Snoring Loudness Research Articles

Քթի միջնապատի ուղղումը մանկական տարիքում

Pediatric septoplasty has been one of the most controversial topics discussed among ENT and plastic surgeons: The aim of the study is to evaluate the outcome of septoplasty several years after performing it during the pediatric age, and if it contributes subsequently to the recurrent deformation of the nasal septum or the external nasal structure. The study also touches on the notion of whether adenoidectomy and/or inferior turbinate reduction without correcting the deviated nasal septum are enough to restore nasal breathing. The study included 56 children aged from 5 to 15 years. All the participating patients were diagnosed with deviated nasal septum, but were divided into 2 groups according to the surgical techniques performed. The first group included 24 patients and their difficult nasal breathing was conditioned by deviated nasal septum, adenoid tissue hypertrophy with 5 of the children also having inferior turbinate hypertrophy. However, they all underwent adenoidectomy and inferior turbinate radiofrequency reduction only. The second group included 32 patients with difficult nasal breathing caused by deviated nasal septum, adenoid tissue hypertrophy with 11 children also having inferior turbinate hypertrophy. All the patients in this group underwent septoplasty, adenoidectomy and where indicated inferior turbinate radiofrequency reduction. All the 24 patients included in the first group exhibited improvement in nasal breathing index from 231,6 ± 9,26 cm3 up to 427,0±5,6 cm3 (p<0,05). As for the snoring loudness scale, there was improvement from 2,6±0,1 to 1,3±0,1 (p<0,05), but without complete disappearance. Patients included in the second group which totalled 32 in number saw improvement in nasal breathing index from 228,5±7,29 cm3 to 592,9±5,29 cm3 (p<0,05) while snoring loudness scale improved from 2,47±0,09 to 0,09±0,05 (p<0,05).

Reliability of parental reporting of child snoring in children referred for obstructive sleep apnea.

Despite the high number of studies based on subjective reports of snoring, self-reported snoring has hardly been validated at all. As there is no "gold-standard" for objective snoring measurements, studies must evaluate whether the presence of snoring based on parental judgement is linked to objective measurements of nasal and/or pharyngeal obstruction in children referred for obstructive sleep apnea. A total of 146 children (median age 11 years) underwent polysomnography (with snoring recording using nasal cannula signal), acoustic rhinometry and pharyngometry, while their parents filled out the Spruyt-Gozal questionnaire assessing both frequency and loudness of subjective snoring. Three categories were further differentiated (null, low and high) for both frequency and loudness. The apnea-hypopnea index was significantly different in the three groups for both frequency (p=0.04) and loudness (p=0.01) of subjective snoring. Children in the low or high groups (frequency or loudness), compared with those in the null group, experienced a decline in both pharyngeal (sitting and supine positions) and nasopharyngeal (supine position) volumes (frequency, pharynx sitting: p=0.03; supine: 0.005 and nasopharynx: p=0.002; loudness, p=0.03; p=0.007 and p=0.03; three group comparisons). Objective snoring frequency during the night obtained with cannula was weakly related to loudness of subjective snoring but not to subjective snoring frequency during the week, and was biased by nasal obstruction. In conclusion, our study showed that parental assessment of snoring is related to a reduction in both pharyngeal and nasopharyngeal volumes in snorers, arguing for the adequacy of their evaluation of both snoring frequency and loudness.

Քթի միջնապատի ուղղումը մանկական տարիքում

Pediatric septoplasty has been one of the most controversial topics discussed among ENT and plastic surgeons. The aim of the study is to evaluate the outcome of septoplasty several years after performing it during the pediatric age, and if it contributes subsequently to the recurrent deformation of the nasal septum or the external nasal structure. The study also touches on the notion of whether adenoidectomy and/or inferior turbinate reduction without correcting the deviated nasal septum are enough to restore nasal breathing. The study included 56 children aged 5-15 years. 33 were male and 23 were female. All the participating patients were diagnosed with deviated nasal septum, but were divided into 2 groups according to the surgical techniques performed. The first group included 24 patients and their difficult nasal breathing was conditioned by deviated nasal septum, adenoid tissue hypertrophy with 5 of the children also having inferior turbinate hypertrophy. However, they all underwent adenoidectomy and inferior turbinate radiofrequency reduction only. The second group included 32 patients with difficult nasal breathing caused by deviated nasal septum, adenoid tissue hypertrophy with 11 children also having inferior turbinate hypertrophy. All the patients in this group underwent septoplasty, adenoidectomy and where indicated, inferior turbinate radiofrequency reduction. All the 24 patients included in the first group exhibited improvement in nasal breathing index from 231,6 ± 9,26 cm3 up to 427,0±5,6 cm3 (P<0,05). As for the snoring loudness scale, there was improvement from 2,6±0,1 to 1,3±0,1 (P<0,05), but without complete disappearance. Patients included in the second group which totalled 32 in number saw improvement in nasal breathing index from 228,5±7,29 cm3 to 592,9±5,29 cm3 P<0,05) while snoring loudness scale improved from 2,47±0,09 to 0,09±0,05 (P<0,05). Our study results have shown us that for pediatric patients diagnosed with deviated nasal septum, it is advisable to perform septoplasty while preserving the corresponding anatomical growth zones, as it provides the patient adequate nasal breathing and prevents potential deformation of facial bone structure in the future.Thus, we can conclude that any cause of difficult nasal breathing in the pediatric age must be alleviated, be it conservatively or surgically, to avoid future complications.

Correlation between oxidative stress and cognitive impairment in patients with obstructive sleep apnea hypopnea syndrome

Background/Aim. It is necessary to find relevant oxidative stress markers for predicting the severity of obstructive sleep apnea-hypopnea syndrome (OSAHS), a sleep disorder-related respiratory disease. The aim of the study was to investigate if there is a correlation between oxidative stress and cognitive impairment in OSAHS patients. Methods. A total of 220 patients were divided into the group of snoring patients, the group with mild to moderate OSAHS, and the group with severe OSAHS according to polysomnography (PSG). Apnea-hypopnea index (AHI), oxygen desaturation index (ODI), and baseline data were monitored. Oxidative stress indices were measured by colorimetry from blood samples taken early in the morning. The patients were then divided into the group with normal cognition and cognitive impairment group based on minimental state examination (MMSE) and Montreal cognitive assessment (MoCA). Independent risk factors for cognitive impairment were analyzed by multi-variate logistic regression. The correlation between oxidative stress and cognitive impairment was analyzed by Pearson?s method. Receiver operating characteristic (ROC) curves made it possible to analyze the efficiency of oxidative stress combined with detection for assessing cognitive impairment in OSAHS patients. Results. The snoring group, mild to moderate OSAHS group, and severe OSAHS group had significantly different snoring loudness, body mass index (BMI), AHI, ODI, MoCA, and MMSE scores, and levels of malondialdehyde (MDA), glutathione peroxidase (GSH-Px), and superoxide dismutase (SOD) (p < 0.05). The cognitive impairment group and group with normal cognition had different BMI, GSH-Px, MDA, SOD, neuroglobin, hypoxia-inducible factor, AHI, and lowest nocturnal oxygen saturation (p < 0.05 or p < 0.01) levels. BMI, GSH-Px, MDA, SOD, neuroglobin, hypoxia-inducible factor, AHI, and lowest nocturnal oxygen saturation were independent risk factors for cognitive impairment. The MoCA and MMSE scores of cognitive impairment had positive correlations with GSH-Px and SOD but negative correlations with MDA (p < 0.05). The area under the ROC curve of GSH-Px, MDA, and SOD and their combination for prediction of cognitive impairment were 0.670, 0.702, 0.705, and 0.836, respectively. Conclusion. Oxidative stress may be the biochemical basis of cognitive impairment in OSAHS patients.

ХРАП И СИНДРОМ ОБСТРУКТИВНОГО АПНОЭ СНА КАК ВОЗМОЖНЫЕ ПРИЧИНЫ СЛУХОВЫХ И ТУБАРНЫХ РАССТРОЙСТВ

Introduction. Snoring occurs in 20,5% of the population, and obstructive sleep apnea syndrome occurs in 5–7% of the population. Primary snoring and obstructive sleep apnea syndrome contribute to the development of a number of diseases of internal organs, among which impairment of auditory and tubal function seems to be understudied. Aim. The aim of the study was to determine the effect of obstructive sleep apnea syndrome and primary snoring on auditory and tubal functions. Material and methods. The study was conducted in two groups: the first group consisted of 30 patients with obstructive sleep apnea syndrome, and the second group consisted of 50 patients with primary snoring. The control group consisted of 50 observed patients without primary snoring and obstructive sleep apnea syndrome. The study protocol included patient questionnaires, examination of oropharyngeal structures, evaluation of auditory function with tonal threshold audiometry and tympanometry. Subgroup assignment was performed after registration of an apnea index of more than 5 episodes per hour. Identified forms of auditory impairment in patients of the study and control groups were processed using StatTech online software with a 95% confidence interval. Results and discussion. The results of the study revealed a statistically significant association between the risk factor (snoring) and the development of tubal dysfunction in both study groups. It was also determined that there were no significant differences in the frequency of hearing loss in the primary snoring and obstructive sleep apnea groups, but when comparing with the control group, it ВЕСТНИК СОВРЕМЕННОЙ КЛИНИЧЕСКОЙ МЕДИЦИНЫ 2021 Том 14, вып. 6 47ОРИГИНАЛЬНЫЕ ИССЛЕДОВАНИЯ was found that the proportion of patients with reduced hearing in the study group was significantly higher. Correlation data were obtained between the duration of snoring and the occurrence of auditory and tubal dysfunction, due to which it can be argued that the form and severity of auditory dysfunction is influenced by the duration of snoring, the time of snoring during the sleep period, and the intensity (loudness) of snoring. The results obtained can be explained by long-term combined effects of noise and hypoxia in sleep in this category of patients, as well as by morphological and functional changes in oropharyngeal structures occurring in primary snoring and obstructive sleep apnea syndrome. Conclusion. In all cases of chronic tubal dysfunction, especially those accompanied by hearing loss, it is advisable to examine the patient for the presence of snoring and apnea.

P134 Modified uvulopalatopharyngoplasty and radiofrequency-in-saline tongue in the management of snoring

Abstract Objective The modified uvulopalatopharyngoplasty has not been investigated as an option in primary snoring. The aim of this study was to determine whether combined palatal and tongue surgery to enlarge and stabilize the upper airway is an effective treatment for patients with primary snoring who cannot tolerate or decline device therapy. Study design This was a retrospective cohort study, and included adult patients with primary snoring who underwent modified uvulopalatopharyngoplasty and radiofrequency-in-saline tongue between January 2009 and December 2020. Patients with clinically significant obstructive sleep apnoea were excluded. Setting Single centre study, based in New South Wales, Australia. Methods Primary outcome measures were the Snoring Severity Scale (a questionnaire, which indicates loudness and frequency of snoring) completed both prior to and following surgery, and the Epworth Sleepiness Scale. Mean questionnaire scores prior to and at three-month follow-up were analysed. Results 97 adult patients underwent upper airway surgery for simple snoring, of which 68 were included in the present study (37.3 ± 11.5 years, n=17 female). The mean SSS prior to surgery was 7.0 ± 1.6 and 1.9 ± 2.3 at 3-month follow up (P < 0.0001).The mean ESS prior to surgery was 9.0 ± 4.8 and 4.1 ± 2.8 at 3-month follow up (P <0.0001). Conclusion The results of this study indicate that modified uvulopalatopharyngoplasty with radiofrequency-in-saline tongue is an effective treatment modality with a low complication rate. This procedure should be offered to carefully selected patients with primary snoring who have failed or declined device therapy.

Validation of snoring detection using a smartphone app

PurposeSnoring is closely related to obstructive sleep apnea in adults. The increasing abundance and availability of smartphone technology has facilitated the examination and monitoring of snoring at home through snoring apps. However, the accuracy of snoring detection by snoring apps is unclear. This study explored the snoring detection accuracy of Snore Clock—a paid snoring detection app for smartphones.MethodsSnoring rates were detected by smartphones that had been installed with the paid app Snore Clock. The app provides information on the following variables: sleep duration, snoring duration, snoring loudness (in dB), maximum snoring loudness (in dB), and snoring duration rate (%). In brief, we first reviewed the snoring rates detected by Snore Clock; thereafter, an ear, nose, and throat specialist reviewed the actual snoring rates by using the playback of the app recordings.ResultsIn total, the 201 snoring records of 11 patients were analyzed. Snoring rates measured by Snore Clock and those measured manually were closely correlated (r = 0.907). The mean snoring detection accuracy rate of Snore Clock was 95%, with a positive predictive value, negative predictive value, sensitivity, and specificity of 65% ± 35%, 97% ± 4%, 78% ± 25%, and 97% ± 4%, respectively. However, the higher the snoring rates, the higher were the false-negative rates for the app.ConclusionSnore Clock is compatible with various brands of smartphones and has a high predictive value for snoring. Based on the strong correlation between Snore Clock and manual approaches for snoring detection, these findings have validated that Snore Clock has the capacity for at-home snoring detection.

Efficacy of pillar implants to reduce snoring and daytime sleepiness.

Objective:To measure the efficacy of pillar implants in reducing snoring.Materials and methods:A total of 30 adult patients who underwent pillar implants were assessed preoperatively and at 1, 3, 6 and 12 months after the implantation. Improvement was measured using snoring frequency, visual analog scale for snoring loudness, and Epworth sleepiness scale for daytime sleepiness.Results:The mean snoring frequency, loudness and Epworth score were reduced from 6.9, 9.2 and 7.4 at the baseline to 5, 5.9 and 5.6, respectively, at 12 months postoperatively (all p < 0.03). The partial implant extrusion rate was 6.7%.Conclusion:We suggest that a pillar implant procedure should be considered before proceeding to more morbid surgeries in patients with snoring and daytime sleepiness.

Snoring and Sleep-Related Symptoms: A Novel Non-Invasive 808 nm Wavelength Diode Laser Non-Ablative Outpatient Treatment. A Prospective Pilot-Study on 45 Patients

Background: Surgical treatments for snoring and sleep-related symptoms are invasive, may have complications, have inconstant success rates, and may have a significant relapse rate. Methods: We evaluated the effectiveness of a non-surgical, non-invasive outpatient 808 nm diode laser treatment. Forty-five patients with snoring and sleep disorders were treated with an Elexxion-Claros® 50W Diode Laser 808-nm using the specific SNORE3 application. The possible presence of obstructive sleep apnea syndrome in patients was diagnosed with Polysomnography. The Epworth sleepiness scale was reported pre- and post-laser treatments. Patients were classified according to both Friedman tongue position and Mallampati classification. During treatment, the pain reported by patients was measured on a visual analogue scale. Results: The following data improved significantly: visual analogue scale for the loudness of snoring, Epworth sleepiness scale, waking up during sleep because of snoring, dreaming during the night, dry mouth on awakening, daytime sleepiness, tiredness on awakening, Mallampati score, Friedman tongue position and degree of oropharynx at nose, oropharynx, hypopharynx, and larynx classification (p &lt; 0.001). A cessation of choking in 89% of the patients and of restless legs syndrome in 83% of the patients (p ≤ 0.005 and p ≤ 0.025) was also noted after the laser treatments. All of the patients who reported suffering from headaches upon waking (10 subjects) reported the complete cessation of this phenomenon after laser therapy. Conclusions: diode laser treatment is a promising procedure not only in reducing the loudness of snoring, but also in raising the global quality of sleep, a statistically significant reduction of AHI, and a cessation of bothersome phenomenon related to apnea. Results were sustainable at one year post-treatment.

Quantification of the loudness of snoring according to Watch-PAT-200 and its relationship with the severity of obstructive sleep apnea syndrome

Evaluate the capabilities of Watch-PAT-200 in obtaining data to determine the relationship between the loudness of snoring and the severity of obstructive sleep apnea syndrome (OSAS). From 2017 to 2019, 208 patients with complaints of nocturnal snoring were examined. Apnea / hypopnea indices (AHI) and respiratory distress index (RDI) were assessed. The study was carried out on a Watch-PAT-200 portable device (Itamar Medical, Israel). The average volume of snoring (dB) and the proportion (%) of sleep time with the intensity of snoring over 50.60 and 70 dB were measured. The correlation of the obtained data with the AHI and RDI indices is estimated. During the study, it was found that the volume of snoring increases as the severity of OSAS increases, therefore, the volume of snoring can be an indicator of the severity of OSAS. There are ample opportunities for screening diagnostics of the loudness of snoring with the subsequent consultation of a somnologist and timely prescription of treatment. Due to the objectivity of the obtained data and ease of use, the Watch-PAT-200 device can be used in outpatient practice for screening diagnostics of snoring and OSAS in the population.

Snoring: is a reliable assessment possible?

PurposeIt is not easy to assess how severe and annoying a patient’s snoring is. Solid parameters are lacking; snorers cannot deliver a reliable self-assessment and it is uncertain whether bed partners’ statements can be relied upon. The purpose of the present study was therefore to investigate whether and how well snoring assessment based on acoustic parameters and bed partners’ reporting agree.MethodsIn a double-blind, placebo-controlled study on snoring treatment, several acoustic parameters [snoring index (SI), percentage snoring time (ST), sound pressure level, sound energy, loudness, psychoacoustic annoyance and psychoacoustic snore score (PSS)] were measured in 18 subjects during 24 polysomnographies. Bed partners also assessed snoring annoyance and loudness as well as treatment outcome.ResultsNo correlation was found between the subjective annoyance caused by snoring and the acoustic parameters. Regarding perceived loudness, there was a moderate, significant correlation with loudness (N5) and PSS over the hour with the highest SI. SI, ST, LAeq and maximum sound pressure level dB(A)max showed no significant correlation. After the intervention only mean sound energy LAeq over the entire night showed a significant correlation (rs = 0.782; p = 0.022) with bed partners’ assessments. However, this result was not confirmed in the second control night.ConclusionsThe non-existent or only weak correlation between bed partners’ ratings and objective parameters indicate that snoring severity should be evaluated with caution. Neither acoustic parameters, at least for one measurement over just one night, nor bed partners’ ratings should be used as the sole basis for snoring assessment.

Evolution and Predictive Factors of Improvement of Obstructive Sleep Apnea in an Obese Population After Bariatric Surgery.

Our objectives were to determine in an obese population (body mass index > 35 kg/m²) the number of patients, after gastric bypass (GBP), who no longer met French Ministry of Health criteria for utilizing positive airway pressure (PAP), and the predictive factors of obstructive sleep apnea (OSA) improvement. Between June 2012 and August 2014 we diagnosed OSA in 129 incident patients requiring PAP therapy before GBP. A postoperative sleep recording was undertaken for 44 of these patients after a weight loss of at least 10%. Most of the patients showed severe OSA with a mean [standard deviation] apnea-hypopnea index (AHI) of 52.8 [23.8] events/h. The body mass index was 46.1 [5.1] kg/m². All the patients were treated via PAP and most of them via auto-titrating PAP with a range of 4-16 cmH₂O. Following the GBP, in 31 patients (70.5%) OSA was improved, allowing PAP to be stopped (AHI < 15 events/h). The Epworth Sleepiness Scale score, the modified Medical Research Council dyspnea scale, the loudness of snoring, and sleep structure were improved. AHI was decreased by a mean of 40.9 [22.4] events/h (P < .001). In a multivariate logistic regression model, age (P = .018) and sleep oxygen desaturation index (P = .049) appeared to predict improvement of OSA. After GBP, 70.5% of the patients no longer met French Ministry of Health criteria for utilizing PAP, allowing discontinuation of this treatment. At diagnosis, a younger age and a less severe sleep oxygen desaturation were predictive factors of this improvement.

The palatal septal cartilage implantation for snoring and obstructive sleep apnea

ObjectivePatients with snoring and obstructive sleep apnea frequently have nasal and palatal obstruction. The objective of this study was to investigate the safety and feasibility of a palatal septal cartilage implant (SCI) for snoring and obstructive sleep apnea. MethodsThis was a preliminary study of 10 consecutive patients who were enrolled retrospectively from electronic charts. The patients had undergone a single-stage operation including septoturbinoplasty and palatal SCI at a tertiary referral hospital. After nasal surgery, the harvested cartilage was prepared and trimmed into strips for palatal implantation. Key procedures of palatal SCI include vertical tunneling of the midline and paramedian soft palate, insertion of the septal cartilage strips, and fixation suture of the implants. The primary outcome measures were adverse events, including implant extrusion, infection, bleeding, velopharyngeal insufficiency and globus symptoms, assessed by the Glasgow–Edinburgh Throat Scale (GETS) questionnaire (10-item, 8-grade [0–7] Likert scale). Secondary outcomes were subjective snoring loudness (visual analogue scale, VAS), excessive daytime sleepiness (Epworth sleepiness scale, ESS) and objective apnea-hypopnea index. All patients were followed up for at least 1 year. ResultsNone of the aforementioned adverse events were noted during the one-year follow-up. Among the ten items of the GETS, the median score of nine items was 0, and the median score of the total GETS was 2.0, which was classified as “asymptomatic”. The snoring loudness improved significantly from 8.0 points (IQR 8.0–9.0) preoperation to 4.0 points (IQR 2.5–6.0) at 3 months postoperation and 4.5 points (IQR 3.3–6.0) at 1 year postoperation (P=0.002 and P=0.002, respectively). The ESS score improved significantly from 11.5 points (IQR 8.3–18.5) preoperation to 8.0 points (IQR 6.3–10.8) at 3 months postoperation and 8.5 points (IQR 6.3–10.8) at 1 year postoperation (P=0.004 and P=0.004, respectively). The apnea-hypopnea index significantly decreased from 54.7 (IQR 23.4–62.8) to 20.5 (IQR 14.7–45.6) (P=0.047) in patients with a lower tongue position (modified Mallampati class≤II; n=7). ConclusionPalatal SCI is a safe and feasible procedure. The advantages include providing implants of tailor-made length, biocompatible autologous cartilage and no need for extra-payment for the implant material. By using the SCI procedure, both nasal obstruction and sleep-disordered breathing can be managed in a single-stage operation. The long-term effectiveness of SCI deserves further research.

The structural changes of upper airway and newly developed sleep breathing disorders after surgical treatment in class III malocclusion subjects.

Bimaxillary surgery is the traditional treatment of choice for correcting class III malocclusion which is reported to cause an alteration of oropharyngeal structures and upper airway narrowing that might be a predisposing factor for obstructive sleep apnea (OSA). This study aimed to analyze sleep parameters in class III malocclusion subjects and ascertain the prevalence of snoring or OSA following bimaxillary surgery.A total of 22 patients with Le Fort I osteotomy and mandibular setback for class III malocclusion were prospectively enrolled. All patients received endoscopic examination, cephalometry, 3-dimensional computed tomography (3D-CT), and sleep study twice at 1 month before and 3 months after surgery.The patient population consisted of 5 males and 17 females with a mean body mass index of 22.5 kg/m2 and mean age of 22.1 years. No patients complained of sleep-related symptoms, and the results of sleep study showed normal values before surgery. Three patients (13%) were newly diagnosed with mild or moderate OSA and 6 patients (27%) showed increased loudness of snoring (over 40 dB) after bimaxillary surgery. According to cephalometric analysis and 3D-CT results, the retropalatal and retroglossal areas were significantly narrowed in class III malocclusion patients, showing snoring and sleep apnea after surgery. In addition, the total volume of the upper airway was considerably reduced following surgery in the same patients.Postoperative narrowing of the upper airway and a reduction of total upper airway volume can be induced, and causes snoring and OSA in class III malocclusion subjects following bimaxillary surgery.

Septoplasty is Promising for Improving Snoring

Abstract Background: An appropriate quantity of sleep is of paramount importance with respect to avoiding illnesses and facilitating the recuperation of the immune system. Sleep deprivation may result in health issues such as hypertension, weight gain, memory loss and diabetes. Snoring and obstructive sleep apnea syndrome (OSAS) are prevalent and important causes of sleep disturbance that have significant physical and social consequences. Any intervention that improves snoring will improve the quality of life of individuals who snore. Objective: The aim of this study was to assess the success and efficacy of septoplasty for patients with snoring. Methods: A total of 120 consecutive patients who underwent septoplasty between May 2011 and January 2015 to treat chronic nasal obstruction and troublesome snoring with sleep disturbance were included in this prospective, non-randomized study. Detailed rhino-pharyngo-laryngological examinations were performed for all patients. Patients not only completed questionnaires that addressed their complaints and their demographic information but were also questioned regarding their ease of breathing, their use of medications before and after surgery and their satisfaction with the surgical outcome. The Nose Obstruction Symptom Evaluation (NOSE) scale was also completed for all patients. Results: A total of 120 patients completed the study, 56% of whom were male and 44% of whom were female. The patients’ mean age and body mass index (BMI) were 34.8 ± 7.4 yrs and 23.66 ± 5.4 kg/m2 , respectively. Sixteen patients (13.3%) were diabetic, and 14 patients (11.6%) were hypertensive. The patients’ mean postoperative NOSE scores and ease-of-breathing scores were significantly improved after septoplasty relative to before septoplasty (p<0.05 for each metric), and both improvements were sustained for at least 6 months after surgery. Patient satisfaction was extremely high; 79 patients (65.8%) reported relief from snoring, whereas the remaining patients reported experiencing a decrease in the loudness of snoring and better uninterrupted sleep. Conclusion: Septoplasty is an effective procedure to relieve snoring in patients with nasal obstruction. Septoplasty improved the quality and duration of uninterrupted sleep. The majority of patients experienced improvement after surgery, and these improvements were sustained for at least six months. The patients’ satisfaction levels were high. Septoplasty is therefore promising for patients who snore due to nasal obstruction.

Relationship Between Snoring Intensity and Severity of Obstructive Sleep Apnea.

ObjectivesThe aim of this study was to determine the relationship between the intensity of snoring and severity of sleep apnea using Watch-PAT (peripheral arterial tone) 100.MethodsA total of 404 patients (338 males and 66 females) who underwent home-based portable sleep study using Watch-PAT 100 for obstructive sleep apnea (OSA) from January 2009 through December 2011 were included in this study. Subjects were divided into 4 groups; no OSA (PAT apnea hypopnea index [pAHI]<5/hour), mild OSA (5≤pAHI<15/hour), moderate OSA (15≤pAHI<30/hour), or severe OSA groups (pAHI≥30/hour). Mean snoring intensity and percent sleep time with snoring intensity greater than 40, 50, and 60 dB were measured by Watch-PAT 100. Correlations of these parameters with apnea hypopnea index (AHI), respiratory disturbance index (RDI), and oxygen desaturation index were assessed.ResultsThe mean age and body mass index were 46.5±14.8 years and 24.7±3.4 kg/m2, respectively. Mean AHI and RDI were 16.5±15.3/hour and 20.8±14.3/hour, respectively. The mean snoring intensity in the no, mild, moderate, and severe OSA groups was 44.0±2.7, 45.4±6.0, 47.7±5.0, and 50.5±5.6 dB, respectively (P<0.001). There was a positive correlation between snoring intensity and pAHI or PAT RDI (pRDI) (r=0.391 and r=0.385, respectively, both P<0.001). There was also a positive correlation between percent sleep time with the snoring intensity greater than 50 dB and pAHI or pRDI (r=0.423 and r=0.411, respectively, both P<0.001).ConclusionThis study revealed that the intensity of snoring increased with the severity of sleep apnea, which suggests that the loudness of snoring might be an indicator of the severity of OSA.

Transoral robotic surgery for obstructive sleep apnea in Asian patients: a Singapore sleep centre experience.

This study investigates the effectiveness of combined palatal surgery and transoral robotic surgical (TORS) tongue base reduction with partial epiglottidectomy in the treatment of obstructive sleep apnea (OSA) in an Asian context. To our knowledge, this is the first report on TORS for OSA in Asian patients in the literature. To report our preliminary experience with combined TORS tongue base reduction and partial epiglottidectomy with palatal surgery as a multilevel surgical treatment strategy for moderate to severe OSA in Asian patients for whom positive airway pressure treatment had failed. A retrospective study of prospectively collected data on 40 Asian patients who underwent primary TORS tongue base reduction with partial epiglottidectomy and palatal surgery for treatment of moderate to severe OSA at an academic tertiary surgical center. Transoral robotic surgery and palatal surgery for surgical management of OSA in patients for whom positive airway pressure treatment had failed. Twenty patients with complete preoperative and postoperative overnight polysomnograms were evaluated for surgical success and cure, according to traditional surgical criteria, and for subjective outcome measures (snoring and satisfaction on visual analog scale [VAS] and Epworth Sleepiness Scale [ESS]) as well as complications. Traditional cure (apnea-hypopnea index [AHI] <5/h) was achieved in 7 of 20 patients (35%), traditional success (AHI <20 [>50% reduction in AHI]) was achieved in another 11 patients (55%), and failure was observed in 2 patients (10%). Subjective improvement in snoring, satisfaction, and ESS score was observed. Improvement in mean (SD) ESS score and snoring loudness on VAS were statistically significant, from 12.4 (2.87) to 6.4 (1.43) and 8.7 (0.8) to 3.5 (1.7), respectively (P < .001 for both). None of the patients needed postoperative tracheostomy. Recorded complications included tonsillar fossa bleeding, pain, temporary dysgeusia, numbness of the tongue, and temporary dysphagia. Transoral robotic surgery for tongue base reduction and partial epiglottidectomy for moderate to severe OSA in Asian patients for whom positive airway pressure treatment had failed is associated with good efficacy and low complication rates.

Singing Exercises Improve Sleepiness and Frequency of Snoring among Snorers—A Randomised Controlled Trial

Objectives: To assess the effectiveness of regular singing exercises in reducing symptoms of snoring and sleep apnoea. Methods: A prospective single blinded randomised controlled trial was conducted in the otolaryngology department of a UK teaching hospital (Exeter). 127 adult patients with a history of simple snoring or sleep apnoea were recruited. 93 patients completed the study. Patients were excluded because of severe sleep apnoea (apnoea index > 40), or morbid obesity (BMI > 40). The study group completed a self-guided treatment programme of singing exercises contained on a 3CD box set, performed for 20 minutes daily. Outcome measures included the Epworth Sleepiness Scale, the SF-36 generic quality of life assessment tool, visual analogue scales (VAS range 0-10) of snoring loudness and frequency, and visual analogue scale of compliance (for intervention group). Results: The Epworth scale improved significantly in the experimental group compared to the control group (difference -2.5 units; 95% CI -3.8 to -1.1; p = 0.000). Frequency of snoring reduced significantly in the experimental group (difference -1.5; 95% CI -2.6 to -0.4; p = 0.01), and loudness of snoring showed a trend to improvement which was non-significant (difference -0.8; 95% CI -1.7 to 0.1; p = 0.08). Compliance with exercises was good; median 6.6 (quartiles = 4.1, 8.3). Conclusions: Improving the tone and strength of pharyngeal muscles with a 3 months programme of daily singing exercises reduces the severity, frequency and loudness of snoring, and improves symptoms of mild to moderate sleep apnoea.

Screening of Pediatric Sleep-Disordered Breathing: A Proposed Unbiased Discriminative Set of Questions Using Clinical Severity Scales

Identification of sleep-disordered breathing (SDB) using questionnaires is critical from a clinical and research perspective. However, which questions to use and how well such questionnaires perform has thus far been fraught with substantial uncertainty. We aimed at delineating the usefulness of a set of questions for identifying pediatric SDB. Random prospective sampling of urban 5- to 9-year-old children from the community and enriched for habitual snoring underwent overnight sleep study. Subjective indicators or questions were evaluated to further characterize and discriminate SDB. Of 1,133 subjects, 52.8% were habitual snorers. This sample was analyzed based on a clinical grouping (ie, established apnea-hypopnea index cutoffs). Several statistical steps were performed and indicated that complaints can be ranked according to a severity hierarchy: shake child to breathe, apnea during sleep, struggle breathing when asleep, and breathing concerns while asleep, followed by loudness of snoring and snoring while asleep. With a posteriori cutoff, a predictive score &gt; 2.72 on the severity scale was found (ie, area under the curve, 0.79 ± 0.03; sensitivity, 59.03%; specificity, 82.85%; positive predictive value, 35.4; negative predictive value, 92.7), making this cutoff applicable for confirmatory purposes. As a result, the set of six hierarchically arranged questions will aid the screening of children at high risk for SDB but cannot be used as the sole diagnostic approach.

Selected surgical managements in snoring and obstructive sleep apnea patients

SummaryBackgroundThe diagnostic process and the surgical procedures in patients with snoring and obstructive sleep apnea syndrome (OSAS) are crucial. The aim of this study was to assess the efficacy of surgical treatment in snoring and OSAS patients.Material/MethodsA precise laryngological examination and screening polysomnography (Poly-Mesam) were performed in all patients with mild, moderate and severe OSAS before and 6 months after surgery. The patients completed questionnaires concerning their complaints. We included patients qualified to septoplasty, laser-assisted uvulopalatoplasty (LAUP), uvulopalatopharyngoplasty (UPPP) and radiofrequency-induced thermotherapy of the tongue base (RITT). Outcome evaluation of surgery was performed on the basis of data received from follow-up laryngological examinations, selected parameters obtained from the Poly-Mesam test and follow-up questionnaires.ResultsIn most cases we observed improvement, defined as decreasing some sleep parameters, such as a respiratory disturbance index (RDI), by more than 50%, decreasing the loudness of snoring, decreasing the number of hypopneas, and obtaining better blood saturation values. After UPPP we noticed changes in retropalatal space, soft palate dimensions and uvula-posterior pharyngeal wall distance. In the postoperative period we did not observe severe complications. In some cases we found short-lived palatal deficiency after UPPP. Patients after RITT experienced discomfort and throat pain lasting from 2 to 4 days. In 2 patients we observed swelling of the tongue base, which decreased after few days.ConclusionsSurgery in OSAS contributes to normalization of some sleep parameters. The majority of patients experienced improvement after surgery.