Severe Snoring Research Articles

Abstract 4112876: Sex Differences in the Relationship Between Self-reporting of Snoring and Cardiovascular Risk

Background: Identifying risk factors for CVD is critical for effective prevention and management. While classic CVD risk factors have been extensively studied, there is a scarcity of research on the association between snoring and CVD risk, particularly in the context of gender differences. Methods: This study utilized data from the National Health and Nutrition Examination Survey (NHANES) conducted between 2015 and 2020. Participants were initially categorized based on the severity of snoring or the presence of snoring. Logistic regression analysis was employed to control for potential confounding variables. Within the snoring group, they were further classified by gender. The utilization of propensity score matching and logistic regression analysis ensured comparability between different genders. Results: Our study included 12,681 participants aged 18 years or older. When compared to the non-snoring group, individuals in the moderate snoring group had a higher odds ratio (OR) of 1.418 (95% CI 1.083 to 1.857, p = 0.011), while those in the severe snoring group had a higher odds ratio (OR) of 1.882 (95% CI 1.468 to 2.409, p < 0.001). In the snoring group, individuals were further categorized by gender: 4527 males and 4131 females. Importantly, male patients showed a higher odds ratio for atrial fibrillation (4.945, 95% CI 1.187 to 20.598, p = 0.028) compared to females. Additionally, male patients had a higher odds ratio for coronary heart disease (2.002, 95% CI 1.152 to 3.479, p = 0.014) compared to females. Conclusion: Sex plays a significant role in the relationship between snoring and CVD risk. males with snoring have a higher risk of developing CVD compared to females. In particular, male snorers are nearly five times more likely to develop atrial fibrillation and about twice as likely to experience coronary artery disease in comparison to female snorers.

Sex Differences in the Relationship Between Self-Reporting of Snoring and Cardiovascular Risk:An Analysis of NHANES.

Identifying risk factors for cardiovascular disease (CVD) is critical for effective prevention and management. While classic CVD risk factors have been extensively studied, there is a scarcity of research on the association between snoring and CVD risk, particularly in the context of sex differences. This study utilized data from the National Health and Nutrition Examination Survey (NHANES) conducted between 2015 and 2020. Participants were initially categorized based on the severity of snoring or the presence of snoring.Within the snoring group, they were further classified by sex. Analysis was carried out using multivariate logistic regression. Our study included 12,681 participants aged 18 years or older. When compared to the non-snoring group, individuals in the moderate snoring group had a higher odds ratio (OR) of 1.418 (95% CI 1.083 to 1.857, p = 0.011), while those in the severe snoring group had a higher OR of 1.882 (95% CI 1.468 to 2.409, p < 0.001). In the snoring group, individuals were further categorized by gender: 4527 males and 4131 females. Importantly, male patients showed a higher OR for atrial fibrillation (4.945, 95% CI 1.187 to 20.598, p = 0.028) compared to females. Additionally, male patients had a higher OR for coronary heart disease (2.002, 95% CI 1.152 to 3.479, p = 0.014) compared to females. Sex plays a significant role in the relationship between snoring and CVD risk. Males with snoring have a higher risk of developing CVD compared to females. In particular, male snorers are nearly five times more likely to develop atrial fibrillation and about twice as likely to experience coronary artery disease in comparison to female snorers. It is recommended that healthcare providers and public health officials prioritize cardiovascular risk assessments for male individuals who exhibit symptoms of snoring.

Abstract P527: Acculturation and Family History Are Associated With Sleep Disturbances in US Americans of South Asian Origin

Introduction: Sleep disorders are an important risk for cardiovascular disease. Although the effects of sleep-disordered breathing have been widely studied in general populations, there is a gap in understanding its prevalence and determinants among South Asians in the United States of America (US), a group with high risk of cardiometabolic disease that presents unique genetic burdens and acculturation issues. We examined the association of family history of sleep disturbances and acculturation in a survey of South Asian immigrants. Methods: We surveyed 105 US South Asian participants (20-75 years, 69% male, 92% born in South Asia) recruited at a community event. Respondents provided information on age, gender, acculturation (measured by the adoption of English spoken at home), and family history of severe snoring in first degree relatives. We used a modified Berlin Sleep Questionnaire, where the obesity criterion was replaced with current diabetes to identify persons with high-risk sleep disturbances and asked about severe snoring in first degree relatives to identify family history of sleep disturbances. We examined the association of high-risk sleep disturbances with family history and acculturation metrics using Chi-squared tests, followed by logistic regression analysis. Results: Of the 105 participants, 28 (26.7%) were identified as high-risk for sleep disturbances. Those at high risk had a median age of 61 years, significantly older than their low-risk counterparts (median age 53; p=0.015). Of the 55% individuals who were acculturated to now speak English at home, 34% had high risk sleep disturbances as compared to 17% with sleep disturbances among those that continued to speak their native non-English language (p=0.044). Of the 10% individuals whose siblings had severe snoring problems, 50% had high risk sleep disturbances vs. 24% in those without sibling history (p = 0.079). In logistic regression models adjusting for age and gender, both sibling history (Odds Ratio 4.6, 95% CI 1.0 to 20.3, p = 0.047) and acculturation (Odds Ratio 3.0, 95% CI 1.1 to 8.6, p = 0.037) were associated with high-risk sleep disturbances. Conclusions: Acculturation as measured by adoption of English as the home language and family history of severe snoring are both associated with sleep disturbances among US South Asians in. Healthcare providers should be especially vigilant for sleep disorders in acculturated South Asian patients and those with such family and social history. Further studies are needed to understand the relationships between genetic predispositions, acculturation, and environmental factors in this population.

ASSOCIATION BETWEEN OBSTRUCTIVE SLEEP APNEA SYMPTOMS AND INCIDENCE OF DE NOVO HYPERTENSION IN A LARGE FRENCH POPULATION-BASED EPIDEMIOLOGICAL COHORT

Objective: There is a strong association between Obstructive Sleep Apnea (OSA) and hypertension but the effects of OSA symptoms on the risk of incident hypertension in previously normotensive individuals are not well documented. The aim of this prospective cohort study was to examine whether OSA symptoms (snoring and sleepiness) are associated with the incidence of hypertension independently of confounding factors including body mass index. Design and method: Data from the French population-based CONSTANCES cohort were analyzed. Participants, aged 18 to 69 years, were included between 2012 and 2016, and screened for OSA in 2017 using the Berlin Questionnaire. Snoring and sleepiness were assessed from the questionnaire, and considered as severe when they were declared to occur at least three times a week. Individuals who had a history of treated OSA, cardiovascular diseases or hypertension (defined either by blood pressure of 140/90 mmHg or more at the inclusion visit, or by self-reported hypertension or antihypertensive drugs delivering until 2017) were excluded from these analyses. We used Cox models, adjusted for age, gender, smoking, alcohol consumption, physical activity, education level, household income and body mass index, to compute hazards ratios (HR) of incident treated hypertension (defined by antihypertensive drugs delivering through linkage to the National Health Data System (SNDS)) until December 2020. Results: Among 36,798 normotensive subjects, the prevalence of high risk of OSA according to Berlin questionnaire was 7.6% and the incidence of treated hypertension was 4.2%. Risk of de novo treated hypertension increased significantly in participants who declared symptoms of severe snoring (adjusted HR [95% CI] = 1.17 [1.04-1.31]), severe sleepiness after sleep (adjusted HR [95% CI] = 1.18 [1.03-1.36]) and severe sleepiness during waking time (adjusted HR [95% CI] = 1.40 [1.23-1.64]), and increased with the weekly frequency of these symptoms with a dose-dependent relationship (p for trend &lt;0.005). Conclusions: Self-declared snoring and sleepiness are associated with an increased risk of developing de novo hypertension. Our results suggest that primary care patients should be routinely screened for these symptoms, not only to identify possible OSA, but also to encourage preventive measures and regular blood pressure monitoring.

Prevalence, treatment and determinants of obstructive sleep apnoea and its symptoms in a population-based French cohort.

Obstructive sleep apnoea (OSA) is associated with increased morbidity and mortality. Although the disorder has been well studied in selected high-risk populations, few data exist on its prevalence in the general population. We aimed to assess the prevalence and determinants of OSA in France. Data from participants of the French population-based CONSTANCES cohort aged 18-69 years at inclusion and being treated for sleep apnoea or screened for OSA in 2017 using the Berlin Questionnaire were analysed. Weighted analyses were performed to provide recent and representative results in the general population. Among 20 151 participants, the prevalence of treated sleep apnoea was 3.5% (95% CI 3.0-3.9%). The prevalence of untreated subjects with a positive Berlin Questionnaire was 18.1% (95% CI 17.3-19.2%) for a total weighted prevalence of treated sleep apnoea or high risk of OSA of 20.9% (95% CI 20.0-21.9%). Regarding prevalence of OSA symptoms, it was 37.2% (95% CI 36.1-38.3%) for severe snoring and 14.6% (95% CI 13.8-15.5%) for hypersomnolence. In multivariable logistic regression analysis, male sex, age, previous cardiovascular events, smoking, low educational level, low physical activity and depressive symptoms were associated with having either treated sleep apnoea or a positive Berlin Questionnaire. In this large French population-based cohort, one in five participants had a high likelihood of OSA, whereas only 3.5% were treated for the disorder, suggesting major underdiagnosis in the general population. OSA diagnosis should be considered more often in people with risk factors such as depressive symptoms as well as unhealthy behaviours and socioeconomic conditions.

Influence of Snoring on the Incidence of Metabolic Syndrome: A Community-Based Prospective Cohort Study in Rural Northeast China.

In recent years, there has been an increase in the incidence of metabolic syndrome (MetS) in rural China. Thus, for better intervention, it is necessary to identify the possible risk factors of MetS. This community-based prospective cohort study was performed to evaluate the relationship between the snoring status and incidence of MetS. In this Northeast China rural cardiovascular health study, 4980 residents aged ≥35 years (2586 men and 2394 women; follow-up proportion: 87.5%) at baseline were recruited between 2012 and 2013 and were followed up between 2015 and 2017. The primary outcome was the incidence of MetS, as defined by the unified criteria for MetS defined in 2009. The residents were classified based on their snoring status, and the outcomes were compared between the two groups. The odds ratio (OR) for MetS incidence was estimated using a logistic regression model and adjusted for confounding factors. With a median follow-up duration of 4.6 years, the MetS incidence was higher among the snorers (men, 26.2%; women, 33.5%) than in the non-snorers (men, 19.7%; women, 23.2%). The participants' diastolic blood pressure was increased at follow-up as compared with the baseline values among the male snorers; however, a decrease was noted among the male non-snorers. Similarly, the female snorers had higher blood glucose levels during the follow-up, whereas the non-snorers had lower blood sugar levels. A significant association was noted between snoring and the incidence of MetS (adjusted OR = 1.51; 95% confidence interval = 1.32-1.74). Moreover, the incidence of severe snoring increased with increased levels of snoring, with severe snorers having an OR twice as high as that of the non-snorers (adjusted OR = 2.10; 95% confidence interval = 1.38-3.20). Overall, snoring was independently associated with a higher incidence of newly diagnosed MetS in rural Northeast China. Thus, more attention should be paid to residents with snoring problems.

Lnc-THRIL and miR-125b relate to disease risk, severity, and imbalance of Th1 cells/Th2 cells in allergic rhinitis.

Tumor necrosis factor and HNRNPL-related immunoregulatory long noncoding RNA (lnc-THRIL) and its target microRNA (miR)-125b are reported to regulate immune response through several means by participating in allergic rhinitis (AR) pathology. This study aimed to investigate the role of lnc-THRIL and miR-125b in detecting AR risk, and to further explore their correlation with disease severity and cytokines released from T helper type (Th) 1 and Th2 in AR patients. A total of 160 AR patients and 80 subjects with severe snoring symptoms (as controls) were recruited. Nasal mucosa samples were collected to measure the expressions of lnc-THRIL, miR-125b, and Th1 and Th2 cytokines by reverse transcription quantitative polymerase chain reaction. The expression of lnc-THRIL decreased while that of miR-125b increased in AR patients when compared with that of controls, and further receiver operating characteristic curve showed that both could well distinguish AR patients from controls. Furthermore, lnc-THRIL negatively correlated with miR-125b in AR patients. lnc-THRIL was negatively correlated with Individual Nasal Symptom Score (INSS) (including nasal rhinorrhea score, sneezing score, and congestion score) and Total Nasal Symptom Score (TNSS), and miR-125b was positively associated with INSS (including itching score, sneezing score, and congestion score) and TNSS. Moreover, lnc-THRIL was correlated with increased Th1 cytokines (interferon-gamma (IFN-γ) and interleukin (IL)-2) but with decreased Th2 cytokines (IL-4 and IL-10), while miR-125b exhibited opposite trends in AR patients. lnc-THRIL and its target (miR-125b) relate to disease risk, symptom severity, and Th1/Th2 imbalance of AR, suggesting their potential as biomarkers for AR management.

Sleep problems in fragile X syndrome: Cross-sectional analysis of a large clinic-based cohort.

Fragile X syndrome (FXS), the leading cause of inherited intellectual disability and autism spectrum disorder, is associated with multiple neurobehavioral abnormalities including sleep difficulties. Nonetheless, frequency, severity, and consequences of sleep problems are still unclear. The Fragile X Online Registry with Accessible Research Database (FORWARD-version-3), including Clinician Report and Parent Report forms, was analyzed for frequency, severity, relationship with behavioral problems, and impact of sleep difficulties in a mainly pediatric cohort. A focused evaluation of sleep apnea was also conducted. Six surveyed sleep difficulties were moderately frequent (~23%-46%), relatively mild, affected predominantly younger males, and considered a problem for 7%-20% of families. Snoring was more prevalent in older individuals. All sleep difficulties were associated with irritability/aggression and most also to hyperactivity. Only severe snoring was correlated with sleep apnea (loud snoring: 30%; sleep apnea: 2%-3%). Sleep difficulties are prevalent in children with FXS and, although they tend to be mild, they are associated with behavioral problems and negative impact to families. Because of its cross-sectional nature, clinic-origin, use of ad hoc data collection forms, and lack of treatment data, the present study should be considered foundational for future research aiming at better recognition and management of sleep problems in FXS.

THE NH-OSA SCORE IN PREDICTION OF CLINICALLY SIGNIFICANT OSA AMONG THAI POPULATION: DERIVATION AND VALIDATION STUDIES

TOPIC: Sleep Disorders TYPE: Original Investigations PURPOSE: Obstructive sleep apnea (OSA) is a common condition which leads to morbidity, especially cardiovascular events. Polysomnography (PSG) is considered the gold standard for diagnosis of OSA however has limited availability and high cost. Despite the development of various screening tools, such as the STOP-BANG Score, the Berlin Questionnaire, the Epworth Sleepiness Scale (ESS), and the NoSAS Score, these tools are validated in Caucasian populations and mainly consist of anthropometric obesity index. This differs from the OSA among Asian population which usually, appears in non-obese patients, and are caused by craniofacial abnormalities. We aimed to develop and validate a risk score in prediction of clinically significant OSA among Thai patients. METHODS: The NH-OSA score (NH-OSA), which consists of the follows; having neck circumference of 13 inches (in female) or 15 inches (in male), or greater (total of 1 point), presence of hypertension (total of 4 points), having body mass index; BMI of 23-24.9 kg/m2, 25-30 kg/m2, greater than 30 kg/m2 (Total of 3,5,7 points, respectively), presence of moderate or severe snoring (total of 9 points), and age of 40 years or greater (total of 5 points), were collected from 1,798 adult patients underwent full-night or split-night PSG in King Chulalongkorn Memorial Hospital from year 2017 to 2019. Clinical risk score was developed using multiple factor analysis and logistic regression. Patients at risk of clinically significant OSA were defined by apnea/hypopnea index (AHI) of 15 or greater. Of the enrolled, 450 patients were randomly included in the internal validation study. Moreover, the NH-OSA was externally validated at the sleep center of Bangkok Christian Hospital. RESULTS: With cutoff value at 14 points, the sensitivity, specificity, and positive likelihood ratio of NH-OSA were 82.1%, 68.7% and 2.62 respectively. The AUC was 0.75 (95%CI 0.73 – 0.78). Both internal and external validation study revealed high AUC of 0.74 (0.68-0.80), 0.75 (0.60-0.90), respectively. These were greater when compared to the STOP-BANG Score (AUC 0.68, 95% CI 0.65-0.71, p < 0.0001), the Berlin Questionnaire (AUC 0.59, 95%CI 0.56-0.62, p < 0.0001), ESS score (AUC 0.49, 95% CI 0.46-0.51, p < 0.0001), and NoSAS Score (AUC 0.69, 95% CI 0.67-0.72, p = 0.0001). CONCLUSIONS: NH-OSA has good performance in prediction of clinically significant OSA with high validity among Thai population. It could help screening patients at risks of OSA for further investigation, particularly in the resource limited area. CLINICAL IMPLICATIONS: NH-OSA is a newly developed tool, which could help screening patients at risks of OSA for further investigation DISCLOSURES: no disclosure on file for Nattapong Jaimchariyatam; No relevant relationships by Jeerath Phannajit, source=Web Response No relevant relationships by Supakorn Srichan, source=Web Response No relevant relationships by Somkanya Tungsanga, source=Web Response

Tonsil microbiocenosis and salivary lactate dehydrogenase activity in children with infectious mononucleosis

The article analyzes clinical data, blood test results, tonsil mucus bacteriological testing, and salivary lactate dehydrogenase activity in children with acute infectious mononucleosis caused by an Epstein-Barr viral infection. Research involves 280 children aged from 7 months to 19 years 8 months with infectious mononucleosis, who were hospitalized in the Lviv Infectious Cli-nical Hospital. Group 1 included 234 children infectious mononucleosis caused by Epstein-Barr virus, group 2 — 46 patients with infectious mononucleosis caused by the combination of Epstein-Barr virus and cytomegalovirus. Severe hepatosplenomegaly, lymphadenitis, nasal speech and snoring, hyperthermic syndrome, acute tonsillitis were found in patients with infectious mononucleo-sis. A bacteriological study identified a number of pathogens that can be classified as pathogenic or opportunistic flora. Staphylococcus aureus, Streptococcus pneumoniae, Pseudomonas aeruginosa, Candida fungi were identified in 43.8 % of children with an isolated form of mononucleosis and in 51.7 % of children with mixed infection. In children with infectious mononucleosis caused by mixed infection, we observed the more severe course of the disease and a significantly higher lactate dehydrogenase activity. A significantly increased activity of lactate dehydrogenase in the saliva of patients with infectious mononucleosis in the presence of pathogenic microflora on the mucous membranes indicates destructive processes in the tissues of the tonsils.

Severe Snoring in a Young Healthy Female: A Diagnostic Surprise.

Laryngeal Inflammatory myofibroblastic tumors or plasma cell granulomas are unusual benign lesions. Subglottic laryngeal lesions of various benign and malignant types usually present with acute or chronic stridor and respiratory obstruction features. We describe the first case in the literature where severe snoring was the presenting complaint in a patient of subglottic mass lesion with comfortable breathing during wake hour. A 28years old female presented with loud snoring and apneic episodes during sleep for three years which showed severe Obstructive Sleep Apnoea (OSA) (AHI, Apnoea- Hypoapnoea Index: 46.5) in polysomnography (PSG) and surprisingly smooth mucosa covered subglottic mass blocking 75% of airway lumen in the laryngoscopic examination. The patient underwent tracheostomy and coblation assisted endoscopic excision, and subsequent histopathology revealed an inflammatory myofibroblastic tumour. She was later decannulated and with no features of sleep apnea post decannulation. Subglottic mass can rarely present with severe snoring and requires solid clinical suspicion for early diagnosis. Hence, subglottic lesion should be one of the differentials for atypical presentations of severe OSA.

Impact of aquatic sports on the evolution of obstructive sleep apnea and snoring and other breathing disorders

Obstructive sleep apnea (OSA) is a clinical syndrome characterized by periodic reduction (hypopnea) or cessation (apnea) of airflow through the nose/mouth during sleep due to collapse of the upper respiratory tract lasting 10 seconds or more. Severe snoring, hypoxemia and micro-awakenings occur, leading to sleep fragmentation, daytime fatigue and drowsiness. One of the key factors for the development of OSA is obesity. Excessive alcohol consumption, smoking, and presence of relatives with sleep apnea are risk-increasing factors. The gold standard in diagnosis is polysomnographic examination.Various values and indices are monitored, the most important of which is the apnea/hypopnea index. Treatment includes control of risk factors and removal of breathing obstacles. In patients with more severe obstructive sleep apnea syndrome, the gold standard of treatment remains constant positive pressure ventilation during sleep. Water sports have been part of programs for prevention of breathing disorders during sleep for many years. Our goal is to confirm whether after active sea treatment, water sports and weight loss of patients symptoms of obstructive sleep apnea and snoring would be favorably affected, as well as to actively promote and educate our patients about a more active sports (and aquatic) life. Results from our studies on patients with problems with the upper respiratory tract and OSA show that more than half did not practice sport. Some have common diseases, incl. allergic conditions. The influence of bad habits and the hereditary factor were confirmed as well. Obstructive sleep apnea and snoring syndrome is a serious disease with consequences for patients and other people. Screening of at-risk patients should be continued and studies should be conducted on the effectiveness of current and new methods for diagnosing and treating the syndrome.

Snoring patterns during home polysomnography. A proposal for a new classification.

Snoring is a very common disorder, but, at present, there is no universally accepted classification for the condition. The main aim of this paper is to introduce a home sleep monitoring-based classification of common snoring patterns in simple snorers and in patients with obstructive sleep apnea-hypopnea syndrome (OSAHS). In total, 561 consecutive patients with a history of snoring, either simple or associated with apnea, were enrolled in this home sleep monitoring study. Analysis of the polysomnographic traces and the snoring sensor allowed the main patterns of snoring and their characteristics to be determined. Four patterns of snoring were identified. In a spectrum of increasing severity (mild, moderate or severe), snoring can be episodic, positional, continuous, or alternating, whereas in obstructive sleep apnea syndrome, the snoring events only occur between successive respiratory obstructive events. In mild snoring, the episodic pattern is the most frequent, whereas in moderate and severe snoring, the continuous snoring pattern occurs in most cases. The proposed classification of snoring patterns would be beneficial for providing a realistic disturbance index, for the selection and evaluation of the outcomes of surgical techniques.

Association of Snoring with Prediabetes and Type 2 Diabetes Mellitus: The Cardiovascular and Metabolic Diseases Etiology Research Center Cohort.

BackgroundEvidence suggests that habitual snoring is an independent risk factor for poor glycemic health. We examined the associations between snoring with prediabetes and diabetes in Korean population.MethodsSelf-reported snoring characteristics were collected from 3,948 middle-aged adults without prior cardiovascular diseases. Multivariable linear regression assessed the association of snoring intensity, frequency, disruptiveness, and disrupted breathing with fasting glucose and glycosylated hemoglobin (HbA1c) level. Then, multinomial regression evaluated how increasing snoring symptoms are associated with the risk for prediabetes and diabetes, adjusting for socioeconomic and behavioral risk factors of diabetes, obesity, hypertension, and other sleep variables.ResultsHigher snoring intensity and frequency were positively associated with fasting glucose and HbA1c levels. Participants presenting the most severe snoring were at 1.84 times higher risk (95% confidence interval [CI], 1.09 to 2.29) for prediabetes and 2.24 times higher risk (95% CI, 1.84 to 2.95) for diabetes, compared to non-snorers. Such graded association was also observed amongst the most frequent snorers with higher risk for prediabetes (odds ratio [OR], 1.78; 95% CI, 1.29 to 2.22) and diabetes (OR, 2.03; 95% CI, 1.45 to 2.85). Disruptive snoring (OR, 1.60; 95% CI, 1.12 to 2.28) and near-daily disruptive breathing (OR, 2.18; 95% CI, 1.02 to 4.19) were associated with higher odds for diabetes. Such findings remained robust after additional adjustment for sleep duration, excessive daytime sleepiness, unwakefulness, and sleep-deprived driving.ConclusionSnoring is associated with impaired glucose metabolism even in otherwise metabolically healthy adults. Habitual snorers may require lifestyle modifications and pharmacological treatment to improve glycemic profile.

Analysing the efficacy of polidocanol in injection snoreplasty

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

The Efficacy of Nasal Surgery on Pharyngeal Airway

Background and Objectives Nasal surgery is known to improve the quality of life in patients with obstructive sleep apnea; however, its effect on the airway structure is little known. This study attempted to identify the impact of nasal surgery on the pharyngeal airway structure. Subjects and Method We enrolled in the study patients who underwent nasal surgery from July 2015 to March 2018 due to nasal obstruction with severe snoring or sleep apnea. Patients with palate surgery or previous history of airway surgery were excluded. Demographic factors, symptoms regarding nasal obstruction, sleep study, preoperative cephalometry, and postoperative 3-month cephalometry were taken into account and analyzed. We also performed a subgroup analysis according to the severity of sleep apnea. Results Sixty-three patients were enrolled in this study. Soft palate thickness showed no significant change. Pre and postoperative soft palate thickness were 10.82±3.00 and 11.11±3.35 (p=0.261), respectively. However, the pharyngeal airway space was enlarged via nasal surgery from 12.05±3.35 to 13.04±3.35 (p=0.006), respectively. The subgroup analysis showed that the pharyngeal airway was mainly enlarged in the patients with lower Apnea-Hypopnea Index (AHI). Conclusion Although nasal surgery does not reduce soft palate thickness, it can enlarge the pharyngeal airway space. The effect of surgery would be more prominent in patients with AHI of lower than 15 event/hour (p=0.005) as nasal surgery alone does not affect the pharyngeal airway of patients with AHI greater than 15. Key words: Cephalometry ㆍ Nasal surgery ㆍ Obstructive sleep apnea ㆍ Pharynx ㆍ Snoring

The relationship between self-reported habitual snoring and hyperuricemia among Chinese urban adults: a cross-sectional study

BackgroundGrowing evidence suggests an independent relationship between habitual snoring and metabolic abnormalities. Currently, there are few data available on the association between snoring and hyperuricemia. Therefore, we evaluated the cross–sectional association between snoring and serum uric acid (UA) concentration and ascertain the effects of different snoring intensities on hyperuricemia among Chinese urban adults in Nanjing. MethodsWe performed a cross-sectional study including 7699 participants (4197 men and 3502 women) from Nanjing Drum Tower Hospital aged ≥18 years over a two year (ie, 2016–2018) period. All participants were divided into four groups based on Snoring scores. Questionnaires, physical examinations and biochemical tests were conducted. Hyperuricemia was defined as levels of serum UA > 6.8 mg/dL in males and >6.0 mg/dL in females. We used a generalized linear model to investigate the association between snoring and serum UA concentration and logistic regression model to investigate the association between snoring and likelihood of having hyperuricemia in the age-, sex-adjusted model and in a multivariable model adjusting for demographic factor, plasma lipid profiles, blood glucose, blood pressure, smoking, and alcohol consumption. ResultsThe prevalence of hyperuricemia was 10.05% in the studied population and gradually increased across the snoring scores (P < 0.0001). We found that mild snoring, moderate, and severe snoring intensity were associated with high serum UA in the age-, sex-adjusted model and in a multivariable model adjusting for demographic and lifestyle/behavioral risk factors. The association was insisted with the addition of variables related to clinical outcomes such as diabetes, hypertension, and high-cholesterol levels. ConclusionsOur results showed self-reported habitual snoring was associated with higher serum UA concentration among Chinese urban adults. Findings of this study indicate the significance of early detection and treatment of snoring to prevent hyperuricemia.

Large B-cell lymphoma with IRF4 rearrangement: a special tonsillar lymphoma in children

ObjectiveTo identify the clinicopathological features and prognosis of large B-cell lymphoma(LBCL) with interferon regulation factor 4 (IRF4) rearrangement. MethodsWe retrospectively analyzed the medical records of four patients from Children’s Hospital of Fudan University diagnosed with LBCL with IRF4 rearrangement during Sep. 2014 to Oct. 2018, and performed a literature review. ResultsFour patients had an average age of 5.7 years. The median duration from presentation to final diagnosis was 25.7 days. All 4 patients were admitted to the hospital due to severe snoring with no causes. The patients showed enlarged lymph nodes in the neck without tenderness. All 4 cases presented as localized disease (St-jude stage II). Lactate dehydrogenase (LDH) and serum albumin were all in the normal range. Morphology showed that normal lymphoid follicles were diffusely invaded by consistent, medium-sized large cells with obvious nucleoli. CD20, CD79α, PAX5, CD10 and BCL6 were diffusely positive. Neoplastic cells were also strongly positive for MUM1 and Ki-67. IRF4 gene rearrangement was detected as positive by IRF4 dual-color break-apart probe. Four patients underwent routine chemotherapy post bilateral tonsillectomy operation. Three achieved complete remission (CR) while the newly diagnosed one is during the second course of chemotherapy. ConclusionsTonsillar LBCL with IRF4 rearrangement in children presents distinct clinicopathologic and molecular genetic features, and it usually has a favorable outcome.

The clinical characteristics of patients with an isolate epiglottic collapse

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

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.