Snoring Index Research Articles

The impacts of ambient relative humidity and temperature on supine position-related obstructive sleep apnea in adults.

Obstructive sleep apnea (OSA) is associated with seasonal variations. The objective of this study was to examine associations of ambient relative humidity (RH) and temperature on sleep parameters. We conducted a cross-sectional study by retrospectively recruiting 5204 adults from a sleep center in Taipei, Taiwan. Associations of 1-night polysomnography with ambient RH and temperature in 1-day, 7-day, 1-month, 6-month, and 1-year averages were examined using linear regression models and a mediation analysis. RH increase was associated with snoring index decrease and apnea/hypopnea index (AHI) increase. Temperature increase was associated with decreases in sleep efficiency and the AHI, and increases in the wake time after sleep onset and snoring index. RH increase was inversely associated with non-rapid eye movement (NREM) sleep stage I (N1), III (N3), and rapid eye movement (REM) sleep, but positively associated with the NREM sleep stage II (N2) stage. Temperature increase was associated with N1, N2, and N3 sleep. An increase in RH was associated with an increase in the arousal index and a decrease in the < 95% arterial oxygen saturation (SaO2) among total, REM, and NREM sleep, whereas a temperature increase was associated with a decrease in the arousal index and an increase in < 95% SaO2 among total, REM, and NREM sleep. An increase in RH was associated with increases in the time spent in a supine posture and the supine AHI. An increase in temperature was associated with decreases in the supine posture, supine AHI, and non-supine AHI. The N3 sleep stage was an important mediator in increasing the supine AHI with a long-term increase in RH. But the N1 and N2 sleep stages mediated a decrease in the supine AHI with an increase in RH. In conclusion, ambient RH and temperature were associated with alterations in sleep parameters in adults, which were mediated by the sleep cycle. An understanding of outdoor environments has important implications for diagnostic classifications in the supine dominance of OSA in adults.

What is responsible for cochlear damage in patients with obstructive sleep apnea? Hypoxia or snoring noise?

Abstract Aim: Our aim in this study was to determine early cochlear changes caused by hypoxia and snoring noise in patients with Obstructive sleep apnea Syndrome and to examine the relationship of these changes with polysomnography parameters. Materials and Methods: A total of 149 patients with symptoms of snoring and sleep apnea who underwent polysomnography were included in this study. We formed a patient and control group based on the apnea-hypopnea index. We compared the audiometric parameters and the Distortion Product Otoacoustic Emission amplitudes of the groups. We evaluated Polysomnography parameters such as snoring number, snoring index, oxygen desaturation index, minimum pO2, mean pO2, pO2 ≤88%, which affect these results, by correlation. Results: High frequency audiometry and high frequency Distortion Product Otoacoustic Emission amplitudes showed statistically significant differences in the Obstructive Sleep Apnea Syndrome group compared to the control group (p&lt;0.001). PO2 ≤88% affected high frequency audiometry and mean pO2 affected high frequency Distortion Product Otoacoustic Emission amplitudes more than snoring number and snoring index. (p&lt;0.001). Conclusion: İn patients with OSAS, the inner ear is affected by hypoxia and snoring. However, the effect of hypoxia on cochlear dysfunction is greater than snoring noise. High-frequency audiometry and Distortion Product Otoacoustic Emission can guide in the early period to determine cochlear damage.

The Snoring Index Identifies Risk of Non-Alcoholic Fatty Liver Disease in Patients with Obstructive Sleep Apnea Syndrome.

Simple SummaryObstructive sleep apnea syndrome (OSA) and non-alcoholic fatty liver disease (NAFLD) are very common and share underlying metabolic risk factors. It remains unclear how exactly the two diseases are related. In this study, patients with obstructive sleep apnea were evaluated for the presence of NAFLD with the aim of finding parameters in polysomnography that may indicate NAFLD. The snoring index turned out to be the most valuable and a very reliable screening tool for the presence of NAFLD—independent of other metabolic risk factors.Background: The aim of this observational cohort study was to explore the severity of liver disease in patients with suspected obstructive sleep apnea in Germany. Methods: Patients undergoing polysomnography or home sleep apnea testing (HSAT) as an evaluation for the presence of OSA were screened using vibration-controlled transient elastography (VCTE) and continuous attenuation parameter (CAP) with a Fibroscan ® Mini 430. Clinical and laboratory data were collected following the overnight exam. Results: In total, 78 patients (28 female (35.9%), mean age 54.2 years) with OSA defined by an apnea-hypopnea-index >5 events/hour were included between OCT 2020 and APR 2021. Patients exhibited a high metabolic risk profile with 17% known diabetes mellitus type 2 (T2D), 62% arterial hypertension, 14% hyperlipidemia and 36% BMI > 30 kg/m2. The prevalence of steatosis defined by a CAP > 280 dB/m was 54%. The prevalence of at least significant fibrosis was 16% (E > 9.0 kPa). Interestingly, patients with a snoring index above the median of 278/h showed significantly higher CAP-values (p = 0.0002). In addition, the proportion of oxygen saturations below 90% (t90) correlated with CAP-values (p = 0.02), as well as metabolic risk factors including increased waist circumference (p = 0.005) and body mass index (BMI) (p = 0.035). On the other hand, the apnea-hypopnea-index (AHI) as a marker of OSA severity did not correlate with VCTE, CAP or laboratory parameters. Conclusion: Patients with moderate to severe OSA have a high prevalence of hepatic steatosis. The snoring index is an easy-to-use clinical tool to identify patients at risk for relevant liver disease within the larger group of patients with OSA.

The safety and short-term efficacy of modified lateral pharyngoplasty combined with multilevel surgery for OSA

Objective:To explore the safety and short-term efficiency of modified lateral pharyngoplasty combined with surgeries in other sites including nose and tongue. Methods:Thirty-five patients with OSA confirmed with polysomnography received modified lateral pharyngoplasty under general anesthesia. Some of the patients may also receive glossopharyngeal or nasal surgeries according to their physical examination, Müller test with electronic nasolaryngology and polysmnography. The postoperativepain, capacities of swallowing and speaking, and related postoperative complications after surgeries were recorded. And the changes of epworth sleep scale （ESS） snoring sore, apnea and hypopnea index （AHI） and lowest oxygen saturation （LSaO2） were compared before and after surgeries. Results:Among the 35 patients, 1 patient experienced experienced dyspnea after extubation and 2 patients experienced postoperative bleeding. The mean VAS after 1, 4 and 7 days of the surgery were 5.41±2.42, 2.93±1.80, 2.91±1.26, respectively. The mean pain visual analogue scale（VAS） was 5.41±2.42, 2.93±1.80 and 2.91±1.26 on the 1st, 4th and 7th day after operation. The mean time of starting to eat liquid and semi-liquid were （3.23±2.11） dand （5.55±2.67） d after surgery, respectively. Twenty-eight patients underwent 3-6 months follow-up, there was no significant difference in body mass index （BMI） before and after surgery, while mean ESS and snore index were significantly improved, ESS decreased from 11.33±4.91 to 6.19±4.45, and snore index decreased from 6.93±2.23 to 1.25±1.96. Among them, 23 of patients those patients received polysomnography after surgeries, AHI, LSaO2 and time with oxygen saturation below 90% （CT90） were significantly improvement. The mean AHI decreased from 45.05±27.90/h to 18.61±20.85/h，and mean SaO2 increased from 71.17% to 80.87%. Conclusion:Modified lateral pharyngoplasty combined with selective nasal and lingual plane surgery in the treatment of OSA is safe and can significantly improve ESS, snoring, AHI， LSaO2and other indicators.Modified lateral pharyngoplasty selectively with surgeries of nose or tongue is a kind of safe and effective surgery to treat OSA that ESS, snoring, AHI and SaO2can have satisfactory improvement.

Accuracy of a Smartphone Application Measuring Snoring in Adults-How Smart Is It Actually?

About 40% of the adult population is affected by snoring, which is closely related to obstructive sleep apnea (OSA) and can be associated with serious health implications. Commercial smartphone applications (apps) offer the possibility of monitoring snoring at home. However, the number of validation studies addressing snoring apps is limited. The purpose of the present study was to assess the accuracy of recorded snoring using the free version of the app SnoreLab (Reviva Softworks Ltd., London, UK) in comparison to a full-night polygraphic measurement (Miniscreen plus, Löwenstein Medical GmbH & Co., KG, Bad Ems, Germany). Nineteen healthy adult volunteers (4 female, 15 male, mean age: 38.9 ± 19.4 years) underwent simultaneous polygraphic and SnoreLab app measurement for one night at home. Parameters obtained by the SnoreLab app were: starting/ending time of monitoring, time in bed, duration and percent of quiet sleep, light, loud and epic snoring, total snoring time and Snore Score, a specific score obtained by the SnoreLab app. Data obtained from polygraphy were: starting/ending time of monitoring, time in bed, total snoring time, snore index (SI), snore index obstructive (SI obstructive) and apnea-hypopnea-index (AHI). For different thresholds of percentage snoring per night, accuracy, sensitivity, specificity, positive and negative predictive values were calculated. Comparison of methods was undertaken by Spearman-Rho correlations and Bland-Altman plots. The SnoreLab app provides acceptable accuracy values measuring snoring >50% per night: 94.7% accuracy, 100% sensitivity, 94.1% specificity, 66.6% positive prediction value and 100% negative prediction value. Best agreement between both methods was achieved in comparing the sum of loud and epic snoring ratios obtained by the SnoreLab app with the total snoring ratio measured by polygraphy. Obstructive events could not be detected by the SnoreLab app. Compared to polygraphy, the SnoreLab app provides acceptable accuracy values regarding the measurement of especially heavy snoring.

Prooxidant and antioxidant systems’ indices as the markers of endogenous intoxication in ronchopathy and syndrome of obstructive sleep apnea in the dynamics of treatment

Introduction: Ronchopathy is a chronic progressive disease manifested by upper airway obstruction and chronic respiratory failure. The key process of pathological snoring is the obstructive breathing disorders. The obstructive sleep apnea syndrome (OSAS) develops on the basis of snoring. OSAS is accompanied by episodes of hypoxia and reoxygenation, which cause an increase of the level of reactive free radicals whith following development of the oxidative stress. The activation of peroxidative processes of proteins (POP) and lipids (POL) are initiated by free radicals which are noticeable components of endogenous intoxication (EI). The aim of the study was to investigate the intensity of POP and POL processes, the levels of OSAS components, and the indices EI in patients with ronchopathy and OSAS of varying severity in the dynamics of treatment. Materials and methods: 40 patients with ronchopathy and OSAS were examined at the State Institution “Institute of otolaryngology named after prof. O.S. Kolomiychenko of the National Academy of Medical Sciences of Ukraine”. All patients were divided according to the degree of snoring and hypoxia index (HI) into 4 groups of 10 persons each. Control group was formed by 10 healthy donors. The object of biochemical studies was blood serum. The intensity of POP was assessed by reaction with 2,4-dinitrophenyl-hydrazine by the Levin’s method in Reznick’s modification. POL intensity was determined by the interaction with 2-thiobarbituric acid (TBA) by Goncharenko. Catalase activity was determined by the method of Korolyuk and co-authors. The content of free thiol groups was determined by interaction with 5,5'-dithio-bis(2-nitrobenzoic acid). The content of medium weight molecules (MWM) and tyrosine-containing peptides (TCPs) were determined by spectroscopy at 254 and 280 nm, respectively. Statistical processing of the results was performed using the software package for biometric data WinPEPI. Results: Prior to the treatment in patients with ronchopathy and OSAS of varying severity, an increase in the content of MWM and TCPs were noted, that indicates the development of endogenous intoxication. In patients of all groups there was an intensification of POP, which was manifested by a significant increase of aDNFGn, aDNFGo, and kDNFGn levels. The content of TBA-positive products in patients with ronchopathy of both groups was at the level of control and increased significantly at progression of pathological process. In addition, in all groups of patients an increase of catalase activity was detected on the background of TCPs level decrease. It was found the efficacy of the offered treatment of patients with ronchopathy and OSAS of varying severity. The indices of EI, POP, POL, and antioxidant system’s were directed to improvement in contrast to the state before treatment, and some of them were improved almost to the level of control. Conclusions: It is established that the progression of hypoxia is accompanied by autointoxication, which is manifested by an increase in the content of MWM, as well as prove for the activation of catabolic reactions and excessive formation of cells’ breakdown products. It was also revealed by the intensification of POP and POL processes, the activation of which are associated with the development of insufficiency of enzymatic and nonenzymatic components of antioxidant system. The performed treatment can be considered as the effective one since on its completion all the studied indices were restored almost to the level of control.

Efficacy, predictors of success and failure of an updated lateral pharyngoplasty approach as an independent procedure in treating obstructive sleep apnea with CPAP failures.

To assess predictors of success and failure of an updated lateral pharyngoplasty as an independent procedure in treating obstructive sleep apnea with CPAP failures. Forty-six patients with known OSAS who were resistant to CPAP or failures were included. BMI, Stop-Bang score, and sleep study data were recorded before and after the updated Cahali pharyngoplasty procedure. Pre-operative DISE was done for all cases; however, postoperative DISE was done only for non-responders. Successful operation outcomes achieved in 69.6% (32 cases) and 30.4% (14 cases) were failure rates. Postoperative snoring index, Stop Bang score, and AHI were significantly decreased compared to pre-operative data (p value < 0.001). There is statistically a significant increase in minimal and baseline SpO2 postoperatively (p value < 0.001). Patients with no laryngeal collapse (L0) predict operation success. However, patients with high pre-operative snoring index, collapse at lateral wall hypopharynx, high tongue collapse, laryngeal collapse, tongue palate interaction, and low grades tonsils (1, 2) predict the failure of the surgery (p value = 0.006*,0.024*,0.047*, respectively). Updated Cahali lateral pharyngoplasty could not be used as an independent procedure in all OSA patients. The lack of laryngeal collapse (L0) is a considerable success predictor for the procedure. However, the pre-operative low-grade tonsils (1, 2) and high snoring index predict operation failure.

Compared to Individuals with Mild to Moderate Obstructive Sleep Apnea (OSA), Individuals with Severe OSA Had Higher BMI and Respiratory-Disturbance Scores.

Objective: Individuals with obstructive sleep apnea (OSA) are at increased risk to suffer from further somatic and sleep-related complaints. To assess OSA, demographic, anthropometric, and subjective/objective sleep parameters are taken into consideration, but often separately. Here, we entered demographic, anthropometric, subjective, and objective sleep- and breathing-related dimensions in one model. Methods: We reviewed the demographic, anthropometric, subjective and objective sleep- and breathing-related data, and polysomnographic records of 251 individuals with diagnosed OSA. OSA was considered as a continuous and as categorical variable (mild, moderate, and severe OSA). A series of correlational computations, X2-tests, F-tests, and a multiple regression model were performed to investigate which demographic, anthropometric, and subjective and objective sleep dimensions were associated with and predicted dimensions of OSA. Results: Higher apnea/hypopnea index (AHI) scores were associated with higher BMI, higher daytime sleepiness, a higher respiratory disturbance index, and higher snoring. Compared to individuals with mild to moderate OSA, individuals with severe OSA had a higher BMI, a higher respiratory disturbance index (RDI) and a higher snoring index, while subjective sleep quality and daytime sleepiness did not differ. Results from the multiple regression analysis showed that an objectively shorter sleep duration, more N2 sleep, and a higher RDI predicted AHI scores. Conclusion: The pattern of results suggests that blending demographic, anthropometric, and subjective/objective sleep- and breathing-related data enabled more effective discrimination of individuals at higher risk for OSA. The results are of practical and clinical importance: demographic, anthropometric, and breathing-related issues derived from self-rating scales provide a quick and reliable identification of individuals at risk of OSA; objective assessments provide further certainty and reliability.

Efficacy of a Smart Antisnore Pillow in Patients with Obstructive Sleep Apnea Syndrome.

Objective Untreated obstructive sleep apnea syndrome (OSAS) increases the risk of cardiovascular, dementia, and motor vehicle accident events. However, continuous positive airway pressure (CPAP) which is the gold standard treatment is not acceptable for many patients with OSAS. Development of devices for the patients of nonadherence to CPAP is necessary. Materials and Methods We evaluated the effect of the smart antisnore pillow (SAP) in patients with OSAS in a prospective, noncontrolled, nonrandomized, pilot study. According to the apnea-hypopnea index (AHI), they were divided into two groups: mild-to-moderate OSAS group and severe OSAS group. Single-night polysomnography (PSG) with application of a SAP was performed. Thirty patients, 15 males and 15 females, 33–82 years old (mean age, 59.3 ± 12.9 years), completed the smart antisnore pillow therapy test. Among them, 23 patients had mild-to-moderate OSAS. Results The SAP significantly improved the snore number (p = 0.018), snore index (p = 0.013), oxygen denaturation index (p = 0.001), total AHI (p = 0.002), and supine AHI (p = 0.002) in the mild-to-moderate OSAS group, but there was no significant improvement in the severe OSAS group. Conclusions We concluded that the SAP is an effective positional therapy device for patients with OSAS of mild-to-moderate severity.

Snoring severity is associated with carotid vascular remodeling in young adults with overweight and obesity

BackgroundSnoring is often used as a surrogate measure for obstructive sleep apnea (OSA), a sleep disorder associated with cardiovascular disease (CVD) risk. Whether snoring is linked to CVD independent of OSA remains unclear. We aimed to explore the snoring and subclinical CVD association in adults with and without OSA. MethodsWe conducted a cross-sectional study in 122 overweight/obese participants (24% male; mean age 40.1 years) attending the 24-month follow-up visit of a lifestyle intervention. Using home-based objective measures of sleep-disordered breathing, we stratified participants into 3 snoring/OSA categories using the snoring index (SI), a measure of snoring vibration, and oxygen desaturation index (ODI): (1) OSA (ODI ≥ 5), (2) non-OSA heavy snorer (ODI <5, above-median SI), and (3) non-OSA low snorer (ODI <5, below-median SI). Vascular measures including pulse wave velocity ([PWV]; carotid-femoral [cf], femoral-ankle [fa], brachial-ankle [ba]), carotid intima-media thickness (IMT), and carotid interadventitial diameter (IAD) were compared across snoring/OSA categories. Linear regressions assessed the association between snoring and subclinical CVD independent of traditional CVD risk factors. ResultsCompared to non-OSA low snorers, common carotid IMT and IAD were higher in non-OSA heavy snorers, and faPWV, IMT, and IAD were higher among those with OSA. The difference between non-OSA heavy snorers and low snorers persisted after adjusting for age, race, sex, blood pressure, body mass index, lipids, and insulin resistance (P < .05 for IMT and IAD). ConclusionsIn overweight/obese young to middle-aged adults, objectively measured snoring was related to vascular remodeling in those without OSA. Snoring may contribute to CVD risk but warrants further examination in larger prospective cohorts.

The anti-snoring bed - a pilot study

PurposeAvoiding supine position can reduce snoring in most habitual snorers. However, devices that restrict the sleeping position cause discomfort or disrupt sleep resulting in low compliance. Therefore, mechanisms, which lift the trunk of the user without disturbing sleep, have been proposed. We present the first study, which investigates whether individual interventions provided by beds with lifting mechanisms are able to stop snoring (success rate) and whether they reduce the snoring index (number of total snores divided by total time in bed) using a repeated measures design. In addition, we investigated whether the intervention is interfering with the subjective sleep quality.MethodsTwenty-two subjects were observed for four nights (adaptation, baseline, and two intervention nights). During intervention nights, the bed lifted the trunk of the user in closed-loop manner. Subjects were divided in three groups (non-snorer, snorer one, and snorer two). Non-snorers were lifted by the bed at random time points during the night. In group snorer one, a stepwise increase of the bed inclination was compared with going directly to a randomly selected angle. In group snorer two, the influence of a small inclination angle (10 ∘) and a big inclination angle (20 ∘) was compared.ResultsSnoring was stopped successfully in 22% (small angle) and 67% (big angle) of the interventions. This did not lead to a significant reduction in the snoring index. The subjective sleep quality was not reduced by the intervention.ConclusionThe anti-snoring bed is able to stop individual episodes of habitual snoring without reducing the subjective sleep quality.Trial Registrationhttps://clinicaltrials.gov, no. NCT04053738, registered 12 August 2019 - Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT04053738.

Influence of age and gender on sleep bruxism and snoring in non-apneic snoring patients: A polysomnographic study.

The present study aimed to assess the influence of gender and age on snoring and sleep bruxism in non-apneic snoring patients. Adult participants with clinical suspicion of snoring and with no other significant medical history were recruited. Single-night video polysomnography was performed to detect snoring and sleep bruxism. Finally, 137 snoring non-apneic participants were included. Statistical analysis of gender groups showed that the total snore index and snore train were significantly higher in men than in women. Men also presented severe bruxism, with significantly more frequent episodes and higher bruxism episodes index scores. The correlation analysis showed the presence of significant linear relationships in the supine sleep position between age and snore index, snore index in non-rapid eye movement 2 (N2) sleep stage, and snore train. The analysis of groups separated according to the criterion of third age quartile showed that the average, maximum and minimum audio volume in the non-supine sleep position was significantly higher in the older group. The analysis of groups separated according to the criterion of median age showed that the bruxism episode index and bruxism phasic episodes were significantly higher in the younger group. Thus, it can be concluded that both age and gender influence snoring and sleep bruxism. Snoring and sleep bruxism seem to be more intensive in men. Older patients seem to snore more in N2 sleep and the supine sleep position and present lower bruxism episodes, especially the phasic type. The results of the present study indicate the need for further research on this topic to establish the possible relationship between snoring and sleep bruxism.

Evaluation of the masticatory biomechanical function in Down syndrome and its Influence on sleep disorders, body adiposity and salivary parameters

To evaluate the phenotypic features of the masticatory biomechanics in atypical subjects with Down syndrome (DS). Its influence was analysed on sleep disorders, body adiposity and its risks, and some physicochemical properties of saliva. Seventy subjects were enrolled to assess masticatory biomechanical function and divided into two groups: DS and control groups. Electrical activities of the masseter and temporal muscles (at rest and in maximum voluntary clench-MVC), maximum bite force-MBF and maximum mouth opening-MMO were investigated. Among the atypical subjects, just 24 participants underwent the anthropometry, the polysomnography II and the saliva testing (salivary flow rate-SFR, buffer capacity-BC and salivary cortisol levels, morning/SC-AM and night/SC-PM). MVC and MBF values showed high statistical significance in the control group (P<.001) than in the DS group of 35. MMO values were slightly increased in the DS group in relation to the control group. Overweight and obesity were found in both genders. Atypical women showed higher risk to develop cardiovascular-metabolic diseases than in atypical men. OSA severe was 20% for atypical women and 42.8% for atypical men, whereas snoring index was present in all genders. SFR was reduced in 100% of atypical subjects (hyposalivation in 10% women and 28.5% men). Furthermore, 100% BC, 66.6% SC-AM and 91.6% SC-PM showed normal patterns. Masseter and temporal muscle hypotonia was found in all atypical subjects with DS. This muscle dysfunction strongly was related to overweight/obesity, risks for development of cardiovascular/metabolic diseases, OSA severity, successive snoring episodes and salivary flow reduction in DS.

Managing obstructive sleep apnea patients with CPAP failure with a novel Lateral Pharyngoplasty as a stand-alone procedure.

Obstructive sleep apnea syndrome (OSAS) is caused by a complete or partial obstruction of the upper airway. A new Cahali lateral pharyngoplasty as a stand-alone procedure for the treatment of OSA patients, whatever the level and pattern of airway obstruction in patients with CPAP failure or non-compliant patients, is it? 40 patients with known OSAS non-compliant with CPAP or CPAP failures included. BMI, Stop-Bang score, and sleep study parameters were reported before and after the new Cahali pharyngoplasty operation. Preoperative DISE was done for all cases. There were 28 (70%) cases with successful operation outcomes, and 12 (30%) failed cases. Postoperative Stop Bang score, AHI, snoring index were significantly reduced in comparison to preoperative data (p-value <0.001); however, minimal SpO2 and baseline SpO2 were significantly increased in comparison to preoperative data. There was a significant improvement in AHI postoperative. Patients collapse at the level of lateral wall hypopharynx, high tongue collapse, laryngeal collapse, tongue palate interaction, all significantly predict failure outcome of the operation (p-value=0.022). However, the absence of laryngeal collapse (L0) had a successful prediction outcome. The high snoring index significantly predicts operation failure. However, preoperative high baseline SpO2 predicts operation success significantly. The new Cahali lateral pharyngoplasty can be used as a stand-alone procedure in the absence of lateral wall collapse at the level of the hypopharynx (LH), high tongue base collapse (TH), laryngeal collapse (L1) or tongue palate interaction.

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.

Dissociation between objectively quantified snoring and sleep quality.

The impact of simple snoring on sleep structure and sleepiness has not been well described. In several studies, self-reported snoring was associated with increased daytime sleepiness. However, most studies did not distinguish patients with simple snoring from those with coexisting obstructive sleep apnea (OSA) using objective measures. We therefore evaluated the relationship between objectively measured snoring and both sleep structure and daytime sleepiness in patients with no or mild OSA. Subjects referred for suspected sleep disorders underwent polysomnography (PSG) during which breath sounds were recorded by a microphone. Those with an apnea-hypopnea index (AHI) <15/h were analyzed. Individual snores were identified by a computer algorithm, from which the snore index (SI) was calculated as the number of snores/h of sleep. Sleep stages and arousals were quantified. Daytime sleepiness was evaluated using the Epworth Sleepiness Scale (ESS) score. 74 (35 males) subjects were included (age, mean ± SD: 46.4 ± 15.3 years and body mass index: 29.8 ± 7.0 kg/m2). The mean SI was 266 ± 243 snores/h. Subjects were categorized according to their SI into 3 tertiles: SI < 100, between 100-350, and >350. No sleep structure indeces, arousals, or ESS score differed among SI tertiles (p > 0.13). There was no correlation between SI and any of these variables (p > 0.29). In contrast, the AHI was significantly related to frequency of arousals (r = 0.23, p = 0.048). These findings suggest that simple snoring assessed objectively is not related to indices of sleep structure or subjective sleepiness.

The Most Effective Amount of Forward Movement for Oral Appliances for Obstructive Sleep Apnea: A Systematic Review

This systematic review clarifies the amount of effective protrusion in mandibular advancement devices of oral appliances required for obstructive sleep apnea (OSA). The systematic review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Review Manager 5 and GRADEpro were used to combine trials and analyze data. The present review included three studies. In mild to moderate OSA cases, measured using the apnea–hypopnea index (AHI), 50% protrusion was more effective than 75% protrusion. However, 75% protrusion was more effective for severe cases. Sleep stage, Epworth Sleepiness Scale (ESS), snoring index, and side effects significantly differed between the groups. Additionally, 75% protrusion was more effective (AHI: 0.38, 95% CI: −0.89 to 1.65, p = 0.56; sleep stage 3: −1.20, 95% CI: 9.54–7.14, p = 0.78; ESS: 1.07, 95% CI: −0.09 to 2.24, p = 0.07; snoring index: 0.09, 95% CI: 0.05–0.13, p < 0.05; side effects: RR: 1.89, 95% CI: 0.36–9.92, p = 0.45). As per the AHI, 75% protrusion was effective in severe cases, whereas 50% protrusion was effective in moderate cases. Analysis of different surrogate outcomes indicated that 75% protrusion was more effective. Further, well-designed, larger trials should determine the benefits for patients. Additionally, investigations of adherence and side effects with long-term follow-up are needed.

The efficacy of the improved tongue base suspension surgery combined with UPPP in the treatment of severe OSA

Objective:This study was designed to show the preliminary efficacy and safety of the improved tongue base suspension surgery in severe obstructive sleep apnea(OSA) patients classified as Friedman Ⅱand Friedman Ⅲ. Method:The severe OSA patients diagnosed by PSG as Friedman Ⅱ type and Ⅲ type underwent surgery treatment. The tongue base of the patient was implanted with titanium plate and fixed on the chin of mandible. The UPPP surgery was performed with reference to H-UPPP. After surgery, the patients were followed up, PSG was re-examined and the change of various subjective and objective indicators of rehabilitation and adverse reactions were observed and recorded.Result: One hundred and two patients with severe OSA who were not tolerant or unwilling to use CPAP treatment were treated by the above surgical method. All the patients underwent surgery successfully and generally recovered about 1 month after the surgery without obvious tongue base pain, foreign body sensation or other discomfort. Eating and speaking function were as usual, the wound was healed well, and no serious infection or rejection was observed. The main postoperative adverse reactionwas tension line fracture(3 cases). Sixty-seven patients completed follow-up. At 3 to 6 months after surgery, the AHI, ESS sleepiness score and snore index were lower than those before surgery, while LSaO₂and CT 90% were higher than those before surgery(P<0.01). The AHI before surgery was 60.5± 22.4, and the average AHI after surgery was 27.8± 22.4. The effective rate of the surgery was 71.6% and the success rate was 58.2%. The AHI has dropped by an average of 54.0%, and snore improved by 63.9%. Conclusion: After preliminary clinical observation, the study suggests that the improved tongue base suspension with UPPP has satisfactory curative effect and feasibility for the treatment of severe OSA patients classified as Friedman Ⅱ type and Ⅲ type.

Objective Relationship Between Sleep Apnea and Frequency of Snoring Assessed by Machine Learning.

Snoring is perceived to be directly proportional to sleep apnea severity, especially obstructive sleep apnea (OSA), but this notion has not been thoroughly and objectively evaluated, despite its popularity in clinical practice. This might lead to overdiagnosis or underdiagnosis of OSA. The goal of this study is to examine this notion and objectively quantify the relationship between sleep apnea and snoring detected using advanced signal processing algorithms. We studied adults referred for polysomnography, from which the apnea-hypopnea index (AHI) was derived. Breath sounds were recorded simultaneously, from which snoring was accurately quantified using acoustic analysis of breath sounds and machine-learning computer algorithms. The snore index (SI) was calculated as the number of snores per hour of sleep. In 235 patients, the mean AHI was 20.2 ± 18.8 and mean SI was 320.2 ± 266.7 events/h. On the one hand, the overall correlation between SI and AHI was weak but significant (r = .32, P < .0001). There was a significant stepwise increase in SI with increasing OSA severity, but with a remarkable overlap in SI among OSA severity categories. On the other hand, SI had weak negative correlation with central AHI (r = -.14, P = .035). SI had modest positive and negative predictive values for OSA (0.63 and 0.62 on average, respectively) and good sensitivity but low specificity (0.91 and 0.31 on average, respectively) attributed to the large number of snorers without OSA. Snoring on its own is probably of limited usefulness in assessing sleep apnea presence and severity, because of its weak relationship with AHI. Thus, the complaint of snoring should be interpreted with caution to avoid unnecessary referrals for sleep apnea testing. Conversely, clinicians should be aware of the possibility of missing diagnosis of patients with sleep apnea who have minimal snoring.

Tonsil size and outcome of uvulopalatopharyngoplasty with tonsillectomy in obstructive sleep apnea.

To investigate the relationship of tonsil volume and grade on outcomes of uvulopalatopharyngoplasty (UPPP) with tonsillectomy in patients with obstructive sleep apnea (OSA). Retrospective cohort analysis. Data of 70 consecutive patients undergoing UPPP with tonsillectomy between 2015 and 2018 were analyzed. Patients with an apnea-hypopnea index (AHI) <10/hr or concomitant surgery other than nasal surgery were excluded. Tonsil volume was measured intraoperatively. Preoperatively and 3 months after surgery we assessed the AHI using respiratory polygraphy, daytime sleepiness using the Epworth Sleepiness Scale (ESS), and a visual analog scale for the snoring index (SI). Tonsil grade and volume both showed a significant correlation with preoperative AHI. Postoperative AHI was not significantly different between grades and volume. The AHI reduction after surgery increased significantly with larger volume and higher tonsil grade. For all grades, the postoperative ESS was significantly reduced compared to the preoperative value, but was not significantly correlated with tonsil volume. Preoperative and postoperative SI was not significantly correlated between tonsil grade or volume. In all grades, SI was significantly reduced after surgery. In our study, we found that large tonsils are responsible for higher preoperative AHI values, and their removal leads to greater reduction of initial AHI. However, the postoperative effect on daytime sleepiness and snoring reduction is not significantly correlated with tonsil size and volume, indicating that these parameters are mainly influenced by other factors. The knowledge of the significance of tonsil size and volume is important for ear, nose, and throat physicians when counseling OSA patients. 2c Laryngoscope, 129:E449-E454, 2019.