Abstract
Snoring sounds generated by different vibrators of the upper airway may be useful indicators of obstruction sites in patients with obstructive sleep apnea hypopnea syndrome (OSAHS). This study aimed to investigate associations between snoring sounds, obstruction sites, and surgical responses (≥50% reduction in the apnea-hypopnea index [AHI] and <10 events/hour) in patients with OSAHS. This prospective cohort study recruited 36 OSAHS patients for 6-hour snoring sound recordings during in-lab full-night polysomnography, drug-induced sleep endoscopy (DISE), and relocation pharyngoplasty. All patients received follow-up polysomnography after 6 months. Fifteen (42%) patients with at least two complete obstruction sites defined by DISE were significantly, positively associated with maximal snoring sound intensity (40–300 Hz; odds ratio [OR], 1.25, 95% confidence interval [CI] 1.05–1.49) and body mass index (OR, 1.48, 95% CI 1.02–2.15) after logistic regression analysis. Tonsil obstruction was significantly, inversely correlated with mean snoring sound intensity (301–850 Hz; OR, 0.84, 95% CI 0.74–0.96). Moreover, baseline tonsil obstruction detected by either DISE or mean snoring sound intensity (301–850 Hz), and AHI could significantly predict the surgical response. Our findings suggest that snoring sound detection may be helpful in determining obstruction sites and predict surgical responses.
Highlights
Identification of the site of upper airway obstruction in obstructive sleep apnea hypopnea syndrome (OSAHS) may be beneficial when deciding on other treatment than continuous positive airway pressure (CPAP) therapy
Patients with a lower apnea-hypopnea index (AHI) and lower B2-Imean or partial-to-complete tonsil obstruction had a better chance of a good surgical response
B2-Imean was an inverse predictor of tonsil obstruction, meaning that tonsil obstruction defined by snoring sound analysis or drug-induced sleep endoscopy (DISE) rather than by conventional Friedman’s anatomic system was a key factor for a surgical response with relocation pharyngoplasty (RP)
Summary
Identification of the site of upper airway obstruction in OSAHS may be beneficial when deciding on other treatment than continuous positive airway pressure (CPAP) therapy. Several clinical tools have been developed to assess upper airway obstructions such as the Friedman stage system (oropharyngeal anatomic classification), nasopharyngoscopy with the Müller manoeuvre, upper airway pressure measurement, magnetic resonance imaging (MRI), and drug-induced sleep endoscopy (DISE). We hypothesized that complex snoring sounds are related to multi-level obstruction. The aims of this prospective study were to [1] examine associations between acoustic parameters of whole night snoring sounds during natural sleep and obstruction sites (multi-level and other levels) defined by DISE, and [2] verify the effects of these variables on surgical responses in patients with OSAHS
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