Loud Breathing Research Articles

Snoring - An Acoustic Definition.

Objective- The distinction of snoring and loud breathing is often subjective and lies in the ear of the beholder. The aim of this study is to identify and assess acoustic features with a high suitability to distinguish these two classes of sound, in order to facilitate an objective definition of snoring based on acoustic parameters. Methods- A corpus of snore and breath sounds from 23 subjects has been used that were classified by 25 human raters. Using the openSMILE feature extractor, 6 373 acoustic features have been evaluated for their selectivity comparing SVM classification, logistic regression, and the recall of each single feature. Results- Most selective single features were several statistical functionals of the first and second mel frequency spectrum-generated perceptual linear predictive (PLP) cepstral coefficient with an unweighted average recall (UAR) of up to 93.8%. The best performing feature sets were low level descriptors (LLDs), derivatives and statistical functionals based on fast Fourier transformation (FFT), with a UAR of 93.0%, and on the summed mel frequency spectrum-generated PLP cepstral coefficients, with a UAR of 92.2% using SVM classification. Compared to SVM classification, logistic regression did not show considerable differences in classification performance. Conclusion- It could be shown that snoring and loud breathing can be distinguished by robust acoustic features. The findings might serve as a guidance to find a consensus for an objective definition of snoring compared to loud breathing.

Misophonia is associated with altered brain activity in the auditory cortex and salience network

Misophonia is characterized by intense rage and disgust provoked by hearing specific human sounds resulting in social isolation due to avoidance. We exposed patients with symptom provoking audiovisual stimuli to investigate brain activity of emotional responses. 21 patients with misophonia and 23 matched healthy controls were recruited at the psychiatry department of the Amsterdam UMC. Participants were presented with three different conditions, misophonia related cues (video clips with e.g. lip smacking and loud breathing), aversive cues (violent or disgusting clips from movies), and neutral cues (video clips of e.g. someone meditating) during fMRI. Electrocardiography was recorded to determine physiological changes and self-report measures were used to assess emotional changes. Misophonic cues elicited anger, disgust and sadness in patients compared to controls. Emotional changes were associated with increases in heart rate. The neuroimaging data revealed increased activation of the right insula, right anterior cingulate cortex and right superior temporal cortex during viewing of the misophonic video clips compared to neutral clips. Our results demonstrate that audiovisual stimuli trigger anger and physiological arousal in patients with misophonia, associated with activation of the auditory cortex and salience network.

Characterization of REM/NREM sleep using breath sounds in OSA

Obstructive Sleep Apnea (OSA) is a serious sleep disorder where patient experiences frequent upper airway collapse leading to breathing obstructions and arousals. Severity of OSA is assessed by averaging the number of incidences throughout the sleep. In a routine OSA diagnosis test, overnight sleep is broadly categorized into rapid eye movement (REM) and non-REM (NREM) stages and the number of events are considered accordingly to calculate the severity. A typical respiratory event is mostly accompanied by sounds such as loud breathing or snoring interrupted by choking, gasps for air. However, respiratory controls and ventilations are known to differ with sleep states. In this study, we assumed that the effect of sleep on respiration will alter characteristics of respiratory sounds as well as snoring in OSA patients. Our objective is to investigate whether the characteristics are sufficient to label snores of REM and NREM sleep. For investigation, we collected overnight audio recording from 12 patients undergoing routine OSA diagnostic test. We derived features from snoring sounds and its surrounding audio signal. We computed time series statistics such as mean, variance, inter-quartile-range to capture distinctive pattern from REM and NREM snores. We designed a Naive Bayes classifier to explore the usability of patterns to predict corresponding sleep states. Our method achieved a sensitivity of 92% (±9%) and specificity of 81% (±9%) in labeling snores into REM/NREM group which indicates the potential of snoring sounds to differentiate sleep states. This may be valuable to develop non-contact snore based technology for OSA diagnosis.

Lateral facial profile may reveal the risk for sleep disordered breathing in children—The PANIC-study

Objective. To evaluate the lateral view photography of the face as a tool for assessing morphological properties (i.e. facial convexity) as a risk factor for sleep disordered breathing (SDB) in children and to test how reliably oral health and non-oral healthcare professionals can visually discern the lateral profile of the face from the photographs. Materials and methods. The present study sample consisted of 382 children 6–8 years of age who were participants in the Physical Activity and Nutrition in Children (PANIC) Study. Sleep was assessed by a sleep questionnaire administered by the parents. SDB was defined as apnoeas, frequent or loud snoring or nocturnal mouth breathing observed by the parents. The facial convexity was assessed with three different methods. First, it was clinically evaluated by the reference orthodontist (T.I.). Second, lateral view photographs were taken to visually sub-divide the facial profile into convex, normal or concave. The photos were examined by a reference orthodontist and seven different healthcare professionals who work with children and also by a dental student. The inter- and intra-examiner consistencies were calculated by Kappa statistics. Three soft tissue landmarks of the facial profile, soft tissue Glabella (G`), Subnasale (Sn) and soft tissue Pogonion (Pg`) were digitally identified to analyze convexity of the face and the intra-examiner reproducibility of the reference orthodontist was determined by calculating intra-class correlation coefficients (ICCs). The third way to express the convexity of the face was to calculate the angle of facial convexity (G`-Sn-Pg`) and to group it into quintiles. For analysis the lowest quintile (≤164.2°) was set to represent the most convex facial profile. Results. The prevalence of the SDB in children with the most convex profiles expressed with the lowest quintile of the angle G`-Sn-Pg` (≤164.2°) was almost 2-fold (14.5%) compared to those with normal profile (8.1%) (p = 0.084). The inter-examiner Kappa values between the reference orthodontist and the other examiners for visually assessing the facial profile with the photographs ranged from poor-to-moderate (0.000–0.579). The best Kappa values were achieved between the two orthodontists (0.579). The intra-examiner Kappa value of the reference orthodontist for assessing the profiles was 0.920, with the agreement of 93.3%. In the ICC and its 95% CI between the two digital measurements, the angles of convexity of the facial profile (G`-Sn-Pg`) of the reference orthodontist were 0.980 and 0.951–0.992. Conclusion. In addition to orthodontists, it would be advantageous if also other healthcare professionals could play a key role in identifying certain risk features for SDB. However, the present results indicate that, in order to recognize the morphological risk for SDB, one would need to be trained for the purpose and, as well, needs sufficient knowledge of the growth and development of the face.

Investigating the Etiopathogenesis of Obstructive Sleep Apnea in Pediatric Patients with Unilateral Craniofacial Microsomia

INTRODUCTION: Bilateral craniofacial microsomia is a risk factor for obstructive sleep apnea (OSA).1,2 We hypothesize that unilateral craniofacial microsomia (UCFM) can also be an unrecognized cause of OSA. In this study, we aim to determine and characterize the etiopathogenesis of OSA in patients with UCFM through the use of three dimensional airflow analysis. METHODS: All pediatric patients diagnosed with UCFM at a tertiary level institution from 1990 to 2010 were reviewed. Patients with confirmed diagnoses of OSA (Apnea Hypopnea Index>1) were compared to control patients with UCFM without OSA otherwise randomly selected. Three dimensional analysis of airflow with a computational fluid analysis model was performed (MIMIC software) on a sample of both affected as well as unaffected individuals. CT data was converted into a 3-dimensional computational model where the Navier-Stokes equations governing fluid flow can yield a variety of objective measures of airflow in the given anatomy. RESULTS: 62 patients were identified as having UCFM, 7 patients were further diagnosed with OSA. 11.5% of the patients diagnosed with UCFM were diagnosed with OSA, compared to 2.5% in the healthy pediatric population (p=0.01). 100% of patients with OSA were Pruzanski grades IIB or higher. OSA presenting symptoms included snoaring (71.4%), failure to thrive (FTT) (57.1%), chronic respiratory infections (42.8%), adenotonsillar hypertrophy (28.6%) or loud breathing (28.5 %). Snoring (p<0.001), presence of Goldenhaar features (p=0.001) and FTT (p=0.004) were identified as significant predictors for OSA in patients with UCFM. Race, obesity, cleft lip/palate, upper respiratory complications, presence of adenotonsillar hypertrophy and side of UCFM were not predictors of OSA in our cohort. Patients with UCFM and OSA had significantly lower total flow rate compare to controls. CONCLUSION: The prevalence of OSA in UCFM patients is 3.9 times greater then in the otherwise healthy population. Snoring, presence of Goldenhaar features and FTT were shown to be predictive factors for OSA in the presence of UCFM (Table 1).Table 1: Univariate Analysis.

Sleep Disordered Breathing in Children and Adolescents with Chiari Malformation Type I

Chiari malformation Type I (CM-I) has been associated with sleep disordered breathing (SDB). The aim of this study was to evaluate the prevalence of SDB in CM-I and its clinical correlates in a population of children and adolescents. Fifty-three consecutive children and adolescents affected by CM-I were enrolled (27 girls and 26 boys, mean age 10.3 ± 4.3, range: 3-18 years). All patients underwent neurological examination, MRI, and polysomnography (PSG). Otorhinolaryngologic clinical evaluation was performed in patients with polysomnographic evidence of sleep-related upper airway obstruction. Mean size of the herniation was 9.5 ± 5.4 mm. Fourteen patients had syringomyelia, 5 had hydrocephalus, 31 presented neurological signs, 14 had epileptic seizures, and 7 reported poor sleep. PSG revealed SDB in 13 subjects. Patients with SDB, compared to those without SDB, had a higher prevalence hydrocephalus (p = 0.002), syringomyelia (p = 0.001), and neurological symptoms (p = 0.028). No significant difference was observed in age, gender, prevalence of epilepsy, and size of the herniation. Obstructive SDB was associated with syringomyelia (p = 0.004), whereas central SDB was associated with hydrocephalus (p = 0.034). In our population of CM-I patients the prevalence of SDB was 24%, lower than that reported in literature. Moreover, our findings suggest that abnormalities in cerebrospinal fluid dynamics in CM-I, particularly syringomyelia and hydro-cephalus, are associated with SDB.

The spectrum of sleep-disordered breathing symptoms and respiratory events in infants with cleft lip and/or palate

ObjectiveTo determine the prevalence of sleep-disordered breathing (SDB) symptoms and respiratory events during sleep in infants with cleft lip and/or palate (CL/P).DesignProspective observational study.SettingCleft palate clinic, tertiary care paediatric hospital,...

Prevalence and risk factors of sleep bruxism and wake-time tooth clenching in a 7- to 17-yr-old population

Sleep-related bruxism (SB) and wake-time tooth clenching (TC) have been associated with temporomandibular disorders (TMDs), headache, and sleep and behavioral complaints. This study aimed to assess the prevalence and risk factors of these signs and symptoms in a 7- to 17-yr-old population (n = 604) seeking orthodontic treatment. Data were collected by questionnaire and by a clinical examination assessing craniofacial morphology and dental status. Sleep-related bruxism was reported by 15% of the population and TC was reported by 12.4%. The SB group (n = 58) was mainly composed of children (67.3% were ≤12 yr of age) and the TC group (n = 42) was mainly composed of adolescents (78.6% were ≥13 yr of age). The craniofacial morphology of over 60% of SB subjects was dental class II and 28.1% were a brachyfacial type. Compared with controls (n = 220), SB subjects were more at risk of experiencing jaw muscle fatigue [adjusted OR (AOR) = 10.5], headache (AOR = 4.3), and loud breathing during sleep (AOR = 3.1). Compared with controls, TC subjects reported more temporomandibular joint clicking (AOR = 5), jaw muscle fatigue (AOR = 13.5), and several sleep and behavioral complaints. Sleep- and wake-time parafunctions are frequently associated with signs and symptoms suggestive of TMDs, and with sleep and behavioral problems. Their clinical assessment during the planning of orthodontic treatment is recommended.

Congenital Vocal Cord Paralysis

Congenital stridor is rare. The most common presentation for congenital stridor is chronic loud breathing since birth. It is noticed in patients by the first 4 to 6 weeks of life. There are many causes of congenital stridor. Laryngomalacia is the most common cause of congenital stridor. Congenital vocal cord paralysis is the second most common cause of congenital stridor. Vocal cord paralysis in infants and children can be either congenital or acquired and either unilateral or bilateral. Although most commonly the paralysis is idiopathic, there are many causes of acquired vocal cord paralysis. Arnold-Chiari malformation is the most common congenital central nervous system abnormality resulting in vocal cord paralysis, and central nervous system abnormalities usually may cause bilateral vocal cord paralysis. In this article, we report 2 patients with idiopathic congenital vocal cord paralysis. One of them has the unilateral vocal cord paralysis, and the other, bilateral.

Screening for Obstructive Sleep Apnea in Preschool Children with Cleft Palate

The objective of this study was to explore the prevalence, range of reported symptoms, and clinical risk factors of obstructive sleep apnea in preschool children with cleft lip and/or palate. Questionnaires were distributed to parents/guardians of all children from birth to 5 years of age who were followed by the cleft clinic. Questionnaire data and cleft classification were available for 248 children, with a mean age of 33.4 months. Obstructive sleep apnea was identified in 31.4% of the children. Only 29.5% of children with obstructive sleep apnea had undergone an investigation of these symptoms. The three most common symptoms reported in children with a questionnaire diagnosis of obstructive sleep apnea were (1) "heavy or loud breathing," (2) "easily distracted," and (3) "on the go" or "driven by a motor." The only clinical risk factor associated with a questionnaire diagnosis of obstructive sleep apnea was the presence of a syndrome (chi(2) = 3.5, p = .05). There were no significant differences in risk of obstructive sleep apnea by age, cleft classification, and surgical status. Preschool children with cleft lip and/or palate have a risk of obstructive sleep apnea that is as much as five times that of children without cleft. Obstructive sleep apnea appears to be underrecognized in this group of children. Further research is needed to investigate important risk factors for obstructive sleep apnea in children with cleft lip and/or palate.

Herzschrittmacher-Implantation bei nichterkanntem obstruktivem Schlafapnoe-Syndrom

A cardiac pacemaker was implanted because of nocturnal sinus arrhythmia into a 53-year-old man with hypersomnia. After other patients had reported loud snoring and breathing pauses, which appeared to be dangerously long, polysomnography was performed. It indicated a marked obstructive sleep apnoea syndrome with an apnoea index of 55 and an average apnoea duration of 35 seconds. The nocturnal cardiac arrhythmias disappeared under continuous nasal raised pressure ventilation.

Case 1: Sounds like trouble

A two-year-old boy was brought to his paediatrician for noisy respiration and difficulty breathing during sleep. He had a history of loud snoring and difficulty breathing, which had worsened over the past six to eight months. His sleep was described as restless, and the parents indicated they had observed obstructive apneas in which breathing efforts continued but the snoring stopped for a few seconds. Trials of oral antibiotics and nasal steroids had not resolved the problem. The child was born at 29 weeks’ gestation as the second of triplets. He had had bilateral inguinal herniorrhaphies, but no long-term sequelae of preterm birth had become apparent. Physical examination performed during wakefulness revealed a child in no distress but was remarkable for tonsillar hypertrophy and mouth breathing. There was nasal congestion, and breath sounds were equal and clear. The cardiac examination was normal, with weight just above the 5th percentile for corrected age. A lateral neck radiograph documented adenoidal enlargement. A test was performed that confirmed the child’s diagnosis.

Méthadone et Syndrome d'Apnées du Sommeil

Sleep apnea syndrome occurs when, during sleep, breathing stops for 10 seconds or longer, with an index of 5 times or more an hour. It is clinically characterized by loud snoring at night, continuous or interrupted by pauses followed by loud breathing. Sleep is fitful, broken by arousals, and yields little rest. There is daytime excessive sleepiness with repeated involuntary falling asleep, often unknown by the subject. In this article, we describe an observation of central sleep apnea syndrome in a female patient receiving an opiate replacement therapy. An analysis of the before and after methadone withdrawal polysomnograhic tracing was done for this patient. This diagnosis etiology and physiopathology are critically approached. Clinicians should be careful in treating induced sleep disorders in such patients. Prescribing benzodiazepines during an opiate withdrawal of the methadone type is not recommended when central apnea occurs.

Nighttime Oxygen Desaturation and Symptoms of Sleep-Disordered Breathing in Long-Stay Nursing Home Residents

Sleep-disordered breathing (SDB) is common in older adults and has been implicated as a cause of decreased quality of life and even death. Sparse data exist on SDB in the nursing home setting. The authors evaluated SDB (using attended nocturnal pulse oximetry) in nursing home residents with daytime sleepiness and nighttime sleep disturbance. Pulse oximetry was used to estimate the prevalence of nighttime oxygen desaturation in 109 long-stay nursing home residents (mean [standard deviation] age = 86.2 [9.2] years; 74% women). Pulse oximetry findings were compared to a structured observational measurement of symptoms of SDB, the Observational Sleep Assessment Instrument. Seventy-one participants had concurrent wrist actigraphy to estimate total sleep time during oximetry recording. Using the oxygen desaturation index (ODI; average number of oxygen desaturations 4% or more below the baseline level per hour), the authors found that 40% of the residents had abnormal ODI (ODI more than 5, which is suggestive of SDB). Of all observational variables assessed, only loud breathing during sleep was significantly correlated with ODI (r =.284; p =.003). When ODI was adjusted for estimated total sleep time, higher adjusted ODI was associated with higher body mass index (kg/m(2)). Abnormal ODI is common in nursing home residents. Observed loud breathing at night and high body mass index may suggest that further assessment of SDB is indicated. Future research should determine the importance of SDB and abnormal nocturnal oxygen desaturation on functioning and quality of life in nursing home residents.

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.