Cause Of Snoring Research Articles

Relationship Between Adenotonsillar Size and Snoring Sound: Acoustic Analysis

Background and Objectives The most common cause of snoring in children is enlarged tonsils and adenoids. However, there is insufficient evidence to determine whether the subjective measurement of tonsil hypertrophy, the most common prevailing method, reflects the actual tonsil size and volume. Therefore, we tried to determine whether the subjective grading of tonsil size and actual tonsil volume is related, and whether tonsil volume, weight, and adenoid index are correlated with the acoustic analysis of snoring.Subjects and Method The study was conducted on 21 children between the ages of 4 and 15 who came for tonsillectomy and adenoidectomy due to snoring symptoms. The degree of adenotonsillar hypertrophy was measured using the Brodsky grading scale and adenoid index. After tonsillectomy, the volume and weight of resected tonsil were measured. For acoustic analysis, the Praat software was used to determine formant frequency and sound intensity. A linear regression model and a dummy variable were used to determine the correlation between the quantitative values of tonsil, adenoid and the result of acoustic analysis.Results The Brodsky tonsil grade tended to match the actual tonsil volume, but it was not statistically significant (<i>p</i>=0.073). There was no correlation between snoring intensity and actual tonsil volume, weight, and adenoid index. Formant frequency 1 and 2 were statistically negatively correlated with the actual tonsil volume (<i>p</i>=0.011, 0.002).Conclusion The study confirmed that the acoustic analysis of pediatric snoring could be a screening test to predict tonsil volume and changes in the vocal tract due to tonsil hypertrophy.

Analysing the efficacy of polidocanol in injection snoreplasty

<p class="abstract"><strong>Background:</strong> Injection snoreplasty was recently introduced as a safe, effective, and minimally invasive treatment for primary snoring. The objective of the study was to assess the effectiveness of the treatment in our patients.</p><p class="abstract"><strong>Methods:</strong> The study was a prospective, non-randomised study done on 40 patients with primary snoring. Study was done in the Department of Otorhinolaryngology and Head and Neck Surgery at Basaveshwara Medical College and Hospital, Chitradurga over 8 months between March 2019 to October 2019. The data was collected from patients about their symptoms. Detailed clinical and radiological examination was done in all patients. Almost each and every causes of snoring were ruled out. 1-3% polidocanol injection of about 1 ml with insulin syringe was administered in all the patients in 1 to 3 sittings after 10% LOX spray application on the site. Patients were assessed after 1, 3 and 6 months and their improvement was noted. </p><p class="abstract"><strong>Results:</strong> There were 24 (60%) males and 16 (40%) females enrolled in our study with mean age as 42±5 years. The average BMI of patients was 27.14±3.1 kg/m<sup>2</sup>. All the patients except 4 were initially injected 1% polidocanol injection; the others were injected 3%. 4 (10%) patients were re-injected at 1 month and 4 (10%) had 2nd re-injection at 3 months follow up. The mean improvement in symptoms was 58%. Eleven patients (27.5%) had moderate snoring while the rest had severe snoring. The only side effect was pain which in majority of patients was mild. There was no correlation between BMI and percentage of improvement.</p><p class="abstract"><strong>Conclusions:</strong> Injection snoreplasty is a safe and cost-effective treatment for primary snoring.</p>

내시경적 아데노이드 등급과 소아 폐쇄성 수면무호흡증 중증도의 상관관계

Background and Objectives: Hypertrophy of adenoids was recognized as one of the main causes of snoring and obstructive sleep apnea (OSA) in pediatric patients. Recently, two endoscopic adenoid grading system was proposed, Parikh grade (P-G) and ACE grade (ACE-G). The aim of this study is to evaluate the correlation between obstructive sleep apnea severity and these two endoscopic adenoid grading systems. Materials and Methods: We retrospectively reviewed the medical records of 52 patients who underwent a polysomnography and endoscopic nasal endoscopy in the secondary referral hospital from 2008 to 2017. Adenoid exam was performed with nasal endoscopy after nasal packing soaked with lidocaine and xylometazoline in out-patient clinic. It was evaluated the correlation between each adenoid grading system and apnea-hypopnea index, adjusted by sex, age, tonsil grade, body mass index, and presence of allergic rhinitis. Results: Mean age was 7.6 year (range : 2-15, SD : 2.57) and 75% of the patient had obstructive sleep apnea (AHI≥1). P-G was statistically correlated with OSA severity. (OR=11.8, 95% CI : 1.5-92.2, p=0.02) Only subgrade E of ACE-G has meaningful correlation with OSA severity (OR=2.07, 95% CI : 0.91-4.81 p=0.03). Conclusion: P-G and subgrade E of ACE-G were statistically related to sleep apnea severity in pediatric patients. Endoscopic adenoid grading system can be useful tool to evaluate adenoid hypertrophy and upper airway in pediatric OSA patients. (J Clinical Otolaryngol 2019;30:204-208)

The clinical characteristics of patients with an isolate epiglottic collapse

ObjectiveWe analyzed the clinical characteristics of patients with isolated epiglottic collapse (IEC) who had an epiglottic anteroposterior (AP) collapse as the only cause of snoring during drug-induced sleep endoscopy (DISE). MethodsA retrospective analysis of 334 consecutive DISE examinations was performed. Patients who had only epiglottic AP collapse were designated as the IEC group. There were four age- and sex-matched controls for each case, and these patients were designated as the control group. Demographic factors, polysomnography findings, cephalometry, and awake nasopharyngoscopic findings were analyzed. ResultsA total of 11 IEC cases and 44 controls were included. The IEC group had a significantly lower apnea-hypopnea index, higher minimum oxygen saturation level, lower body mass index, and shorter mandible plane to hyoid distance than the controls. However, there were no differences in epiglottic shape or curvature between the two groups. In addition, no IEC was noted during awake endoscopy. Nine (81.8%) epiglottic collapses were resolved with the mouth open and jaw thrust maneuver, which simulated the use of an oral appliance. Six (54.4%) were resolved with head turning, mimicking the lateral sleep position. ConclusionThe clinical characteristics of IEC patients differed from the control group, and IEC could not be identified during awake endoscopy. Therefore, patients with severe snoring but AHI < 5 or mild sleep apnea on polysomnographic findings and DISE, should be considered likely to have IEC. In addition, use of an oral appliance is recommended as an effective treatment for IEC.

RATIONALE FOR USING ORAL APPLIACE TO TREAT SNORING AND OBSTRUCTIVE APNEA SYNDROME

Snoring and its common complication, obstructive apnoea syndrome, are among the urgent issues of current medicine and dentistry. The relevance of this problem is evidenced by its high prevalence worldwide. According to the latest research, obstructive sleep apnoea syndrome affects 10% of men aged 30-49 years and 17% of men aged 50-70 years, 3% of women aged 30-49 years and 9% of women aged 50-70 years. The snore detection rate in recent years has been progressively increasing. Snoring and obstructive apnoea syndrome are most often caused by the disorders of the dento-maxillary system including distal position of the mandible; maxilla narrowing, high-arched (or Gothic) palate, dysfunction of the temporomandibular joint; macroglossia. The likelihood of obstructive apnoea in patients with an acute angle of the mandibular plane and underdeveloped chin also increases. All of these causes narrow the airway lumen and reduce the dimensional characteristics of the oral cavity. Depending on the causes of snoring and obstructive apnoea syndrome, there are different methods for their treating. Intraoral appliances are becoming widely used in the world practice; and the protocols of treatment and prevention for snoring and obstructive apnoea in Western countries recommend using the appliances. In 2000, the American Academy of Sleep Medicine created a section of oral appliances used to treat snoring and obstructive apnoea syndrome. All of them have both advantages and disadvantages. The disadvantages due to using intra-oral devices for the treatment and prevention of snoring and obstructive apnoea include: TMJ pain, excessive salivation or vice versa, dry mouth, toothache and insomnia. Purpose of the study: to improve the oral appliance for the treatment of snoring and obstructive apnoea syndrome. Conclusions. We have proposed and developed an oral appliance for the prevention of snoring and apnoea, which function is based on fixing the physiological bite at rest.

Role of adenotonsillectomy in OSAS children and behavioural disturbance

AimThe main aim of this study was to assess the presence of behavioural disturbances in child with OSAS before and after adenotonsillectomy (AT). BackgroundIn children adenotonsillar hypertrophy is associated with increased probability of OSAS. Children with OSAS present neurobehavioral disorders like attention deficit and hyperactivity, learning disabilities and daily attitudes due to excessive sleepiness. Materials and methods195 consecutive young patients suffering from OSAS and recurrent throat infections (control group) underwent AT. All underwent clinical evaluation, polysomnography, Behaviour Assessment System for Children questionnaire (BASC-2), for parents evaluation of behavioural disturbances and nasal functionality tests (before and 6 months after surgery). ResultsSnoring and nocturnal apnoea were no more present in almost all. In OSAS group before AT 12 children were normal, 4 children were borderline and 2 were clinically significant at the BASC-2. After AT 16 children were normal, 2 children were borderline and none was clinically significant according to the same questionnaire. In the control group 9 children were normal and 1 was borderline both before and after AT. ConclusionAdenoids/tonsils hypertrophy and nasal hypoventilation are frequent causes of snoring and OSAS. AT improves significantly both snoring/apnoeas and OSAS children's behavioural disturbances. Polysomnography cannot be carried out routinely due to the lack of specialised centres and because of its excessive cost. Nasal functionality tests can be useful for the differential diagnosis between sleep apnoea syndrome and other noises.

Does ′weight reduction′ help all adult snorers?

Background:Obesity is now a global epidemic. Obese people are at higher risk of snoring. Weight reduction could influence the prevalence of snoring. Present study tried to find out, whether weight reduction is of benefit in all adult snorers.Materials and Methods:It is a cross sectional study, on 349 subjects (196 males and 153 females). They and their spouses were asked for snoring habits. Their neck circumference, height and weight was measured and Body mass index (BMI) was calculated, and they were classified into low normal, high normal, pre-obese and obese BMI groups. Prevalence rates of snoring in different groups were compared, to find out any statistically significant difference, between them.Results:Statistically significant difference, in prevalence rates of snoring was found, when obese and pre-obese group were compared with normal BMI group, separately. No significant difference was found in prevalence rates, when comparison was made between obese and pre-obese group. Difference in prevalence of snoring, was also not significant, when comparison was made between low normal and high normal BMI groups. Neck circumference of snorers was significantly more than the neck circumference of non-snorers in all BMI groups. Gender wise difference, in prevalence of snoring was also not significant.Conclusion:Body mass index target needs to be set at 25 kg/m2, in weight reduction programmes, to achieve clinically relevant response in a snorer. There is no need to put extra emphasis, on further reduction of BMI. Weight reduction, is not helpful in all adult snorers, especially those with normal BMI, where other causes of snoring, like fat around upper airways, need to be considered.

The Effect of Adenotonsillectomy in the Production of IGF‐1 (Insulin‐like Growth Factor‐1) in Children

Objective: Airway obstruction caused by adenotonsillar hypertrophy is the main cause of snoring and sleep apnea in children and often associated with several other signs and symptoms, including growth development. The objective of this study was to evaluate the effect of adenotonsillectomy in the production of IGF-1 (insulin-like growth factor-1) in children. Method: A total of 26 children of both sexes with adenotonsillar hypertrophy with formal indication for adenotonsillectomy (study group) and 21 control children (with indication for surgery for other reasons, eg, postectomy) were submitted to evaluation of peripheral blood IGF-1. The samples were taken immediately preoperatively and 30 days after surgery. Results: The preoperative levels of IGF-1 showed values within the normal range for age in both groups. Two children in the study group had values below normal for their age. The comparison of pre- and postoperative levels in children undergoing tonsillectomy showed a statistically significant increase ( P &lt; .01) by Student t test for paired samples. The 2 children with preoperative values below normal for age recovered normal levels of IGF-1 after surgery. Conclusion: The data from our study suggest that adenotonsillar hypertrophy, resulting in snoring and sleep apnea can affect negatively the production of circulating IGF-1, probably related to the disturbances of height and growth development, and demonstrate that adenotonsillectomy contributes to enhancing and restoring the values of IGF-1.

Single dose injection snoreplasty: investigation or treatment?

Many surgical and nonsurgical procedures have been designed for the treatment of snoring due to palatal flutter. All work in some, but not all, snorers. The difficulty lies in making the definitive diagnosis of palatal flutter as the cause of snoring, and in deciding which patients should undergo which treatment, which in some cases are relatively radical. This study aimed to assess the usefulness of injection snoreplasty in differentiating palatal flutter from other forms of snoring. This was done in the hope of determining which patients would benefit from definitive palatal surgery such as uvulopalatopharyngoplasty and laser-assisted uvuloplasty. Sixty consecutive patients referred for habitual snoring were treated with sodium tetradycil sulphate during their first consultation visit. No patients were excluded and none refused the treatment. Forty patients received a single 1 ml dose of 1 per cent sodium tetradycil sulphate, and twenty patients received a single 1 ml dose of 3 per cent sodium tetradycil sulphate under topical anaesthesia. Visual analogue snoring scales were completed by the patient and their partner six weeks, three months, six months and 12 months after the procedure. Forty of the 60 patients showed improvement in snoring and therefore were considered for definitive surgery. Four of the 60 patients found the investigation unpleasant and did not want any further treatment. Of the 40 patients who showed improvement, 29 maintained this at one year. The other 11 underwent uvulopalatopharyngoplasty or laser-assisted palatoplasty. All patients had successful snoring scale outcomes following the surgery. A significant number of the patients, 62 per cent, were demonstrated to have significant improvement in the short term. Single dose injection snoreplasty seems not only to be an effective investigation but may constitute a safe and simple treatment within the clinic. At the very least, patients in whom the palate appears not to be the problem are prevented from undergoing painful, unpleasant surgery. Our results support the use of injection snoreplasty, both as an investigation and in some patients as a treatment, for habitual snoring.

Le ronflement chez l'enfant

Only snoring loud enough to be heard behind a closed door have to be investigated and treated. Snoring is severe when associated with sleep apneas. The 3 most frequent causes of snoring in children are enlarged adenoids, enlarged tonsils and blocked nose due to allergic rhinitis.

Acoustic analysis of pediatric snoring

Videotaping was conducted at home, in cooperation with patients' mothers. The recorded sounds were then analyzed. Compared with snoring sounds obtained via polysomnography, representative cases that demonstrate the usefulness of videotaping at home were presented. The subjects were eight children who received polysomnography, recording the snoring at our department during the 1-year period, from March 2002 to February 2003. The snoring recording was conducted using polysomnography. As for the taping method, the sounds from the microphone were taken into an acoustic analysis system II (TDT) and recorded on an MD, using a ZS-M75 (SONY). As for the method of analysis, the MD-recorded snore sounds were analyzed using Time Frequency Representation (TFR) (Avaaz Innovation), an acoustic analysis software program for Windows. The snoring sounds recorded by home video camera as well as those obtained by polysomnography were analyzed. The snoring sounds obtained via polysomnography and by the home video camera contained noise components on sound spectrograms and showed waves in which the basic frequency changed. It thought that the noise made by the adenoids and the hypertrophy of palatine tonsil were not the cause of snoring, but rather that the vibration of the soft palate and the uvula participated in pediatric snoring.

A new technique for laser-assisted uvulopalatoplasty: decision-tree analysis and results.

Report a new technique of laser-assisted uvulopalatoplasty (LAUP) for snoring performed as a one-stage procedure. A decision-tree was used in a prospective study of 89 patients from April 1994 to May 1997. It included a fiberscopy and Muller's maneuver, rhinomanometry, pH monitoring, computed tomography scan to measure the pharyngeal lumen, pulse oximetry, and polysomnography in case of sleep apnea syndrome was suspected. The authors performed their LAUP technique on 43 patients (48.5%) whose snoring was mainly caused by the velum. This technique consists of scarifying the velum by vaporizing the mucosa and the submucosa along a rectangle extending from the palatal dimple to the uvula and having a width of 1.5 to 2 cm. Vaporization of the palatal arches follows without exceeding the junction of the anterior and posterior pillars in height. The uvula is cut if necessary, preserving a length of at least 0.5 cm. The other patients underwent different procedures according to the cause of snoring. There was no significant difference between LAUP and uvulopalatoplasty (UPPP) regarding pain. No permanent phonatory disorders and no regurgitation occurred. Satisfaction evaluated on a scale ranging from 0 to 10 was equivalent for the two techniques: mean value = 7.68 (+/-2.18) for LAUP and 8.60 (+/-2.27) for UPPP. The mean follow-up was 17 months (range, 1-37 mo). Satisfaction was also identical for all techniques. Our LAUP technique combined with other procedures according to a decision-tree is efficient and safe.

Giant Cervical Osteophytes Their Significance in ENT Practice.

Foresteir's disease or Diffuse idiopathic skeletal hyperostosis (DISH) involving the cervical vertebrae in two patients is being presented as an uncommon cause of snoring and dysphagia. The radiological features of the giant osteophytes involving the cervical vertebrae are detected on routine skiagrams of the neck. A review of literature over ten years showed no such record of such a lesion occurring in C1-C2 vertebrae, whereas the occurrence in the lower cervical vertebrae is occasionally seen causing dysphagia. The relative merits of the surgical approaches are discussed.

Anaesthesia for Laser Pharyngoplasty—A Comparison of the Tracheal Tube with the Reinforced Laryngeal Mask Airway

A common cause of snoring is palatal flutter which occurs when turbulent air flow causes the flexible soft palate to flutter. Surgical correction involves either removal of the soft palate or a reduction in its flexibility. Laser pharyngoplasty is a new surgical procedure designed to stiffen the soft palate. It presents a unique combination of problems for the anaesthetist. In this paper we describe the evolution of the anaesthetic technique for laser pharyngoplasty and analyse the results of the first 165 cases. Points of particular interest include the use of the reinforced laryngeal mask airway compared with the tracheal tube and late onset pain.

Snoring and sleep apnea syndrome: surgical treatment and MESAM-IV controlled, postoperative results

Approximately 20% of the population snore. Snoring is caused by a vibration of oropharyngeal soft tissues during air flow. The anatomical origin of snoring can be the soft palate with a hyperplastic uvula or the region of the base of tongue. An uvulopalatopharyngoplasty (UPPP) as a mode of surgical treatment is only appropriate in the first case. A patient can be considered to be suffering from sleep apnea syndrome if snoring is associated with a temporary complete obstruction of the upper airway with a subsequent decrease in oxygen saturation. In this case continuous positive airway pressure (CPAP) therapy can be beneficial; however, the role of surgery is confined to those operations providing unimpaired nasal air flow. Following extensive preoperative diagnostics, including sleep monitoring with the MESAM-IV-system, 68 patients with palatal snoring underwent surgery. 46 could be examined 6 to 8 months postoperatively: In 41 patients snoring disappeared completely or was reduced to a few occasional episodes. 5 patients continued to snore after the UPPP. These patients were obese at the time of surgery and a preoperative attempt to lose weight was only partially successful. Although we identified the soft palate as the probable cause of snoring by fiberoptic examination, especially the overweight patients bear the risk of additional narrow segments in the region of the base of the tongue. The appropriate weight loss is therefore a fundamental prerequisite for successful treatment. 5 patients with sleep apnea syndrome combined with nasal obstruction underwent septum, turbinate and sinus surgery to create unobstructed nasal airflow. The following CPAP treatment was of great benefit to them.(ABSTRACT TRUNCATED AT 250 WORDS)

The ABZzzzs of snoring.

Snorers sleep through their obnoxiously loud breathing, but other members of their household often do not. Their bed partner and family members may grow so tired of the noise that they insist the offender seek medical attention. Physiologic problems such as obesity, narrowing of the airway, or inadequate oropharyngeal muscle tone often can be identified as the cause of snoring. Whenever possible, the underlying disorder should be treated.