up of patients treated with MAD is recommended, as individual patients may experience marked orthodontic side-effects.

Acrylic Resins↗

PubMed1996

Management of simple snoring, upper airway resistance syndrome, and moderate sleep apnea syndrome.

The spectrum of respiratory sleep disorders has been extended in the last years to include conditions that are less well defined than severe obstructive sleep apnea (OSA). Moderate OSA, snoring, and upper airway resistance syndrome (UARS) represent three conditions in which there are still unresolved pathophysiological, epidemiological, and clinical questions. Therefore, the therapeutic approach remains unclear. We have tried to define these entities and to review the respective indications and efficacy of pharmacological treatment, weight loss, sleep posture, oral appliances, upper airway surgery, and finally, continuous positive airway pressure (CPAP). From these data, we also aim to define strategies of treatment for moderate OSA, snoring, and UARS. However, these conditions are likely to be particularly appropriate for randomized trials comparing different modalities of treatment that may be the only way to validate these treatment strategies.

Airway Obstruction↗

PubMed2004

Sleep pressure correlates of cognitive and behavioral morbidity in snoring children.

STUDY OBJECTIVES: Sleep architecture is not preserved in children with sleep-disordered breathing but, rather, undergoes dynamic changes that exhibit significant correlation with severity of sleep-disordered breathing. A sleep pressure score (SPS) with a cutoff value of 0.25 was derived from analysis of a large cohort of snoring and control children. Neurocognitive batteries were applied to examine the potential effect of SPS. DESIGN: Prospective study. PARTICIPANTS: 199 children who underwent a battery of neurobehavioral tests following an overnight sleep study were assigned to SPSHigh (> or = 0.25) or SPSLow (< 0.25) groups, and their neurocognitive performances were compared. RESULTS: Children in the SPSHigh group were significantly more likely to have deficits in memory, language abilities, verbal abilities, and some visuospatial functions than were children in the SPSLow group. These effects remained highly significant after adjusting for confounding variables and exhibited small to moderate effect sizes. CONCLUSIONS: We conclude that a sleep-pressure numerical factor derived from the overnight polysomnogram in snoring children is associated with deficits in neurobehavioral daytime functions that is independent of respiratory disturbance and hypoxemia and suggests a significant role for disturbed sleep homeostasis in pediatric sleep-disordered breathing.

Child↗

PubMed1987

Snore-induced Mallory-Weiss syndrome.

A Mallory-Weiss gastric mucosa laceration and upper gastrointestinal bleed was caused by intense snoring. This cause of gastrointestinal hemorrhage should be considered in the patient who snores.

Adult↗