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PubMed2005

Prevalence of obstructive sleep apnea syndrome and associated symptoms in 3--11-year-old Turkish children.

Our objective was to investigate the prevalence of sleep-disordered breathing (SDB) and obstructive sleep apnea syndrome (OSAS) in 3-11-year-old Turkish children. A cross-sectional study was conducted in Zonguldak, northwestern Turkey. Symptomatic children were identified by using a self-administered questionnaire and were classified into three groups: nonsnorers, occasional snorers, and habitual snorers. All habitual snoring children were invited to undergo polysomnography (PSG). Nine hundred fifty-four children (79.5%) were nonsnorers, 205 (17.2%) were occasional snorers, and 39 (3.3%) were habitual snorers. There was no significant relationship between gender and habitual snoring (male, 3.4%; female, 3.1%; P > 0.05; odds ratio (OR), 1.13; 95% confidence interval (CI), 0.59-2.14). There was a statistically significant relationship between habitual snoring and allergic rhinitis (OR, 4.23; 95% CI, 2.14-8.35). Four children who snored every night, and who had apnea spells and/or troubled sleep, underwent adenoidectomy and/or tonsillectomy before polysomnographic evaluation because of clinical detoriation. Twenty-eight of 39 children with habitual snoring participated in PSG evaluation. PSG revealed that 11 children (0.9% of the total population) had OSAS. When 4 operated children were added to these 28 children, we found the minimum prevalence of OSAS to be 1.3% in our study group. There was a significant correlation between OSAS and troubled sleeping (P <0.001; OR, 4.37; 95% CI, 1.33-14.3). We found the prevalence of habitual snoring to be 3.3% in Turkish children by using self-administered questionnaires. Allergic rhinitis was significantly correlated with habitual snoring. Minimum estimated prevalence of OSAS was found to be 1.3%.

Age Distribution↗
PubMed1997

Symptoms of sleep disorders, inattention, and hyperactivity in children.

Children with sleep disorders are often inattentive or hyperactive, and some carry a diagnosis of attention deficit/hyperactivity disorder (ADHD) until their sleep disorder is detected. However, the potential behavioral impact of undiagnosed sleep disorders is not known. We sought to determine whether children with higher levels of inattention and hyperactivity more frequently have symptoms of sleep-related breathing disorders (SRBDs) or periodic limb movement disorder (PLMD). We surveyed parents of 2-18-year-old patients at a child psychiatry clinic (n = 70) and a general pediatrics clinic (n = 73) to assess the children's behavior, snoring, complaints of restless legs at night, and daytime sleepiness. A validated pediatric sleep questionnaire provided the explanatory variables, and a scale for inattention and hyperactivity, derived from the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV), provided the dependent variable. Habitual snoring was more frequent (33%) among children who carried a diagnosis of ADHD than among the other children at the psychiatry or general pediatric clinics (11 and 9%, respectively, chi-square test, p = 0.01). Snoring scores, derived from six snoring- and SRBD-related question items, were associated with higher levels of inattention and hyperactivity. The complaint of restless legs and a composite score for daytime sleepiness showed some evidence, though less consistent, of an association with inattention and hyperactivity. The association of snoring with inattention and hyperactivity suggests that SRBDs and perhaps other sleep disorders could be a cause of inattention and hyperactivity in some children. If a causal effect is present, our data suggest that 81% of habitually snoring children who have ADHD--25% of all children with ADHD--could have their ADHD eliminated if their habitual snoring and any associated SRBD were effectively treated.

Adolescent↗
PubMed2006

Randomized-controlled study comparing post-operative pain between coblation palatoplasty and laser palatoplasty.

OBJECTIVES: This study aimed to evaluate differences in post-operative pain comparing KTP laser-assisted uvulopalatoplasty without tonsillectomy (LAUP) with a new described surgical method: coblation uvulopalatoplasty with tonsillectomy (CP). We also evaluate the impact of each surgical technique in reduction of snoring loudness. MATERIAL AND METHODS: Single blind randomized-controlled trial. From a population of 41 consecutive patients on the waiting list for uvulopalatoplasty for simple snoring, the study group was reduced to 17 CP and 13 LAUP. Post-operative pain and reduction of snoring loudness were recorded using visual analogue scales (VAS) during the first 15 post-operative days. Post-operative snoring loudness was documented for 1-year period. RESULTS: Both groups had similar post-operative pain during the first seven post-operative days. A statistically significant reduction in post-operative pain was observed in the CP group after day 8, and maintained until the end of the study. Reduction of snoring loudness was significant in both groups, but no differences were observed between them. DISCUSSION: Coblation uvulopalatoplasty compared with LAUP demonstrates a reduction in post-operative pain, significant after the first post-operative week. The collateral thermal injury caused by laser is responsible for the slow-healing rate and maintained post-operative pain. Coblation dissociates tissue at lower temperatures with minimal collateral thermal injury and consequently faster and less painful recovery. Both surgical procedures have significant and similar reduction in snoring loudness. CONCLUSIONS: Both methods are adequate treatment options for snoring. The less painful recovery in CP promotes this surgical technique as our preferred choice for palate surgery.

Adult↗
PubMed1996

Excessive daytime sleepiness at work and subjective work performance in the general population and among heavy snorers and patients with obstructive sleep apnea.

STUDY OBJECTIVE: To evaluate excessive daytime sleepiness (EDS) at work and effects on reported work performance among men in the general population and male patients suffering from snoring and obstructive sleep apnea syndrome (OSAS). DESIGN AND PARTICIPANTS: A cross-sectional study of Swedish men between the ages of 30 and 64 years in the county of Kopparberg, in mid-Sweden. A random sample of the general population (n = 285) and consecutive patients referred to a sleep laboratory who fulfilled objective diagnostic criteria (snorers = 289, OSAS = 62) responded to a questionnaire. Responders from the general population were divided into 2 groups, nonsnorers (n = 223) and snorers (n = 62). To validate a question on snoring in the questionnaire, 50 men, randomly selected from the sample of the general population, underwent sleep apnea screening in their homes. RESULTS: The specificity of the questions about snoring was 83% and the sensitivity was 42%. The risk ratios for reporting EDS at work were 4-fold for snorers in the general population, 20-fold for snoring patients, and 40-fold for patients with OSAS as compared with nonsnoring men in the general population. Patients with OSAS and snoring patients both showed increased ratios on measures of difficulties with concentration, learning new tasks, and performing monotonous tasks when compared with nonsnorers. CONCLUSION: Snoring and sleep apnea were highly associated with excessive EDS at work and subjective work performance problems. The results provide additional evidence that snoring is not merely a nuisance.

Adult↗
PubMed2002

Inattention, hyperactivity, and symptoms of sleep-disordered breathing.

OBJECTIVE: Inattention and hyperactivity are frequent among children with sleep-disordered breathing (SDB) and often improve when SDB is treated. However, the frequency of SDB symptoms among inattentive and hyperactive children has received little study. DESIGN: Cross-sectional survey. SETTING: Two university-affiliated but community-based general pediatrics clinics. PATIENTS: Patients consisted of N = 866 children (469 boys), aged 2.0 to 13.9 years (mean: 6.8 plus minus 3.2 years), with clinic appointments. MEASURES: A validated Pediatric Sleep Questionnaire assessed for habitual snoring (1 item), snoring severity (a 4-item subscale), sleepiness (4 items), and overall risk of SDB (16 items). Parents also completed 2 common behavioral measures, an inattention/hyperactivity scale (IHS) derived from the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, and the hyperactivity index (HI, expressed as a t score) of the Conners' Parent Rating Scale. RESULTS: Habitual snoring was reported in 16% (95% confidence interval [CI]: 13, 19) of the participants. High HI scores (>60) were found in 13% (95% CI: 11, 16) of all participants, 22% (95% CI: 15, 29) of habitual snorers, and 12% (95% CI: 9, 14) of nonsnorers. Odds ratios between HI >60 and each of the following were: habitual snoring, 2.2 (95% CI: 1.4, 3.6); 1 additional positive symptom-item on the snoring scale, 1.3 (95% CI: 1.1, 1.5); 1 additional positive item on the sleepiness scale, 1.6 (95% CI: 1.4, 2.0); and a 1-standard deviation increase in the overall SDB score, 1.7 (95% CI: 1.4, 2.0; all odds ratios age- and sex-adjusted). Results were similar for high IHS scores (>1.25). Stratification by age and sex showed that most of the association with snoring (but not sleepiness) derived from boys <8 years old. CONCLUSIONS: Inattention and hyperactivity among general pediatric patients are associated with increased daytime sleepiness and---especially in young boys---snoring and other symptoms of SDB. If sleepiness and SDB do influence daytime behavior, the current results suggest a major public health impact.

Adolescent↗
PubMed2002

Technical report: diagnosis and management of childhood obstructive sleep apnea syndrome.

OBJECTIVE: This technical report describes the procedures involved in developing the recommendations of the Subcommittee on Obstructive Sleep Apnea Syndrome in children. The group of primary interest for this report was otherwise healthy children older than 1 year who might have adenotonsillar hypertrophy or obesity as underlying risk factors of obstructive sleep apnea syndrome (OSAS). The goals of the committee were to enhance the primary care clinician's ability to recognize OSAS, identify the most appropriate procedure for diagnosis of OSAS, identify risks associated with pediatric OSAS, and evaluate management options for OSAS. METHODS: A literature search was initially conducted for the years 1966-1999 and then updated to include 2000. The search was limited to English language literature concerning children older than 2 and younger than 18 years. Titles and abstracts were reviewed for relevance, and committee members reviewed in detail any possibly appropriate articles to determine eligibility for inclusion. Additional articles were obtained by a review of literature and committee members' files. Committee members compiled evidence tables and met to review and discuss the literature that was collected. RESULTS: A total of 2115 titles were reviewed, of which 113 provided relevant original data for analysis. These articles were mainly case series and cross-sectional studies; overall, very few methodologically strong cohort studies or randomized, controlled trials concerning OSAS have been published. In addition, a minority of studies satisfactorily differentiated primary snoring from true OSAS. Reports of the prevalence of habitual snoring in children ranged from 3.2% to 12.1%, and estimates of OSAS ranged from 0.7% to 10.3%; these studies were too heterogeneous for data pooling. Children with sleep-disordered breathing are at increased risk for hyperactivity and learning problems. The combined odds ratio for neurobehavioral abnormalities in snoring children compared with controls is 2.93 (95% confidence interval: 2.23-3.83). A number of case series have documented decreased somatic growth in children with OSAS; right ventricular dysfunction and systemic hypertension also have been reported in children with OSAS. However, the risk growth and cardiovascular problems cannot be quantified from the published literature. Overnight polysomnography (PSG) is recognized as the gold standard for diagnosis of OSAS, and there are currently no satisfactory alternatives. The diagnostic accuracy of symptom questionnaires and other purely clinical approaches is low. Pulse oximetry appears to be specific but insensitive. Other methods, including audiotaping or videotaping and nap or home overnight PSG, remain investigational. Adenotonsillectomy is curative in 75% to 100% of children with OSAS, including those who are obese. Up to 27% of children undergoing adenotonsillectomy for OSAS have postoperative respiratory complications, but estimates are varied. Risk factors for persistent OSAS after adenotonsillectomy include continued snoring and a high apnea-hypopnea index on the preoperative PSG. CONCLUSIONS: OSAS is common in children and is associated with significant sequelae. Overnight PSG is currently the only reliable diagnostic modality that can differentiate OSAS from primary snoring. However, the PSG criteria for OSAS have not been definitively validated, and it is not clear that primary snoring without PSG-defined OSAS is benign. Adenotonsillectomy is the first-line treatment for OSAS but requires careful postoperative monitoring because of the high risk of respiratory complications. Adenotonsillectomy is usually curative, but children with persistent snoring (and perhaps with severely abnormal preoperative PSG results) should have PSG repeated postoperatively.

Adenoidectomy↗
PubMed1996

Patient evaluation of laser-assisted uvulopalatoplasty.

OBJECTIVE: Most papers on LAUP lack patient evaluation of success rate with any statistical significance. We describe a method that we use to measure the improvement in snoring as well as changes related to quality of life. METHODS: We use a specially designed questionnaire, answered by the patient immediately prior to and immediately after treatment, and 1 week, 1 month, and 6 months postoperatively. Thirty-five patients were included in the study. RESULTS: Significant improvements were observed in a decrease in frequency of sleeping in a separate room due to snoring, a decrease in frequency of awaking during the night due to snoring, and a decrease in loudness of snoring. The anticipated decrease in preoperative snoring and the actual decrease in snoring postoperatively was also realized. CONCLUSION: The questionnaire is discussed as an instrument in patient evaluation of LAUP, treatment in which success may not necessarily be judged as 100% reduction in snoring.

Humans↗
PubMed2003

Symptoms of sleep breathing disorders in children are underreported by parents at general practice visits.

Sleep breathing disorders (SBD) in children are reportedly underdiagnosed in general practice. A contributory factor may be parental underreporting of symptoms. This possibility was examined by comparing the frequency with which snoring was mentioned at general practitioner visits by parents with frequency that snoring was reported on questionnaire evaluation immediately prior to consultation. We also examined the effects of age and gender on SBD symptoms. Parents of 626 children aged 0 to 16 years attending their general practitioner for sick child visits completed selected items from the Sleep Disturbance Scale for Children and the Obstructive Sleep Apnea Syndrome Expanded Childhood Questionnaire. Parents and general practitioners were also asked if snoring was discussed at the current consultation visit or at a prior consultation visit in the previous 12 months. Eighteen percent (112 of 626) of children were frequent snorers (more than three times per week), whereas 0.6 to 5.0% of children snored and had one or more additional SBD symptom suggestive of obstructive sleep apnea. SBD symptoms tended to peak in early to middle childhood with few gender differences. We found that snoring was patently underreported by parents. In the children with a history of frequent snoring on questionnaire evaluation and where the reason for the consultation visit was documented, snoring was mentioned by parents at the current consultation visit in only 8% (8 of 100) of cases and at a prior consultation visit in only 15% (15 of 100) of cases. The present findings support a need for increased parental education regarding the symptoms and clinical significance of SBD.

Adolescent↗
PubMed2005

The relationship of glucose tolerance to sleep disorders and daytime sleepiness.

The purpose of the study was to find out if snoring, sleep apnea and daytime sleepiness are independent indices of obesity related to type two diabetes (T2D), and whether depression is independently associated with features of sleep apnea. A population-based cohort study was conducted among 593 subjects (245 men and 348 women) born in 1935 and living in Oulu in 1996-1998. Glucose status was determined with a standard 2h oral glucose tolerance test, and sleeping disorders were recorded on the Epworth sleepiness scale (ESS) and in a questionnaire of five questions about sleeping and snoring. Depression was measured by the Zung self-rated depression scale. Insulin sensitivity was measured by quantitative insulin sensitivity check index. Habitual snoring was more common in diabetic subjects than in subjects with impaired glucose regulation (IGR) or normal glucose tolerance (NGT). All sleep disorders associated with neck circumference, waist circumference and body mass index (BMI). There was also a relationship between impaired insulin sensitivity and habitual snoring in bivariate analysis. In multiple logistic regression analysis, depression associated independently with daytime sleepiness (OR 3.00, 95% CI 1.40-6.46). Type 2 diabetes (T2D) (OR 1.93, 95% CI 1.04-3.57) and smoking (OR 1.69, 95% CI 1.00-2.84) associated independently with habitual snoring. BMI (OR 1.20, 95% CI 1.09-1.34) and male gender (OR 2.61, 95% CI 1.05-6.72) associated independently with sleep apnea. In a multiple regression model, BMI, neck circumference and habitual snoring associated independently with T2D. Habitual snoring was associated with T2D and impaired insulin sensitivity. Daytime sleepiness seemed to be linked with depression but not with using sleep medication, IGR and T2D.

Arousal↗
PubMed1992

Epidemiology of obstructive sleep apnea syndrome.

Obstructive sleep apnea syndrome (OSAS) is the most common organic disorder of excessive daytime somnolence. In cross-sectional studies the minimum prevalence of OSAS among adult men is about one per cent. Prevalence is highest among men aged 40-65 years. The highest figures for this age group indicate that their prevalence of clinically significant OSAS may be 8.5% or higher. Habitual snoring is the most common symptom of OSAS (70-95%). The most significant risk factor for OSAS is obesity, especially upper body obesity. Other risk factors for snoring, and for OSAS, are male gender, age between 40 and 65 years, cigarette smoking, use of alcohol, and poor physical fitness. Upper airway obstruction with snoring or sleep apnea are commonly seen in children of all ages. Snoring is very common among infants and children with Pierre Robin syndrome and among infants with nasal obstruction. Snoring and obstructive sleep apnea are also very common in men with acromegaly. Many other syndromes or diseases exist in which the upper airway is narrowed. Prevalence of snoring and sleep apnea is increased in all such situations. It has been suggested that sleep apnea may be one mechanism contributing to sleep-related mortality. The prevalence of every night snoring seems to decrease after the age of 65. However, more than 25% of persons over 65 have more than five apneas per hour of sleep. It remains to be seen whether this finding has clinical significance. Partial upper airway obstruction, even without apneas, may influence pulmonary arterial pressure and may cause daytime sleepiness and some health consequences.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1996

Breathing disorders during sleep and cognitive performance in an older community sample: the EVA Study.

OBJECTIVES: To determine whether poor cognitive performance was associated with symptoms related to the sleep apnea syndrome, snoring, and breathing stoppage during sleep. DESIGN: Cross-sectional analysis of data collected at baseline in the EVA Study, a 4-year cohort study. SETTING: The city of Nantes in western France. SAMPLE: A total of 1389 persons, aged 60 to 70 years, recruited from the electoral rolls of the city of Nantes. MEASUREMENTS: Demographic characteristics and data on drug use and tobacco and alcohol consumption were collected using a standardized questionnaire. Weight and height were measured. Individuals completed a previously validated sleep questionnaire about nocturnal sleep characteristics, snoring, breathing stoppage during sleep, and day-time sleepiness. Trained psychologists administered eight neuropsychological tests: The Mini-Mental State Examination, Trail Making Test, Digit Symbol Substitution Test of the WAIS-Revised, Benton Visual Retention Test, Paced Auditory Serial-Addition Task, Auditory Verbal Learning Test, Raven Progressive Matrices, and Word Fluency Test. Depressive symptomatology was assessed by the Center for Epidemiologic Studies-Depression scale. MAIN RESULTS: In this older sample, 49.5% of subjects reported snoring, and 10.8% reported breathing stoppage during sleep. Both respiratory disorders were associated significantly with male gender and high body mass index. In men, prevalence of snoring was increased significantly in those with alcohol consumption greater than 40 mL per day. Breathing stoppage during sleep was associated with depressive symptoms in women. Logistic regression models adjusted for age, gender, educational level, tobacco status and alcohol consumption, depressive symptomatology, and number of medications found that both snoring and breathing stoppage were associated with low scores (< or = 10th percentile) in tests requiring visual attention skills, the Trail Making Test (OR = 2.14, 95% CI = 1.24-3.69 and OR = 1.88, 95% CI = 1.04-3.39, respectively), and the Digit Symbol Substitution Test (OR = 1.80, 95% CI = 1.09-2.99 and OR = 1.58, 95% CI = .87-2.89, respectively). These relationships were significant only when either snoring or breathing stoppage was associated with daytime sleepiness. CONCLUSIONS: This cross-sectional analysis suggested that in community-dwelling individuals 60 to 70 years of age, snoring and breathing stoppage during sleep associated with daytime sleepiness were risk factors for low cognitive performance in tests requiring visual attention skills.

Age Factors↗
PubMed2006

Obstructive sleep apnoea in children with Down syndrome.

INTRODUCTION: Children with Down syndrome (DS) are prone to develop obstructive sleep apnoea (OSA) for a combination of reasons, including small upper airway, midfacial hypoplasia, micrognathia and muscular hypotonia. The objective of this study was to compare the prevalence of OSA in DS children, with or without snoring, with snoring children matched for gender, age and weight for height. METHODS: DS children were prospectively recruited from the Hong Kong Down Syndrome Association. All recruited DS children underwent a sleep polysomnography (PSG) in our sleep laboratory. The same number of patients without DS who underwent sleep PSG in the same period were enrolled as controls after they were matched for gender, age and weight for height. OSA was defined as apnoea-hypopnoea index (AHI) greater than 1.5. RESULTS: 22 DS patients and 22 snoring controls completed the overnight PSG. The mean age of DS children and snoring controls was 10.82 +/- 5.93 and 10.27 +/- 5.68 years, respectively. The prevalence of OSA was 59 percent in DS children and 32 percent in snoring controls. Median and interquartile range (IQR) of AHI of DS children (median 1.80, IQR is 0.40 to 7.10) were significantly higher than those of controls (median 0.50, IQR is 0.00 to 2.03, p-value equals 0.041). Out of 13 DS children with OSA, eight of them (61.5 percent) had no habitual snoring. CONCLUSION: 59 percent of DS children in the current series were found to have OSA and they were more likely to develop OSA than controls. Nearly 40 percent of DS children with OSA did not have habitual snoring.

Adolescent↗
PubMed1997

Efficacy of laser-assisted uvulopalatoplasty.

BACKGROUND AND OBJECTIVE: Laser-assisted uvulopalatoplasty (LAUP) is being used increasingly as a surgical treatment for snoring and obstructive sleep apnea (OSA). There is limited evidence for the success of LAUP in eliminating OSA. This study assesses the efficacy of LAUP in eliminating snoring and OSA and addresses which patients may be the best candidates for LAUP treatment. STUDY DESIGN/MATERIALS AND METHODS: From January 1994 to January 1996, 297 patients were evaluated for snoring, with 190 (64%) exhibiting some degree of OSA documented by a PSG: 41/ 190 (22%) mild OSA; 33/190 (17%) moderate OSA; 85/190 (45%) severe OSA; 31/190 (16%) severity unknown. Ninety patients (90/ 297) have undergone LAUP treatment: 58/90 (64%) with OSA and 32/90 (36%) with snoring only. RESULTS: Our results indicate a significant reduction of snoring in patients without OSA, but diminishing success in patients with increasing degrees of OSA. Additionally, LAUP was not efficacious in treating OSA: pre-op respiratory disturbance index (RDI) of 10.8 vs. post-op RDI of 19.5 for mild OSA (P = 0.14); pre-op RDI of 22.9 vs. post-op RDI of 25.4 for moderate OSA (P = 0.43); pre-op RDI of 56.8 vs. post-op RDI of 46.3 (P < 0.05), which is statistically but not clinically significant (i.e., RDI remained in the severe range). CONCLUSION: We conclude that LAUP is an effective treatment for nonapneic snoring, but does not provide sufficient resolution of OSA, and based on our results, LAUP should be considered as an adjunctive therapy rather than a sole treatment for OSA in most cases.

Adult↗
PubMed1995

Upper airway obstruction during midazolam sedation: modification by nasal CPAP.

We examined the depressant effect of midazolam on respiration in 21 healthy women undergoing lower abdominal surgery with spinal anaesthesia. Airway gas flow, airway pressure, and the sound of snoring were recorded together with arterial oxygen saturation (SpO2). After spinal anaesthesia was established, subjects were deeply sedated with pentazocine 15 mg followed by incremental doses of midazolam 1 mg i.v. up to 0.1 mg.kg-1. When SpO2 decreased to < 90% or snoring and/or apnoea was observed, continuous positive airway pressure applied through the nose (nasal CPAP) was increased until the respiratory deterioration was reversed. While one patient remained free of respiratory events, the other 20 patients were successfully treated with nasal CPAP restoring normal SpO2 (95.5 +/- 1.7%) without snoring. Stepwise reduction of nasal CPAP determined the minimally effective CPAP to prevent snoring to be 5.1 +/- 2.1 cm H2O. Further reduction of nasal CPAP induced snoring in 15 patients and obstructive apnoea in five patients with the latter accompanied by a severe reduction of SpO2 (87.4 +/- 6.1%). Patients with apnoea were older than those who snored (P < 0.05. We conclude that upper airway obstruction contributes considerably to decreases in SpO2 during midazolam sedation for spinal anaesthesia.

Abdomen↗
PubMed2004

Study of lubricant-induced changes in chronic snorers (SLICCS).

OBJECTIVE: The efficacy of many of the noninvasive treatments for snoring has not been evaluated in controlled trials. This paper seeks to evaluate the efficacy of an oil-based spray in the treatment of snoring, in a double-blinded, placebo-controlled, crossover trial using objective acoustic analysis and subjective questionnaires. STUDY DESIGN AND SETTING: Participants were randomized to use both oil-based oral spray (treatment) and water-based oral spray (placebo) during a two-night in-home study period. Questionnaires were completed by participant and bed-partner in addition to audio-tape recordings which were analyzed for frequency, duration, and mean energy of snoring. RESULTS: Greatest snoring rate demonstrated 30% = benefit; 40% = no change; 30% = adverse effect (n = 20). Percent time snoring yielded: 30% benefit; 15% no change; 55% adverse effect (n = 20). Study data results for mean energy were (n = 12): benefit = 17%, no change = 33%, adverse effect = 50%. Bed-partner observations (n = 17) demonstrated 37% = benefit; 38% = no change; 25% = adverse effect. CONCLUSION/SIGNIFICANCE: Objective and subjective evaluation of the performance of the oil-based Snoreless spray in comparison to placebo demonstrated a lack of efficacy in snoring reduction.

Acoustics↗
PubMed2005

The association of tongue scalloping with obstructive sleep apnea and related sleep pathology.

OBJECTIVE: The association between OSAS and patient history and physical exam findings is previously established; however, to our knowledge there are no studies that evaluate the role of tongue scalloping as a reliable clinical indicator for OSA, snoring, or the presence of other sleep pathology as evidenced by polysomnography. This study evaluates the hypothesis that such an association exists. SUBJECTS AND METHODS: Sixty-one otolaryngology clinic patients were evaluated by history and physical exam for the presence and degree of tongue scalloping, snoring, and other previously established clinical indicators for sleep-disordered breathing and obstructive apnea. Twenty-five of the 61 study patients were additionally evaluated by overnight polysomnography to provide conclusive diagnosis of sleep pathology. The degree of tongue scalloping was graded from 0 to 3 and its significance as a screening, diagnostic, and predictive factor for sleep pathology was then statistically determined. RESULTS: Twenty-seven patients (44%) had known or newly documented OSA and 47 (77%) had a history of snoring. Twenty-seven patients (44%) had some degree of tongue scalloping (1-3) and 74% of these patients were male. The presence of any degree of tongue scalloping (grade 1-3) in patients with known or newly documented OSA showed sensitivity, specificity, PPV, and NPV of 52%, 68%, 70%, and 50% respectively. The presence of tongue scalloping in patients with either known snoring history or newly documented snoring showed sensitivity, specificity, PPV, and NPV of 47%, 64%, 81%, and 26% respectively. Presence of tongue scalloping was 71% specific for abnormal sleep efficiency (<85%), 70% specific for abnormal AHI (>5), and 86% specific for nocturnal desaturation >4% below baseline. Presence of tongue scalloping also showed PPV of 67% for abnormal AHI, 89% for apnea or hypopnea, and 89% for nocturnal desaturation. Presence and severity of tongue scalloping showed positive correlation with increasing Mallampati and modified Mallampati airway classification. CONCLUSIONS: In high-risk patients we found tongue scalloping to be predictive of sleep pathology. Tongue scalloping was also associated with pathologic polysomnography data and abnormal Mallampati grades. We feel the finding of tongue scalloping is a useful clinical indicator of sleep pathology and that its presence should prompt the physician to inquire about snoring history.

Adult↗
PubMed2004

Computerized tomographic evaluation of effects of mandibular anterior repositioning on the upper airway: a pilot study.

STATEMENT OF PROBLEM: Snoring is related to narrowing of the upper airway. Treatment options for snoring may have potential side effects or discomfort which may not be tolerated by some patients. Mandibular advancement devices may cause fewer negative side effects than other treatment modalities and have been advocated as a treatment for snoring. PURPOSE: The aim of the pilot study was to evaluate effects of the anterior mandibular positioner (AMP) on upper airway structures in patients with a snoring problem. MATERIAL AND METHODS: Fifteen subjects with snoring problems as identified by spouses or close relatives were selected to complete a questionnaire related to snoring, respiratory symptoms, body mass index (BMI), and smoking habits. Computerized tomography (CT) scans were obtained with and without AMP device fabricated as a monoblock of acrylic resin. Measurements of the oropharynx including length (mm), cross-sectional area (mm2), and plane angle (degrees) were made using anatomic landmarks on standardized CT images and lateral scanograms. The data were statistically evaluated using Wilcoxon signed rank test (alpha=.05). RESULTS: When the AMP was inserted, the cross-sectional area of the oropharynx increased by 60 mm2 on average (P<.05). A mean increase of 2.4 mm (range 1-7 mm) was observed in the posterior airway space on lateral scanograms (P<.005). The range for mandibular advancement was between 4 and 8 mm (mean 5.73 mm). CONCLUSION: The primary effect of the AMP was enlargement of the oropharyngeal airway. Within the limitations of this pilot study, the results suggest that CT evaluation of the upper airway structures may be helpful in determining treatment modality and monitoring the effectiveness of the positioner.

Adult↗
PubMed2000

Airway disorders and pulmonary function in snorers. A population-based study.

The aim of our study was to determine the relationship between snoring, airway disorders and pulmonary function in the general population. We performed a stratified random sampling from the population (n = 92,364). Four hundred subjects agreed to participate and were invited to the clinic, where a detailed medical history, physical examination, spirometric test and maximal respiratory pressures measurements were carried out. Snoring was reported by 152 subjects (38%). Nasal obstruction and the presence of abnormal pharynx exploration were more frequent in subjects with snoring. Age, body mass index and neck circumference were significantly higher in the snorer group. In addition, we found that the non-snoring group had a significantly higher frequency of tonsillectomy during infancy and adolescence than the snorer group. We did not detect any significant difference in spirometric test values or in maximal respiratory pressure values between snorer group and non-snorer group. In conclusion, in the general population snoring is associated with nasal obstruction and abnormal pharynx exploration. Furthermore, snoring appears not to be associated with modifications in spirometric or in maximal respiratory pressure tests.

Adult↗