Chronic Snoring Research Articles

Effect of Tongue Position on Facial Morphology of Pakistani Adults and Different Growth Patterns.

To determine the effect of tongue position on facial morphology of Pakistani adults and different growth patterns. Cross-sectional study. Place and Duration of the Study:Department of Orthodontics, Karachi Medical and Dental College, Karachi, Pakistan, from January to April 2021. The study included individuals aged 17 to 30 years with no history of prior orthodontic treatment, absence of wound, burn, or scar tissue in the neck region, comfortable breathing through the nose, absence of deglutition disorder, and a skeletal Class I or II relationship. The exclusion criteria were a cleft lip or palate, or a history of chronic mouth breathing, snoring, or tonsillectomy. According to their skeletal relationships, the subjects were split into three groups; Group I (low-angle), Group II (normal growth), and Group III (high-angle). Vertical growth pattern was assessed on radiograph by interpreting the values of NS / ML (nasion-sella / mandibular plane) angle, and angle formed between FH / ML (Frankfort horizontal plane / mandibular plane). A predesigned proforma was used to record all the measurements made on pre-treatment lateral cephalograms by the sole investigator. Data were analysed using SPSS 24.0. Data from the lateral cephalogram of 79 patients, consisting of 18 (22.8%) males and 61 (77.2%) femaleswho met the inclusion criteria, were analysed.The sample included 15 low-angle, 45 normal vertical growth, and 19 high-angle cases. Fifty participants had Class I skeletal relationships, while 29 had Class II relationships. According to the ANOVA test, FH / ML and NS / ML measurements showed no statistically significant variations in tongue position and growth trends. There was no statistically significant difference between tongue position and facial morphology of Class I or II subjects with different vertical growth patterns. However, there was a statistically sufficient evidence showing the tongue height was greater in Class I skeletal relationship patients as compared to Class II skeletal cases (p = 0.008). Tongue position, Tongue space, Tongue length, Growth pattern.

Pulmonary hypertension in patients affected by sleep-related breathing disorders: up to date from the literature.

Sleep-related breathing disorders (SBD) are conditions of abnormal and difficult respiration during sleep, including chronic snoring, obstructive sleep apnea (OSA), central sleep apnea (CSA), sleep-related hypoventilation disorders and sleep-related hypoxemia. Some of them have a limited impact on health, but others (e.g., OSA) can have serious consequences, because of their dangerous effects on sleep and the hematic balance of oxygen and carbon dioxide. According to several population-based studies, prevalence of OSA is relatively high, approximately 3-7% for adult males and 2-5% for adult females in the general population. However, methodological differences and difficulties in characterizing this syndrome yielded to variability in estimates. Moreover, it is estimated that only about 40% of patients with OSA are diagnosed, which can lead to underestimation of disease prevalence. OSA is directly correlated with age and male sex and to risk factors such as obesity. Several studies found that OSA is associated with an increased risk of diabetes, some cancer types, cardiovascular and cerebrovascular diseases, such as hypertension, coronary artery disease and stroke. Pulmonary hypertension (PH), a noted cardiovascular disease, is significantly associated with sleep-related breathing disorders and lot of scientific studies published in the literature demonstrated a strong link between these conditions and the development of pulmonary hypertension PH. PH is relatively less common than sleep-related breathing disorders. The purpose of this systematic review is to analyze both the current knowledge around the consequences that SBD may have on pulmonary hemodynamics and the effects resulting from pharmacological and non-pharmacological treatments of SDB on PH.

Prevalence of Snoring in Pregnancy and Its Maternal-Fetal Outcomes at Vajira Hospital

Background: Snoring is an important symptom that is associated with obstructive sleep apnea and increases the risk of adverse pregnancy outcomes. In Thailand, the prevalence of snoring during pregnancy is uncertain. Determining the prevalence and characteristics may reduce the prevalence of snoring and improve pregnancy outcomes. Objective: The primary outcome was to determine the prevalence of snoring in Thai pregnant women in the third trimester, including pregnancy and chronic onset. The secondary outcome was to investigate the associations between pregnancy outcome and habitual snorer or those identified as high risk by the Thai Berlin Questionnaire. Materials and Methods: Three hundred eighty-two singleton pregnant women aged at least 18 years and at least 33 weeks of gestational age were recruited from the antenatal care clinic at Vajira Hospital, Navamindradhiraj University, between November 2021 and September 2022 and filled out the Thai Berlin Questionnaire. The 382 pregnant women were identified the presence of snoring or high risk of OSA in the previous month. Medical records, including demographic information and pregnancy outcomes, were collected, and analyzed. Results: The prevalence of snoring was 31.4% in the third trimester of pregnancy of which 27% were pregnancy onset snoring and 4.4% were chronic onset snoring. Habitual snoring was significantly different from non-snoring in regard to the requirement for positive-pressure ventilation in newborns (aOR 6.67, 95% CI 1.2 to 35.54). The high risk group had significantly more pregnancy induced hypertension than the low risk group (aOR 5.96, 95% CI 2.15 to 16.5), gestational hypertension (aOR 13.6, 95% CI 2.1 to 86.8), preeclampsia (aOR 4.07, 95% CI 1.09 to 15.2), severe preeclampsia (aOR 4.9, 95% CI 1.15 to 20.93), preterm birth (aOR 6.21, 95% CI 1.58 to 24.42), and low birth weight of newborn (aOR 6.09, 95% CI 2.5 to 14.87). Conclusion: The prevalence of snoring among Thai pregnant women was comparable to previous Western studies. Screening pregnant women at risk of the symptom may provide an early chance to lower the prevalence of snoring and adverse pregnancy outcomes. Keywords: Snoring; Snoring in pregnancy; Pregnancy outcomes

Nasopharyngeal Presentation of a Pharyngeal Cleft Cyst in a Dog.

A 2 yr old castrated male shih tzu was presented for assessment of worsening chronic snoring since first detected at 3 mo of age. An upper respiratory endoscopic examination and a computed tomographic scan showed a well-circumscribed, fluid-filled nasopharyngeal mass located in the median plane on the nasal side of the soft palate. This lesion was removed using a ventral approach to the nasopharynx by blunt-sharp dissection from the submucosal tissues of the soft palate. Histopathology revealed a cystic lesion lined by a single layer of a pseudostratified columnar ciliated epithelium, characteristic of a pharyngeal cyst. Follow-up 5 mo after surgery revealed complete resolution of the clinical signs with no evidence of local recurrence. Pharyngeal cysts are developmental abnormalities of the branchial apparatus. Most derive from the second branchial arch and cause cysts, sinuses, and fistulae to develop in the neck region. In our case, the lesion was located in the nasopharynx, leading to snoring and exercise intolerance. This condition should be included in the differential diagnosis of suspected nasopharyngeal obstruction.

Influences of Airway Obstruction Caused by Adenoid Hypertrophy on Growth and Development of Craniomaxillofacial Structure and Respiratory Function in Children.

Adenoid hypertrophy (AH) is a common disease in otorhinolaryngology. Children with chronic snoring and hypoxia are susceptible to long-term nasal obstruction, while long-term open-mouth breathing may cause craniofacial bone development disorders and dull facial expressions, the so-called adenoid face. The purpose of this work is to analyze the influence of AH-induced airway obstruction (AO) on the growth and development of craniomaxillofacial structure and respiratory function (RF) in children. The clinical data of 56 AH children (observation group) and 42 healthy children with physical examination (control group) who visited the Hebei Eye Hospital during the same period were retrospectively analyzed. All children received acoustic rhinometry and X-ray cephalometric measurements. The upper airway structure, sleep disorder score, and A/N value of nasopharyngeal lateral X-ray images were compared between cases and controls. For AH children, sleep tests were also performed to assess their RF. X-ray cephalometric measurements of facial morphology showed obvious vertical growth, mandibular retrognathia, and enlarged mandibular angle in AH children. AH mainly affects the size of the nasopharyngeal and oropharyngeal airway. AH children presented with higher nasal airway resistance (5.11 ± 1.95 cmH2O/L min) and lower nasopharyngeal volume (NPV) (16.86 ± 3.93 cm3) than controls. Of the AH children, 45 had abnormal RF, including 4 with obstructive sleep apnea syndrome. The A/N value of nasopharyngeal lateral X-ray images was significantly higher in AH children than in controls. Besides, worse sleep quality was found in AH children. The above differences were all of statistical significance. The above indicates that AH can affect the size of the nasopharyngeal and oropharyngeal airway, change children's respiratory mode and RF, increase nasal resistance, and decrease NPV, resulting in upper respiratory tract stenosis, as well as craniomaxillofacial and oral malformations, which affects children's normal growth and development.

OUTCOME OF PATIENTS WITH ADENOID HYPERTROPHY UNDERGOING ENDOSCOPIC GUIDED MICRODEBRIDER - ASSISTED ADENOIDECTOMY

Adenoid, a nasopharyngeal lymphoid tissue forming a part of the Waldeyer's ring, was initially described in 1868 by Meyer. Adenoid hypertrophy (AH) can result in upper airway obstruction in children. Children with this condition present with symptoms of chronic nasal obstruction, rhinorrhoea, mouth breathing, snoring, recurrent sinusitis, and recurrent otitis media with effusion. Adenoidectomy is one of the most common surgical procedures performed in children, either alone or in conjunction with tonsillectomy or grommet insertion. The conventional adenoidectomy using curette is performed blindly by most surgeons without visualising the nasopharynx; which leads to uncommon complications such as inadequate adenoid tissue removal, eustachian tube scarring, bleeding and nasopharyngeal stenosis. This has lead to development of alternate surgical methods, which has been made possible with the advent of rigid nasal endoscopes, cold light source, fibre optics and powered instruments.

The Relationship Between Oxidative Stress and Adenotonsillar Hypertrophy in Children

Objective: In this study, it was aimed to evaluate the preoperative and postoperative oxidative stress levels of children with obstructive adenotonsillar hypertrophy and to compare the obtained data with healthy children. Material and Methods: 25 patients and 25 healthy controls were included in the prospective study conducted between March and September 2015. In the study sample, children who were diagnosed with adenotonsillar hypertrophy due to chronic tonsillitis, snoring and mouth breathing and who were planned for adenotonsillectomy were included in the patient group. Control group included 25 healthy volunteers with the same demographic characteristics. Serum and urine samples were collected from the patient group twice, before and after surgery, and once from the control group. 8-hydroxy-2-deoxyguanosine levels of all samples were determined by EIA method, protein carbonyl levels were determined by ELISA method and malondialdehyde levels were determined by manual spectrophotometric method. Results: In the study, it was found that the serum malondialdehyde levels of children with adenotonsillar hypertrophy were significantly higher than the control group (p=0.003) and that there was no difference in terms of other parameters (p>0.05). After the operation, it was determined that the levels of all three parameters evaluated significantly decreased compared to before (p<0.05). It was determined that there was a statistically significant and weak correlation between malondialdehyde and 8-hydroxy-2-deoxyguanosine values before the operation (p=0.003, r=0.566). Conclusion: Hypertrophic adenotonsillar, which is common in the pediatric population, causes many clinical conditions and adversely affects the health and quality of life of children. In line with our findings, we can say that serum and urine MDA levels and tissue PCO levels are useful markers in the evaluation of oxidative damage in children with obstructive ATH and may help to elucidate the etiopathogenesis of the disease. Considering the effects of ATH on health, it is recommended to be considered as an important health problem and to examine the clinical, biochemical and histopathological studies of the disease in a larger sample group.

Timing is everything: snoring onset and blood pressure trajectories in pregnancy.

Timing is everything: snoring onset and blood pressure trajectories in pregnancy.

Cone beam CT evaluation of skeletal and nasomaxillary complex volume changes after rapid maxillary expansion in OSA children

ObjectiveThe first objective of this study was to evaluate skeletal changes and changes in dimensions and volume of the upper airways before and after rapid maxillary expansion (RME) therapy in children with obstructive sleep apnoea (OSA), by Cone Beam computed tomography (CBCT). The second objective was to evaluate if RME therapy could improve both the patency of the nasal airways and the Obstructive Sleep Apnoea Syndrome (OSAS). Methods19 children with OSA and malocclusion took CBCT scans with a Dentascan and 3D reconstruction program before (T0) and 4 months after (T1) RME. Patients underwent an ENT visit with auditory and respiratory tests, including a daytime sleepiness questionnaire, a 19-channel polysomnography, and an orthognatodontic examination before orthodontic therapy (T0), after 2 months (T1) with the device still on, and 4 months after the end of the orthodontic treatment (T2). ResultsIn all cases opening of the mid-palatal suture was demonstrated. Nasal osseous width, volume of the total upper airways, nasal cavity and nasopharynx and oropharynx increased significantly (P, .001). The increased W-ANS, W-mid and WPNS were closed linked to the enlarged midpalatal suture (P, .001). The increased WPNS were closed linked to the enlarged pterygoid processes (P, .001). The increased V-NC and V-NPA was closely linked to the enlarged W-PNS (P, .001) as well as VOPA and consequently to the enlarged midpalatal suture and pterygoid processes. ConclusionRME treatment had a positive effect on children affected by chronic snoring and OSA, causing an increase in volume of the nasal cavity and nasopharynx, with expansion of the nasal osseous width and maxillary width. Enlarged nasal width at the PNS plane contributed to the increase in nasopharynx volume. Enlarged maxillary width showed a direct correlation to increased airways volume, bringing a functional improvement. The results show that the RME therapy can restore and improve a normal nasal airflow with disappearance of obstructive sleep breathing disorder.

Maternal habitual snoring and blood pressure trajectories in pregnancy.

Habitual snoring has been associated with hypertensive disorders of pregnancy. However, exactly when blood pressure (BP) trajectories diverge between pregnant women with and without habitual snoring is unknown. Moreover, the potentially differential impact of chronic vs pregnancy-onset habitual snoring on maternal BP trajectories during pregnancy has not been examined. This study compared patterns of BP across pregnancy in 3 groups of women: those with chronic habitual snoring, those with pregnancy-onset habitual snoring, and nonhabitual snoring "controls." In a cohort study of 1,305 pregnant women from a large medical center, participants were asked about habitual snoring (≥ 3 nights/week) and whether their symptoms began prior to or during pregnancy. Demographic, health, and BP data throughout pregnancy were abstracted from medical charts. Linear mixed models were used to examine associations between habitual snoring-onset and pregnancy BP trajectories. A third of women reported snoring prior to pregnancy (chronic snoring) and an additional 23% reported pregnancy-onset snoring. Mean maternal age (SD) was 29.5 (5.6), 30 (6), and 30.5 (5.7) years in controls, chronic, and pregnancy-onset snoring, respectively. Overall, women with pregnancy-onset snoring had higher mean systolic BP and diastolic BP compared to those with chronic habitual snoring or nonhabitual snoring. In gestational week-specific comparisons with controls, systolic BP became significantly higher around 18 weeks' gestation among women with pregnancy-onset snoring and in the third trimester among women with chronic snoring. These differences became detectable at 1 mm Hg and increased thereafter, reaching 3 mm Hg-BP difference at 40 weeks' gestation in women with pregnancy-onset snoring relative to controls. Pairwise mean differences in diastolic BP were significant only among women with pregnancy-onset snoring relative to controls, after 15 weeks' gestation. Pregnancy-onset and chronic maternal snoring are associated with higher BPs beginning in the second and third trimester, respectively. Pregnancy BP trajectories could identify critical windows for enhanced BP surveillance; the divergent BP trajectories suggest that the 2 groups of women with habitual snoring in pregnancy may need to be considered separately when gestational time intervals are evaluated for increased BP monitoring. Dunietz GL, Hao W, Shedden K, etal. Maternal habitual snoring and blood pressure trajectories in pregnancy. J Clin Sleep Med. 2022;18(1):31-38.

Impact of Snoring on Telomere Shortening in Adolescents with Atopic Diseases.

Atopic diseases can impose a significant burden on children and adolescents. Telomere length is a cellular marker of aging reflecting the impact of cumulative stress exposure on individual health. Since elevated oxidative stress and inflammation burden induced by chronic atopy and snoring may impact telomere length, this study aimed to investigate whether snoring would moderate the relationship between atopic diseases and telomere length in early adolescence. We surveyed 354 adolescents and their parents. Parents reported the adolescents’ history of atopic diseases, recent snoring history as well as other family sociodemographic characteristics. Buccal swab samples were also collected from the adolescents for telomere length determination. Independent and combined effects of atopic diseases and snoring on telomere length were examined. Among the surveyed adolescents, 174 were reported by parents to have atopic diseases (20 had asthma, 145 had allergic rhinitis, 53 had eczema, and 25 had food allergy). Shorter TL was found in participants with a history of snoring and atopic diseases (β = −0.34, p = 0.002) particularly for asthma (β = −0.21, p = 0.007) and allergic rhinitis (β = −0.22, p = 0.023). Our findings suggest that snoring in atopic patients has important implications for accelerated telomere shortening. Proper management of atopic symptoms at an early age is important for the alleviation of long-term health consequences at the cellular level.

470 Maternal Habitual Snoring and Blood Pressure Trajectories in Pregnancy

Abstract Introduction Habitual snoring has been associated with hypertensive disorders of pregnancy. However, exactly when blood pressure (BP) trajectories diverge between pregnant women with and without habitual snoring is unknown. Moreover, the potentially differential impact of chronic versus pregnancy-onset habitual snoring on maternal BP trajectories during pregnancy has not been examined. Methods In a cohort study of 1,305 pregnant women from a large Midwestern medical center, participants were asked about habitual snoring (≥3 nights/week) and whether their symptoms began prior to or during pregnancy. Demographic and BP data throughout pregnancy, systolic (SBP) and diastolic (DBP) were abstracted from medical charts. Linear mixed models were used to examine associations between habitual snoring-onset and pregnancy BP trajectories. Results Thirty percent of women reported snoring before pregnancy (chronic snoring) and an additional 23% reported pregnancy-onset snoring. Overall, women with pregnancy-onset snoring had higher mean SBP and DBP compared to those with chronic habitual snoring or controls (non-habitual snoring). In gestational week-specific comparisons with controls, SBP became significantly higher around 20 weeks’ gestation among women with pregnancy-onset snoring and in the third trimester among women with chronic snoring. Pairwise mean differences in DBP were significant only among women with pregnancy-onset snoring relative to controls, after 15 weeks’ gestation. Conclusion In a large cohort of pregnant women, those with pregnancy-onset or chronic habitual snoring had significantly elevated systolic BP in comparison to non-habitual snoring controls, in the second and third trimester, respectively. The findings of divergent BP trajectories suggest the two groups of women with habitual snoring in pregnancy should be considered separately when evaluating gestational ‘windows’ for increased BP monitoring and provide insight into pathophysiologic changes. Support (if any) Dr. Dunietz was supported by an F32 National Research Service Award from the National Institute of Child Health and Development (NIH/NICHD F32 HD091938); Dr. O’Brien was supported by the following during the course of this study: the Gene and Tubie Gilmore Fund for Sleep Research, the University of Michigan Institute for Clinical and Health Research (MICHR) grants UL1RR024986 and UL1TR000433, MICHR seed pilot grant F021024, the National Heart, Lung, and Blood Institute (R21 HL089918 and K23 HL095739) and in part by R21 HL087819.

Snoring and depression symptoms in pregnant women

ObjectivePregnant patients are vulnerable to both depression and sleep-disordered breathing, and both convey risks for maternal and fetal outcomes. Previous research has indicated that sleep-disordered breathing is associated with depression, but further information related to the risk of depression based on timing of onset of snoring is needed. DesignWhen presenting to clinic for their initial prenatal visit, pregnant patients completed a packet of questionnaires, which included measures related to depression (Edinburgh Postnatal Depression Scale) and snoring. Habitual snoring was defined as snoring 3 or more nights per week. ResultsIn total, 1367 women were included and 34.1% reported habitual snoring, either chronic (24.4%) or pregnancy-onset (9.8%), with increased frequency of pregnancy-onset habitual snoring in later stages of pregnancy. Unadjusted analyses suggested increased odds of depressive symptoms in chronic and pregnancy-onset habitual snoring groups relative to nonsnorers (odds ratio [OR]: 2.01, 95% confidence interval [CI]: 1.39, 2.92, P < .01; OR: 2.50, 95% CI: 1.54, 4.07, P < .01, respectively). These findings were maintained after adjusting for maternal age, marital status, gestational age, and parity (chronic habitual snoring OR: 1.69, 95% CI: 1.14, 2.53, P < .01; pregnancy-onset habitual snoring OR: 2.79, 95% CI: 1.35, 5.78, P < .01). ConclusionsMaternal snoring may be a risk factor for prenatal depressive symptoms. Pregnancy-onset habitual snoring confers additional risk for depression compared to not snoring during pregnancy.

Evaluating sleep quality with coronavirus disease 2019 (COVID-19) testing.

Free AccessLetters to the EditorEvaluating sleep quality with coronavirus disease 2019 (COVID-19) testing Katie Viehmann-Wical, DrPHc, MCHES, RRT-NPS Katie Viehmann-Wical, DrPHc, MCHES, RRT-NPS Search for more papers by this author Published Online:February 1, 2021https://doi.org/10.5664/jcsm.8966SectionsAbstractPDF ShareShare onFacebookTwitterLinkedInRedditEmail ToolsAdd to favoritesDownload CitationsTrack Citations AboutABSTRACTCitation:Viehmann-Wical K. Evaluating sleep quality with coronavirus disease 2019 (COVID-19) testing. J Clin Sleep Med. 2021;17(2):355.INTRODUCTIONWhat a great time to be in sleep medicine! This is the perfect time for sleep specialists to speak up about the immune-boosting, virus-fighting health benefits of sleep.Rapid eye movement (REM) sleep is the key sleep cycle for fighting viruses.1–3 The 2–5% of patients positive for coronavirus disease 2019 (COVID-19) admitted into the hospital and intensive care units are most likely patients with REM sleep problems. Asking patients getting tested for COVID-19 if they have untreated snoring (even better using a Pittsburgh Sleep Quality Index form) would quickly identify the high-risk population for sleep problems and worse COVID-19 prognosis.Promoting sleep health and educating individuals how to protect REM sleep would decrease deaths, restore economic stability, and decrease severity for the 2–5% of individuals admitted for COVID-19 treatment. Unfortunately, sleep health knowledge and understanding are low among health care providers and even lower within the general public.4The 3 main underknown health challenges that fragment, block, or decrease REM sleep are as follows: undiagnosed and untreated nightly snoring/sleep apnea,5 drinking alcohol within 6 hours of bedtime,6 or having caffeinated products in the last 6 to 8 hours before bed.7 Sleep specialists are key to diagnosing and treating chronic snoring and sleep apnea, plus educating patients about major risk factors that decrease high-quality REM sleep.The key area where sleep specialists can decrease virus severity is with patients with undiagnosed/untreated sleep apnea. Sleep apnea fragments and blocks REM sleep,5 decreasing immunity.1,3 Apnea is also associated with gut dysbiosis, leading to weight gain and hormone imbalance.8 A body mass index, especially over 40 kg/m2 in males, is associated with higher risk of COVID-19 symptoms and death.9 Diagnosing and treating the nearly one-quarter of females and one-half of males10 with undiagnosed moderate–severe chronic snoring/apnea would protect health and ability to fight off viruses.1,3DISCLOSURE STATEMENTThe author has seen and approved this manuscript. The author reports no conflicts of interest.REFERENCES1. Irwin MR. Sleep and inflammation: partners in sickness and in health. Nat Rev Immunol. 2019;19(11):702–715. https://doi.org/10.1038/s41577-019-0190-z CrossrefGoogle Scholar2. Redwine L, Dang J, Hall M, Irwin M. Disordered sleep, nocturnal cytokines, and immunity in alcoholics. Psychosom Med. 2003;65(1):75–85. https://doi.org/10.1097/01.PSY.0000038943.33335.D2 CrossrefGoogle Scholar3. Moldofsky H. Sleep and the immune system. Int J Immunopharmacol. 1995;17(8):649–654. https://doi.org/10.1016/0192-0561(95)00051-3 CrossrefGoogle Scholar4. Jaiswal SJ, Owens RL, Malhotra A. Raising awareness about sleep disorders. Lung India. 2017;34(3):262–268. Google Scholar5. Kimoff RJ. Sleep fragmentation in obstructive sleep apnea. Sleep. 1996;19(9, Suppl):S61–S66. https://doi.org/10.1093/sleep/19.suppl_9.S61 CrossrefGoogle Scholar6. Stein MD, Friedmann PD. Disturbed sleep and its relationship to alcohol use. Subst Abus. 2005;26(1):1–13. https://doi.org/10.1300/J465v26n01_01 CrossrefGoogle Scholar7. Drake C, Roehrs T, Shambroom J, Roth T. Caffeine effects on sleep taken 0, 3, or 6 hours before going to bed. J Clin Sleep Med. 2013;9(11):1195–1200. https://doi.org/10.5664/jcsm.3170 LinkGoogle Scholar8. Mashaqi S, Gozal D. Obstructive sleep apnea and systemic hypertension: gut dysbiosis as the mediator? J Clin Sleep Med. 2019;15(10):1517–1527. https://doi.org/10.5664/jcsm.7990 LinkGoogle Scholar9. Tartof SY, Qian L, Hong V, et al.. Obesity and Mortality Among Patients Diagnosed With COVID-19: Results From an Integrated Health Care Organization. Ann Intern Med. 2020;173(10):773–781. CrossrefGoogle Scholar10. Heinzer R, Vat S, Marques-Vidal P, et al.. Prevalence of sleep-disordered breathing in the general population: the HypnoLaus study. Lancet Respir Med. 2015;3(4):310–318. https://doi.org/10.1016/S2213-2600(15)00043-0 CrossrefGoogle Scholar Previous article Next article FiguresReferencesRelatedDetails Volume 17 • Issue 2 • February 1, 2021ISSN (print): 1550-9389ISSN (online): 1550-9397Frequency: Monthly Metrics History Submitted for publicationOctober 19, 2020Submitted in final revised formOctober 27, 2020Accepted for publicationOctober 27, 2020Published onlineFebruary 1, 2021 Information© 2021 American Academy of Sleep MedicinePDF download

Are Sleep Questionnaires Valid in All Adult Age Groups as Screening Tools for Obstructive Sleep Apnea?

Background and Objectives: Evaluation of Epworth Sleepiness Scale (ESS), Berlin, STOP, and STOP-Bang questionnaire validities for obstructive sleep apnea (OSA) screening among various adult age groups.Materials and Method: Results for each of those questionnaires were compared with diagnostic overnight polysomnography (PSG) data obtained for 396 patients suffering either insomnia, sleep apnea, excessive daytime sleepiness, or chronic snoring who had been divided into three age groups (20-39, 40-59, or ≥60 years). For each questionnaire, the sensitivity, specificity, accuracy, and area under the curve (AUC) were calculated.Results: Among the OSA group [apnea hypopnea index (AHI) cutoff ＞5], Berlin and STOP questionnaire sensitivity and specificity were significantly different among the age groups. Among the moderate-to-severe OSA sub-group (AHI cutoff ＞15), the specificity of Berlin, STOP, and STOP-Bang questionnaire was significantly different among age groups.Conclusion: The Berlin and STOP questionnaires differed with patient age in OSA screening. The ESS questionnaire, by contrast, did not show any age-related differences of sensitivity and specificity in OSA screening or moderate-to-severe OSA screening.

A new office-based procedure for treatment of snoring: The S.I.Le.N.C.E. study.

ObjectiveDemonstrate the safety and effectiveness of palatal foreshortening and stiffening in reducing snoring severity in nonobstructive sleep apnea (non‐OSA) patients complaining of chronic disruptive snoring.MethodsIn a US‐based 8‐center, open‐label, prospective, single‐arm cohort study, 52 consenting adults with chronic disruptive snoring (snoring impacting a patient's life and causing patient or bed partner to seek medical intervention) were treated via office‐based placement of resorbable, bidirectional, barbed suture implants into the soft palate under local anesthesia. Prior to intervention, home sleep tests (HSTs) were performed to rule out OSA and to document snoring noise level. Both subject and their bed/sleep partners (also consented) completed questionnaires including: bed/sleep partner's scored visual analog scale (VAS) for subjects' snoring severity, and subject scoring for Epworth Sleepiness Scale (ESS) and Pittsburgh Sleep Quality Index (PSQI). Following intervention, HSTs, VAS, ESS and PSQI were repeated at 30, 90 and 180 days.ResultsMean baseline bed/sleep partner VAS was 7.81 ± 1.59. Mean postimplant VAS scores decreased significantly at each measured interval; to 5.772.35 (P < .001) at 30 days, 4.48 ± 1.81 (P < .001) at 90 days, and 5.40 ± 2.28 (P < .001) at 180 days. Post treatment improvements in daytime sleepiness and QOL were also observed. Two partial extrusions were reported. No further adverse events were identified.ConclusionThe current study demonstrates the safety and efficacy of the Elevoplasty procedure in reducing snoring severity over a follow‐up period of 6 months.Level of Evidence2b

Adenoid hypertrophy among school-aged Iraqi children, the effect of severity and duration on its co-morbidities

Adenoid hypertrophy is a common pediatrics health problem that usually results in several morbidities such as sleep disorder, adenoid facies, impaired physical growth, cardiac complications, glue ear and nocturnal enuresis. Patients and methods: Forty-two school-aged children were enrolled in this study (6-12 years old), thirty were male and twelve were female, all are suffering from chronic snoring. All of them were subjected to standard history and physical examination to the most related health problems such as assessment of physical growth, craniofacial malformation, associated tonsillar enlargement. Investigations were performed in the form of lateral neck X-ray and ECG for all of them. The study period was 9 months from 1st of March 2018 to the 1st of December 2018. Results: There was a significant association between a higher grade of disease and speech disorders, tonsillar hypertrophy, adenoid facies, recurrent otitis media, nocturnal enuresis, impaired school performance, physical growth impairment, apnea at sleep, day time drowsiness, ECG abnormalities and deglutition problems (P &lt; 0.05). The associated co-morbidities, namely Speech disorders, tonsillar hypertrophy, adenoid facies, recurrent otitis media, nocturnal enuresis, impaired school performance, impaired school performance, physical growth impairment, apnea at sleep, day time drowsiness, ECG abnormalities and deglutition problems, were significantly correlated to the longer duration of disease. Conclusion: Longer duration of disease and higher grade of adenoid hypertrophy are strongly correlated with disease complications and morbidities, hence early diagnosis and properly timed management is important to prevent these complications.

Using Haptic Feedback as a Treatment for Position Dependent, Severe, Chronic Snoring

Severe snoring reduces sleep duration, sleep quality and has been linked to severe daytime fatigue, obesity and possibly sleep apnea and cardiovascular disease. Most snoring is position dependent and most prominent while sleeping on one’s back. The haptic sleep device (HSD) prevents sleeping on the back by using vibrating disks, which are activated until the sleeper rotates off the back. We monitored four heavy snorers, six moderate to light snorers, and four non-snorers. Our results show that wearing the HSD was associated with a reduction in sleeping on the back, a longer duration of sleep, and a reduction in restlessness during sleep. The HSD is designed to train a person, over time, to sleep on their side. These data indicate that the HSD is an effective anti-snoring device and could lead to other health benefits for the user.

Microdebrider Intracapsular Tonsillectomy and Traditional Extracapsular Dissection Tonsillectomy in Children: A Comparative Study

Objective: We planned to compare the outcome of the standard dissection tonsillectomy and microdebrider intracapsular tonsillectomy on the same patient to avoid confounders that may mask an actual association or, falsely establish an apparent association between the type of surgery and outcome when no actual association between them exists. Patients and Methods: Thirty children with chronic tonsillitis, snoring and sleep apnea due to tonsillar hypertrophy were included in the study. One tonsil was removed using the microdebrider intracpsular method and the other side by the standard dissection technique. The two sides were compared for duration of surgery, intraoperative blood loss, need for bipolar cauterization and stitches, reactionary and secondary bleeding, pain, wound healing and recurrence. Results: The operative time was significantly shorter in tonsillar sides performed with the microdebrider (P-value = 0.02). The intraoperative bleeding and the need for using bipolar diathermy were more in microdebrider (P-value < 0.001 and 0.03, respectively). While the use of stitches was significantly higher with dissection technique (P-value = 0.03). There was no difference regarding postoperative pain in the first day, but subsequently there was more pain among dissection side with significant difference (P-value < 0.001). Healing was significantly faster in microdebrider side (P-value < 0.001). Recurrence was detected among one side operated with the microdebrider with no significant difference between both sides (P-value = 0.3). Conclusion: Microdebrider intracapsular tonsillectomy is a safe and effective procedure in treating children with chronic tonsillitis and sleep apnea.

Reduction in Parasympathetic Tone During Sleep in Children With Habitual Snoring.

Introduction: Changes in the autonomic nervous system due to Obstructive Sleep Apnea (OSA) during the life span have been described. Some pediatric studies have shown cardiovascular effects in children who do not fit the criteria for OSA; namely children with mild sleep disordered breathing.Objective: We investigated heart rate variability (HRV) during sleep in children with chronic snoring and flow limitation events during sleep.Methods: Ten children and adolescents with chronic snoring and an apnea hypopnea index < 1, associated to high Respiratory Index, and 10 controls matched for age, gender, and Tanner stage were monitored following one night of habituation in the sleep laboratory. HRV was studied at each sleep stage. The time and frequency domains were calculated for each 5-min period.Results: All patients were chronic heavy snorers. They presented an apnea hypopnea index = 0.8, respiratory disturbance index = 10.2/h with lowest O2 saturation 96.1 ± 2.4%. The total power of HRV was decreased in all stages (p < 0.05). There was also a decrease in NN50 and pNN50 during all sleep stages compared to healthy controls (p = 0.0003 and p = 0.03, respectively).Conclusion: A reduction in parasympathetic tone was found in the patient group. This may represent an autonomic impairment during sleep in children with mild SDB. A reduction in HRV in children with habitual snoring could be associated with possible increases in cardiovascular risk in adulthood.Significance: The study indicates that children with habitual snoring have important parasympathetic tone changes during sleep.