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PubMed2000

[Approaches to surgical treatment of snoring and sleep apnea].

Examination and treatment data on 186 patients suffering from snoring and sleep apnea and surgical methods to manage these pathological conditions are reviewed. The stages of the surgical treatment of snoring and sleep apnea are the following: correction of nasal breathing, surgical intervention on the palatine using different tools (laser, scalpel, loop, electric knife). Effectiveness of the treatment methods, complications, postoperative developments are compared.

Adolescent↗
PubMed2001

Surgical management for snoring and sleep apnea.

Obstructive sleep apnea is a serious medical problem producing both physical and behavioral derangement. It is essential to provide a thorough workup and evaluation of all patients seeking care for snoring or OSA. Polysomnography is the standard for evaluation and assessment of the severity of OSA in every patient. The evaluation and workup for surgical intervention should include a thorough history, complete head and neck evaluation, nasopharyngeal laryngoscopy with a flexible fiberoptic endoscope, and appropriate imaging (e.g., cephalometrics). This workup allows pathologic entities of the upper airway (e.g., neoplasia, cysts) to be ruled out and regions of disproportionate anatomy (e.g., large soft palate, uvula, base of tongue, and a hypoplastic mandible) to be documented. Treatment of site-specific based on the finding of the evaluation. Treatment of snoring is often addressed by more conservative palatal procedures such as LAUP, RVTR, or electrocautery of the soft palate. The more aggressive palatal procedures such as UPPP are generally reserved for OSA. Nasal airway reconstruction may aid in the treatment of OSA, because increased nasal resistance and obstruction may significantly increase the negative pressure of the upper airway, leading to collapse of the velopharyngeal, base-of-tongue, and hypopharyngeal regions. Children with OSA usually respond well to adenotonsillectomy. Occasionally, uvulopalatopharyngeal procedures may be necessary. Craniofacial anomalies and significant skeletal anomalies such as severe mandibular hypoplasia have historically been problematic. Tracheostomies were at one time the only way to secure the airway in these patients. New developments in distraction osteogenesis have enabled mandibular lengthening and airway improvement, leading to earlier decannulation of these patients. The combined phase I and phase II treatment has a success rate of greater than 90%. Phase I treatment may include nasal reconstruction, uvulopalatopharyngeal, base-of-tongue, and hypopharyngeal surgery. Phase I surgery has a documented success rate of about 70% to 80%. Phase II surgery (MMA) has a success rate approaching 100%. In certain cases, MMA may be used as the primary treatment of OSA.

Adenoidectomy↗
PubMed2001

[Laser assisted uvulopalatoplasty (LAUP) in the treatment of snoring and obstructive sleep apnea syndrome].

Laser Assisted Uvulopalatoplasty (LAUP) the surgical technique for the treatment of snoring and obstructive sleep apnea syndrome was first performed by Kamami in 1988. LAUP can reduce the airway obstruction in the oropharynx level. LAUP is the simple, reliable surgical procedure performed in an office setting under the local anesthesia, without hospitalization. From 1998 to 2000 37 patients underwent LAUP in our ENT Department in Zabrze. This group comprised of 19 OSA patients and 18 habitual snorers. In cases of nasal obstruction by turbinate hypertrophy or septal deviation we performed septoplasty or partial inferior turbinectomy by laser CO2. In some cases with palatin or lingual tonsils hypertrophy we also performed tonsillectomy or lingual tonsil laser ablation. In 5 patients LAUP was performed in several stages. Before and after the surgical treatment each patient were evaluated by PolyMESAM--the device belongs to the third diagnostic level. In all postoperative evaluated OSA patients the RDI decreased significantly. In 4 patients (50% of evaluated after LAUP patients) the RDI dropped to 10 or lower. Snoring was eliminated or significantly reduced in 83% of patients classified as the habitual snorers. No serious complications were observed. LAUP is a good alternative to UPPP in the surgical treatment of habitual snorers and some of the patients with OSA syndrome.

Adult↗
PubMed2002

Acoustic analysis of snoring: review of literature.

Acoustic analysis of snoring could make patient assessment more accurate, treatment planning more efficient and could provide objective documentation reliable for comparison. However, spectral characteristics are irregular and difficult to analyse. The authors give an overview of the available literature and the various applied methods. These methods differ in purpose and are subject to restrictions. Until now, acoustic analysis of snoring remains controversial. For linking the results of the acoustic analysis with anatomical levels or degree of obstruction, further study is needed to develop a reliable parameter.

Acoustics↗
PubMed2002

Flextube reflectometry for level diagnosis in patients with obstructive sleep apnoea and snoring.

The aim of this study was to use sound reflections in a flexible tube (flextube reflectometry) for identifying the predominant obstructive level of the upper airway in a series of patients referred to a sleep clinic. We also wished to study the relationship between the number of flextube narrowings per hour recording and the RDI (respiratory disturbance index = apnoeas and hypopneas per hour recording) by ResMed AutoSet (AS), which is a device based on nasal pressure variations. We performed sleep studies on 54 patients referred for snoring or OSA; 1) at home with AS; 2) in hospital using flextube reflectometry and AS simultaneously. The predominant obstructive level of the upper airway was retropalatal in 15 of the patients and retrolingual in 25 of the patients determined by flextube reflectometry. In 14 there was no predominant level of narrowing. We found a statistically significant correlation between the number of flextube narrowings per hour recording and the RDIs by the AS (Spearman's correlation coefficient r = 0.62, p < 0.001, n = 54). Flextube reflectometry may provide useful information regarding the level of obstructive predominance during obstructive events. The method also determines the frequency of respiratory disturbances and records snoring sound.

Adult↗
PubMed2002

[Objective assessment and therapeutic efficacy of an improved mandibular advancement device for snoring and sleep apnea syndromes with polysomnography].

In the treatment of snoring (SN) and sleep-related breathing disorders (SRBD), mandibular advancement devices (MAD) are of increasing importance. Their mode of action is based on the advancement of the mandible, thereby increasing various upper airway dimensions and thus airway patency and airflow during sleep. The aim of the present study was to investigate efficacy and tolerability of an individually fitted MAD on 11 patients (10 males, 1 female), mean age 57 years, using sleep laboratory methods in 3 subsequent nights (adaptation-, baseline-, treatment night). The MAD consists of 2 separate parts that attach to both dental arches. On occlusion the upper maxillary part with a protruding cone meets an inclined plane of the lower mandibulary part, thereby forcing the mandible to advance. 10 patients (6 with obstructive sleep apnea, 3 with obstructive hypopnea and 1 primary snorer) tolerated the MAD well; one patient (primary snorer) removed the MAD after 1 hour. Regarding the target variable, the snoring index (SI), confirmatory statistics demonstrated a significant improvement from 108 to 53/h sleep, though normalisation could not be achieved. Descriptive data analysis showed significant improvement of the apnea-hypopnea index (AHI) from 15 to 5.5/h and of the oxygen desaturation index (O2-DI) from 21 to 13/h sleep. Arousal variables and periodic leg movement index (PLMI) improved as well. Objective sleep efficiency and subjective sleep- and awakening quality remained unchanged. Thus, besides the good therapeutic efficacy (the medians of improvement of the SI, AI, AHI, O2-DI and PLMI were 37, 48, 53, 51 and 29%, respectively), acute acceptance of the MAD was also satisfactory. Last but not least our present study showed once more the necessity of an adaptation night, as from the first to the second sleep laboratory night respiratory indices deteriorated significantly.

Adult↗
PubMed2002

Dental devices; classification for intraoral devices for snoring and/or obstructive sleep apnea. Final rule.

The Food and Drug Administration (FDA) is classifying the intraoral devices for snoring and/or obstructive sleep apnea into class II (special controls). These devices are used to control or treat simple snoring and/or obstructive sleep apnea. This classification is based on the recommendations of the Dental Devices Panel (the Panel), and is being taken to establish sufficient regulatory controls that will provide reasonable assurance of the safety and effectiveness of these devices. This action is being taken under the Federal Food, Drug, and Cosmetic Act (the act), as amended by the Medical Device Amendments of 1976 (the 1976 amendments), the Safe Medical Devices Act of 1990 (the SMDA), and the Food and Drug Administration Modernization Act of 1997 (FDAMA). Elsewhere in this issue of the Federal Register, FDA is publishing a notice of availability of the guidance document that will serve as the special control for this final rule.

Dental Devices, Home Care↗
PubMed1992

[Pharyngeal video-fibroscopy: value in the management of apneic snoring].

The pharyngeal video fibroscopy (P.V.F.) should complete the classical diagnostical management of each snoring associated with obstructive sleep apnea. Easily made on a seated awake patient the P.V.F. is the one dynamical pharyngeal procedure. It also let see the snoring and reproduce the upper airway obstruction. The Müller test seats the level of this obstruction, helps the surgeon in the choice of the procedure and should reduce the failure rate.

Adult↗
PubMed1992

Clinical evaluation of the nasal dilator Nozovent. The effect on snoring and dryness of the mouth.

When the lateral walls of the nostrils are dilated with Nozovent, inhalation requires less force, thus reducing the risk of vibrations of the soft palate creating the snoring sound. There is also less need for mouth-breathing. When 17 patients were tested during 10 nights, every second night using Nozovent, the sleeping partners noted significantly less snoring these nights than during the nights without Nozovent. The patients themselves also noted significantly less dryness of the mouth when they dilated the nostrils with Nozovent, being able to avoid mouth-breathing.

Adult↗
PubMed2003

A mandibular protruding device in obstructive sleep apnea and snoring.

UNLABELLED: The overall purpose behind treatment in sleep-breathing disorders is to ease breathing and thereby reduce the risk of morbidity. The mandibular protruding device (MPD) is one method of treating both obstructive sleep apnea (OSA) and snoring. The aims of the studies were to study MPD users after 2 years and evaluate the following aspects of the MPD: subjective and objective effects on sleep, influences on airway passages and hard tissues, and the incidence and types of adverse events of the masticatory system including temporomandibular disorders. Further aims were to evaluate the impact of body posture and the effects of the MPD on pharyngeal width and to validate two methods for measuring mandibular protrusion and MPD advancement. MATERIALS AND METHODS: Seventy-seven subjects with OSA or snorers without OSA. were admitted to the study after a medical examination, which included a somnographic registration. The patients completed questionnaires regarding sleep quality and symptoms from the masticatory system, and underwent a clinical jaw function examination, were given an MPD, and were subjected to lateral cephalometric examination. Two follow-ups, 6 months and 2 years after MPD treatment were conducted. The study population comprised 65 patients at the 2-year follow-up. RESULTS: At the 2-year follow-up, a significant reduction of the subjective complaints was noted by 90% of the MPD users. In the objective evaluation, the oxygen desaturation index (ODI) of the OSA group (n = 39) decreased significantly from a mean of 14.7 to 3.1 and the mean arterial oxygen saturation (SaO2) increased significantly from 78% to 89%. The snorers maintained their initial values. In the total group, MPD treatment significantly increased most pharyngeal measures and lifted the hyoid bone. The pharyngeal area decreased significantly--by more than 50%--when the patient was supine, and the velum area increased significantly. At the 2-year follow-up, on upright cephalogram without MPD, the pharyngeal area had significantly increased and the velum area had significantly decreased. The mandible was posteriorly rotated (P < 0.01) as well as the lower incisors were proclined (P < 0.05). Mandibular advancement and vertical opening with an MPD, as measured with a ruler, compared well with measurements taken from a cephalogram. At the 2-year follow-up significant changes in the mean mandibular range of protrusion (+0.6 mm), overjet (-0.5 mm), and overbite (-0.8 mm) were registered. Nine of the 65 patients had developed a lateral open bite, and 2 were aware of the change. The reported frequency of headache was significantly reduced. At the 2-year follow-up there was a significant reduction in pain during mandibular movements. CONCLUSIONS: MPD treatment significantly reduced subjective complaints of sleep disturbances and significantly reduced ODI values among OSA patients. A high MPD compliance rate after 2 years (84%) indicated a well-tolerated treatment and a low rate of side effects were noted. The key factor in OSA and snoring is the obstruction of pharynx. The MPD treatment significantly increased the pharyngeal passages and significantly reduced the size of velum and thereby facilitated the breathing.

Adult↗
PubMedDate not supplied

Obstructive sleep apnea, nasal congestion, and snoring: their systemic effects and impact on quality of life.

A literature review was conducted to evaluate the available published data on sleep-related breathing disorders with a focus on obstructive sleep apnea (OSA) syndrome, nasal congestion, and snoring. The MEDLINE database was used to obtain pertinent reviews and articles. The pathophysiology of snoring, a partial blockage of the airway, and of apnea or total airway obstruction, is described. Contributing factors to the etiology of the OSA syndrome as well as current methods of diagnosis are discussed. Adverse systemic sequelae of the OSA syndrome, especially those pertaining to the cardiovascular and respiratory systems, are detailed. Treatment options, both nonsurgical and surgical, which are used to improve the quality of life of patients with these disorders, are presented also.

Disease Management↗
PubMed2004

A simple appliance for the management of obstructive sleep apnoea--the MEDUNSA Anti-Snoring Device (MASD).

Obstructive sleep apnoea (OSA) is a breathing abnormality that occurs during sleep. It is characterised by snoring and episodes of sleep disturbance that can occur from 10 to 500 times per night causing excessive daytime exhaustion. A large tongue and a retrognathic mandible have been listed as aetiological factors. Orthodontic appliances that have been used to manage the condition are usually complicated, uncomfortable, expensive and delicate. The aim of this clinical procedure is to design a simple, inexpensive, durable and user-friendly appliance that can be used in the management of OSA. The procedure involves taking upper and lower impressions of a patient with OSA and articulating the study casts in a registered protrusive bite. Gum guards of the dental arches are then constructed and fused together in the protrusive position with a 5 to 10 mm open bite. The forward and downward advancement of the mandible caused by the appliance drags the tongue and other structures along, and thus opens the posterior pharyngeal airway during sleep. For ease of reference this appliance has been named the MEDUNSA Anti-Snoring Device (MASD) and it differs from similar appliances in that it is entirely toothborne and does not impinge on the surrounding soft tissues. The MASD was used in a patient with OSA at the MEDUNSA Oral Health Centre. Pre-treatment and post treatment airway dimensions from the lateral cephalograms confirm an increase of 50 per cent in airway size at the level of the epiglottis with a corresponding reduction in clinical symptoms. The MASD is an extremely valuable tool to dentists, orthodontists, as well as any other health professionals managing sleep-breathing abnormalities. While the MASD has been successful in this preliminary case, clinical trials are under way to further evaluate the MASD.

Adult↗
PubMed2004

Magnetic resonance imaging in simple snoring and obstructive sleep apnea-hypopnea syndrome.

PURPOSE: Obstructive Sleep Apnea-Hypopnea Syndrome (OSAHS) is a condition characterised by periodic cessation of breathing during sleep, associated with Upper Air-Digestive Ways (UADW) morphologic abnormalities that can be detected, in awake patients, by using various imaging techniques. The purpose of this study is to determine the usefulness of MR imaging and new original morphometrical measurements that we are proposing in patients with Sleep Obstructive Breathing Disordered (SOBD). MATERIALS AND METHODS: We studied 70 patients (52 with OSAHS and 18 snoring without OSAHS) using 1.5T and 0.5T MR imagers with neck and head coils and T1-DP-T2-weighted SE sequences. During the procedure, the patients were awake and with tidal breathing. We also evaluated sagittal pharyngeal diameters at different levels; the length and maximum width of soft palate; the distance between the hyoid bone and the C2C3-Me line (ideally joining the geometrical centre of the C2-C3 intervertebral space to the lower point of mandibular symphysis) measured on the perpendicular; the angle resulting from the longitudinal axis of the cervical spine and the epiglottis axis (alpha); the slope angle of the tongue -- resulting from the longitudinal axis of the cervical spine and the longitudinal axis of the tongue (beta). We used sagittal, coronal and axial sections of the head and neck. RESULTS: In OSAHS patients, pharynx calibre medium sizes were reduced compared with simple snoring patients. Only in OSAHS patients (not in simple snorers without OSAHS) we observed: 16 patients with narrowing sites = or <3 mm. On axial images we observed three different narrowing patterns: rounded, with greater anterior-posterior axis; with greater axis in lateral direction. In OSAHS patients we also observed, on average, increase of the distance between the hyoid bone (Hmr point) and the line C2C3-Me; increase in the angle resulting between cervical rachis and epiglottis (alpha); reduction of sloping angle of the tongue (beta). CONCLUSIONS: MR imaging, together with the morphometrical measurements we are proposing, is useful to evaluate UADW in SOBD. In particular, we noted that increase of the distance between the hyoid bone (Hmr point) and the line C2C3-Me (due to lowering of the hyoid bone), increase in the angle resulting between the cervical rachis and the epiglottis (alpha) and the reduction of the sloping angle of the tongue (beta), are highly specific and sensitive indexes in OSAHS. There are different levels and findings of narrowing in OSAHS and their identification is very important for a surgical approach: the uvulo-palato-pharyngoplasty (UPPP) has a higher success rate in patients with obstruction at retro-palatopharynx site, but it is associated with no (or poor) results in hypopharyngeal obstruction.

Cephalometry↗
PubMedDate not supplied

Laser-assisted uvulopalatoplasty for the treatment of snoring.

Snoring is seldom discussed outside of the household. Unfortunately, snoring can be a sign of a life-threatening disease called obstructive sleep apnea, or, OSA. This article helps dentists detect OSA early by paying attention to subtle findings during routine oral exams, asking pertinent questions and, finally, making a referral to specialists who are trained and experienced in treating these cases. The article also delineates a range of treatment modalities, including laser-assisted uvulopalatoplasty and its modification.

Airway Obstruction↗
PubMed2005

[Histopathologic changes of the soft palate in snoring and obstructive sleep apnea syndrome patients].

Histology of the soft palate and uvula in snorers and patients with OSA syndrome has been a subject of investigation of many authors. In majority of specimens the hypertrophy of the salivary glands as well as congestion and dilation of the thin-walled vessels were observed. Some of the samples presented atrophy of the muscle bundles. Also, the inflammatory changes as lymphocytic infiltrations were proven. In each case adults served as a control group. In this study the histologic analysis of the soft palate and uvula samples from patients suffering from snoring and OSA syndrome was performed. The uvula samples from the newborn who died on the first day of their lives were chosen as a control group. The choice of such a group excluded the influence of vibration force on the soft palate structure. Comparisons among the groups were made by Fisher exact two-tailed test. The muscular atrophy was observed only in patients with airway disturbances. No case of neonatal tissue sample with this pathology was found. Less dilation and congestion of the blood vessels were observed in the newborn group. Significantly more frequent superficial salivary glands localized between the muscle bundles and epithelium were found in the OSA and snoring patients. Our results showed distinct differences between the tissues of the patients with airway disturbances and the control group. These differences may be caused by the influence of the vibration on the soft palate and uvula, but on the other hand they may be the reason for excessive flaccidity of these structures and disturbances occurring during sleep.

Adult↗
PubMed2006

[Treatment of snoring by a Herbst-activator. Satisfaction of patient and bedfellow].

Snoring is primarily a social problem which for instance brings considerable pressure on someone's conjugal relationship. Often treatment is demanded by the bedfellow. Patient as well as bedfellow needs to be involved in the treatment of the problem. In this study, twenty-three habitual snorers and their bedfellows completed a questionnaire concerning the effect of the treatment of snoring by a Herbst-activator before treatment and 3 and 6 months after treatment. Two-thirds of the patients and bedfellows were satisfied with the therapy results. The bedfellows exhibited an even more positive therapy effect than the patients.

Adult↗
PubMedDate not supplied

Snoring and its management.

There are numerous strategies, devices and procedures available to treat snoring. The surgical procedures have an overall success rate of 60-70%, but this probably decreases over time, especially if there is weight gain. There are no long-term rigorously-designed studies comparing the various procedures for decreasing snoring.

Humans↗
PubMed1991

[Experience with surgical therapy in snoring and sleep apnea].

Knowledge of the connection between habitual snoring diseases and obstructive sleep apnoea has stimulated research into sleep disturbance in patients at high risk of cardiovascular disease. Any disturbance of nasal ventilation leads to a higher resistance to breathing and may cause cardiovascular complications in the long run. Anatomical and functional conditions that lead to intermittent incomplete blockage or complete occlusion of the upper respiratory tract must be detected and surgically eliminated, if possible. Surgical procedures for treating snoring and obstructive sleep apnoea may be successful and fill the gap between conservative treatment and continuous nasal positive airway pressure therapy. Our experience in 24 patients in presented.

Adult↗