Snoring Intensity Research Articles

Pediatric obstructive sleep apnea-related risk factors: A cross-sectional study.

This study investigated obstructive sleep apnea (OSA)-related risk factors in children and adolescents. Records of 187 subjects from a private medical clinic were reviewed. Overnight polysomnography recordings and self/parent reports were gathered. Descriptive analysis of sociodemographic, anthropometric, sleep quality and sleep architecture variables and OSA diagnosis were performed. Associations between independent variables and OSA diagnosis were assessed through multivariable logistic regression with robust variance, with a significance level of 5%. Results: 132 participants were diagnosed with OSA, and 55 were classified as "no OSA" (29.41%). Those overweight or obese were 4.97 times more likely to have OSA than those with normal weight (P= 0.005). Those who reported loud snoring were 2.78 times more likely to have OSA than those who reported mild or moderate snoring intensity. A one-unit increase in arousal index leads to 1.39 increase in the odds ratio (OR) of individuals diagnosed with OSA (P < 0.001), and each one-unit increase in sleep efficiency leads to 1.09 higher odds of not having OSA (P= 0.002). Significantly increased OSA-related risk factors among overweight/obese children and adolescents and among those who had a parental/self-report of loud snoring were found.

The Potential Effect of Changing Patient Position on Snoring: A Systematic Review.

Approximately 45% of adults snore occasionally, and 25% snore regularly, with a higher prevalence in men and an increase among postmenopausal women due to hormonal changes. Snoring is a health concern linked to vascular disease and decreased quality of life for both snorers and their bed partners. Effective snoring treatment, which aims to reduce or eliminate the sound, is challenging and depends on factors like age, comorbidities, disease severity, and anatomical features. This review aims to provide a systematic overview of the current literature on the effects of positional therapy (PT) on snoring. Various devices facilitate PT, including anti-snoring pillows and vibration alarms. PT devices maintain head and neck alignment to keep airways open, while head of bed elevation (HOBE) solutions reduce upper airway collapses by elevating the head and trunk. Studies show that PT and HOBE reduce snoring by increasing airway cross-sectional area and decreasing closing pressure. Despite their benefits, these non-surgical treatments have limitations, such as discomfort in certain sleeping positions and intolerance to prolonged head elevation. While reducing snoring intensity is critical for health reasons, further comparative studies between the different devices are needed to enhance snoring management.

SnoreLab Application in the Assessment of Obstructive Sleep Apnea Syndrome: A Pilot Study

Background: SnoreLab (Version 5.3, Reviva Softworks Ltd., London, UK) is featured as the number one mobile application (app) for measuring snoring intensity and duration. The aim of this study was to conduct a comparative analysis between the results derived from SnoreLab and polysomnography (PSG). Methods: Male and female patients between 18 and 75 years of age, seeking medical counseling for suspected obstructive sleep apnea syndrome (OSAS), were considered eligible to participate in this study. Exclusion criteria were psychological or neurological disorders, drug or alcohol abuse, and inability to follow instructions. All patients underwent one overnight in-hospital PSG with simultaneous snoring recording using the SnoreLab app. Results: Nineteen patients (15 men, 4 women) aged 50.9 ± 10.5 years were included. The overall cohort exhibited a Snore Score of 24.8 ± 22.2 alongside an AHI of 15.1 ± 17.0, indicating moderate OSAS. Interestingly, elevated Snore Scores were observed in both the simple snoring (30.7 ± 19.2) and severe OSAS group (35.2 ± 21.4) (Kruskal–Wallis p-value = 0.176). The analysis of the Spearman’s test did not reveal a statistically significant correlation between PSG parameters and the Snore Score. Conclusions: While SnoreLab records snoring, it is not designed for screening sleep apnea. Although SnoreLab may not replace PSG for use in diagnosis, it could serve as a complementary tool for monitoring snoring and to improve the interaction between patients and clinicians when integrated into a suitable clinical assessment.

Effect of Palatal Botulinum Toxin Injection in Habitual Snoring

Snoring is a loud buzzing noise caused by the soft palate and pillar vibration. Loud snoring at least three nights per week is described as habitual snoring (HS). Aim of the Study: To evaluate the effect of palatal botulinum toxin in snoring patients. Patients and Methods: An Experimental clinical trial study was conducted on thirty-seven patients with habitual snoring between July 2021 and January 2022. The participants and their partners completed a questionnaire submitted before and after injection. Recordings of snoring sounds before injection (as a baseline) and after injection were monitored by a mobile application designed to record and analyze snoring (Goodsomia Lab.). Unilateral injections of 10 botulinum toxin type A units were done into the soft palate muscles. Result: Snoring was improved in all patients, with no significant side effects reported. Epworth Sleepiness Scale was 9.9 ± 0.9 before botulinum toxin injection and 8.2 ± 1.7 one week after injection, while the snoring index was 131 ± 66 and 61.5 ± 28, respectively. The average Intensity of Snoring and maximal Intensity of Snoring before botulinum injection were 57 ± 7.5 and 90.5 ± 1.6, respectively, and changed to 44 ± 4.2 and 87.8 ± 1.9 seven days after injection. Regarding the lowest pulse oxygen saturation, there is a statistically better rate after toxin injection, 90.7 ± 0.9, than before injection, 89.1 ± 1.8. Discussion: Snoring treatment with botulinum toxin is safe, easy to perform, non-invasive, and reversible.

Tonsil volume and outcome of radiofrequency uvulopalatoplasty with or without tonsillectomy in adults with sleep-disordered breathing

PurposePredictors for the outcome of uvulopalatopharyngoplasty with and without tonsillectomy (UPPP ± TE) in sleep-disordered breathing have not been fully established. This study investigates tonsil grade, volume, and preoperative examination in predicting radiofrequency UPP ± TE outcomes.MethodsAll patients undergoing radiofrequency UPP with tonsillectomy if tonsils were present between 2015 and 2021 were retrospectively analyzed. Patients underwent a standardized clinical examination, including Brodsky palatine tonsil grade from 0 to 4. Preoperatively and 3 months after surgery, sleep apnea testing was performed using respiratory polygraphy. Questionnaires were administered assessing daytime sleepiness using the Epworth Sleepiness Scale (ESS) and snoring intensity on a visual analog scale. Tonsil volume was measured intraoperatively using water displacement.ResultsThe baseline characteristics of 307 patients and the follow-up data of 228 patients were analyzed. Tonsil volume increased by 2.5 ml (95% CI 2.1–2.9 ml; P < 0.001) per tonsil grade. Higher tonsil volumes were measured in men, younger patients, and patients with higher body mass indices. The preoperative apnea–hypopnea index (AHI) and AHI reduction strongly correlated with tonsil volume and grade, whereas postoperative AHI did not. The responder rate increased from 14% to 83% from tonsil grade 0 to 4 (P < 0.01). ESS and snoring were significantly reduced after surgery (P < 0.01), but the reduction was not influenced by tonsil grade or volume. No other preoperative factor other than tonsil size could predict surgical outcomes.ConclusionsTonsil grade and intraoperatively measured volume correlate well and predict the reduction of AHI, while they are not predictive of ESS and snoring response after radiofrequency UPP ± TE.

The efficacy of STOP-BANG questionnaire in screening of benign snoring and mild obstructive sleep apnea

Polysomnography is the gold standard for diagnosing sleep-related breathing disorders. Respiratory pulse oximetry can be used for screening, and several pre-screening questionnaires are available to assess the risk of obstructive sleep apnea. STOP-BANG questionnaire is simple and effective according to the literature. Investigating the effectiveness of the STOP-BANG questionnaire for screening benign snoring and mild obstructive sleep apnea. We analyzed the data of patients examined in our department for suspected sleep-related breathing disorder between 20. 06. 2021 and 19. 03. 2022. We compared the subsequently calculated STOP-BANG scores to the respiratory pulsoximetry results. Due to the lack of information regarding the intensity of snoring, the analysis was performed both with positive and negative results for this criterion. Sensitivity, specificity, positive and negative predictive values were calculated. We analyzed the data of 36 patients, one of them was examined twice due to weight loss. Benign snoring was confirmed by 19 patients, mild obstructive sleep apnea in 9, moderate in 4, and severe in 5 cases. Assuming loud snoring, the sensitivity was 100%, the specificity 21%, the positive predictive value 29%, and the negative predictive value 100%. Assuming no loud snoring, the sensitivity was 100%, the specificity 54%, the positive predictive value 41%, and the negative predictive value 100%. STOP-BANG questionnaire is effective, and can also be used in primary care to screen benign snoring and mild obstructive sleep apnea. Unnecessary device tests can be reduced by using it, resulting in significantly shorter waiting times for the sleep tests for high-risk patients. Orv Hetil. 2023; 164(7): 265-272.

Correlation between snoring sounds and obstructive sleep apnea in adults: a meta-regression analysis

Snoring is a dominant clinical symptom in patients with obstructive sleep apnea (OSA), and analyzing snoring sounds might be a potential alternative to polysomnography (PSG) for the assessment of OSA. This study aimed to systematically examine the correlation between the snoring sounds and the apnea-hypopnea index (AHI) as the measures of OSA severity. A comprehensive literature review using the MEDLINE, Embase, Cochrane Library, Scopus, and PubMed databases identified the published studies reporting the correlations between and severity of snoring and the AHI values by meta-regression analysis. In total, 13 studies involving 3,153 adult patients were included in this study. The pooled correlation coefficient for snoring sounds and AHI values was 0.71 (95%CI: 0.49, 0.85) from the random-effects meta-analysis with the Knapp and Hartung adjustment. The I 2 and chi-square Q test demonstrated significant heterogeneity (97.6% and p<0.001). After adjusting for the effects of the other covariates, the mean value of the Fisher's r-to-z transformed correlation coefficient would have 0.80 less by the snoring rate (95%CI = -1.02, -0.57), 1.46 less by the snoring index (95%CI = -1.85, -1.07), and 0.21 less in the mean body mass index (95%CI = -0.31, -0.11), but 0.15 more in the mean age (95%CI = 0.10, 0.20). It fitted the data very well (R 2=0.9641). A high correlation between the severity of snoring and the AHI was found in the studies with PSG. As compared to the snoring rate and the snoring index, the snoring intensity, the snoring frequency, and the snoring time interval index were more sensitive measures for the severity of snoring.

Relationship Between Adenotonsillar Size and Snoring Sound: Acoustic Analysis

Background and Objectives The most common cause of snoring in children is enlarged tonsils and adenoids. However, there is insufficient evidence to determine whether the subjective measurement of tonsil hypertrophy, the most common prevailing method, reflects the actual tonsil size and volume. Therefore, we tried to determine whether the subjective grading of tonsil size and actual tonsil volume is related, and whether tonsil volume, weight, and adenoid index are correlated with the acoustic analysis of snoring.Subjects and Method The study was conducted on 21 children between the ages of 4 and 15 who came for tonsillectomy and adenoidectomy due to snoring symptoms. The degree of adenotonsillar hypertrophy was measured using the Brodsky grading scale and adenoid index. After tonsillectomy, the volume and weight of resected tonsil were measured. For acoustic analysis, the Praat software was used to determine formant frequency and sound intensity. A linear regression model and a dummy variable were used to determine the correlation between the quantitative values of tonsil, adenoid and the result of acoustic analysis.Results The Brodsky tonsil grade tended to match the actual tonsil volume, but it was not statistically significant (&lt;i&gt;p&lt;/i&gt;=0.073). There was no correlation between snoring intensity and actual tonsil volume, weight, and adenoid index. Formant frequency 1 and 2 were statistically negatively correlated with the actual tonsil volume (&lt;i&gt;p&lt;/i&gt;=0.011, 0.002).Conclusion The study confirmed that the acoustic analysis of pediatric snoring could be a screening test to predict tonsil volume and changes in the vocal tract due to tonsil hypertrophy.

Holistic care for obstructive sleep apnea (OSA) with an emphasis on restoring nasal breathing: A review and perspective.

Obstructive sleep apnea (OSA) is characterized by partial or complete airway blockage during sleep. Nocturnal nasal obstruction usually leads to mouth breathing while sleeping, which worsens sleep apnea by aggravating tongue base and lateral pharyngeal wall collapse. The pathogenesis of OSA is multifactorial, and the precipitating factors vary significantly among individuals. Although continuous positive airway pressure (CPAP) is considered the first-line therapy for OSA, its adherence rate remains a challenge. Oral appliances are more suitable for simple snorers or patients with mild OSA. Maxillomandibular advancement (MMA) is highly effective for treating those with mandibular retrognathia and moderate-to-severe OSA. Intrapharyngeal surgeries yield favorable outcomes in patients with large tonsils and low tongue resting position (Friedman Stage I); however, their efficacy declines with time. Each therapy has its own strength and weakness; thus, the principle of multimodality treatment should be adopted. Nasal surgery plays an indispensable role in the holistic care for OSA. In addition to alleviating nasal congestion, nasal surgery significantly reduces snoring intensity and daytime sleepiness, which improves the quality of life of patients with OSA. Although it significantly reduces the respiratory disturbance index, its effect on the apnea-hypopnea index remains controversial. A combination of nasal surgery and multilevel pharyngeal surgery may result in better prognosis. Nasal surgery can significantly reduce the therapeutic pressure and improve the CPAP compliance of patients undergoing CPAP therapy. In conclusion, multimodality treatment and holistic care for OSA should involve nasal surgery for optimizing treatment outcomes.

Efficiency of oro-facial myofunctional therapy in treating obstructive sleep apnoea: A meta-analysis of observational studies.

The literature on oro-facial myofunctional therapy (OMT) in children and adults with obstructive sleep apnoea (OSA) was systematically reviewed to investigate the effects of OMT on patients with OSA by age and disease severity to verify the effect of OMT on OSA. All the comparative literature was retrieved from the PubMed, Embase and Cochrane libraries. We searched the articles published up to 12 February 2022 and followed the preferred reporting project for systematic review and meta-analysis of reports. The quality of the studies was evaluated using the Newcastle-Ottawa scale. Of the primary indicators for evaluating OSA, 13studies reported on the apnoea index (AHI), showing a decrease in the mean standard deviation of AHI from before OMT to after OMT (p<.00001). The lowest oxygen saturation was reported in nine studies, and the mean standard deviation of the lowest oxygen saturation increased from before to after OMT (p=.0009). Ten studies reported the Epworth Sleepiness Scale (ESS), indicating that the mean standard deviation of the ESS decreased from before to after OMT (p<.00001). The subgroup analysis showed that the AHI scores indicating mild and moderate OSA were significantly reduced, and the AHI scores indicating severe OSA also decreased, but this was not statistically significant. The lowest oxygen saturation increased obviously in patients with both mild and moderate and severe OSA. Of the secondary indicators of OSA, there was a statistically significant improvement in snoring intensity (p=.0002). Oral and facial muscular function therapy can be used as a simple and non-invasive new technique to improve the AHI, minimum oxygen saturation, ESS, and snoring intensity in patients with mild and moderate OSA and the lowest oxygen saturation in patients with severe OSA.

Myofunctional assessment for obstructive sleep apnea and the association with patterns of upper airway collapse: a preliminary study.

ObjectivesTo organize an assessment instrument with questionnaires and myofunctional orofacial/oropharyngeal assessment for OSA patients and correlate it with the upper airway obstructive site detected during drug-induced sleep endoscopy (DISE).Material and Methods29 OSA patients aged 22-65 years with an indication to undergo DISE to evaluate an alternative treatment to PAP and signed the consent form. Patients over 65 years old with maxillofacial deficiency and BMI>30 were excluded. The subjects answered the Pittsburgh, Berlin (snore), and Epworth questionnaires. The myofunctional orofacial/oropharyngeal assessment comprised soft palate, palatine pillars, and uvula (structure and mobility), tonsils (size), mandible (bony bases), hard palate (depth and width), tongue (posture, volume, width, and height), floor of mouth (mylohyoid), tongue suction and sustaining (mobility), “lowering of the back of the tongue” (stimulus), which were scored by three speech-language pathologists with expertise. DISE was scored according to VOTE classification. The statistical analysis (t-test) compared groups without and with obstruction in VOTE with questionnaires and myofunctional orofacial/oropharyngeal assessment.ResultsThe following were significantly different: snoring frequency (p=0.03) with VOTE/velopharynx; intensity (p=0.02) and frequency of snoring (p=0.03) with VOTE/lateral wall of oropharynx; suction the tongue and sustain (p=0.02) with VOTE/velopharynx; hard palate depth (p=0.02) and width (p=0.05) with obstruction VOTE/epiglottis; tonsils volume (p=0.05) with VOTE/epiglottis; tongue posture (p=0.00) with obstruction VOTE/epiglottis; floor of the mouth (p=0.02) with VOTE/epiglottis.ConclusionHigher snoring frequency and intensity was observed in patients with obstruction at the velopharynx and oropharyngeal lateral wall. Obstruction at the velopharynx was associated with poor tongue ability to suck the tongue against the hard palate. Obstruction at the epiglottis had structural and functional associations, including the oropharyngeal lateral wall, affected by the palatine tonsils size, depth and width of the hard palate, tongue position, and flaccidity of the floor of mouth. Considering that this is a preliminary study, the data should be carefully verified and not generalized.

The effects of lateral pharyngoplasty on carotid intima-media thickness in patients with obstructive sleep apnoea.

IntroductionObstructive sleep apnea (OSA) is a known risk factor for development of carotid atherosclerosis. The treatment of OSA, through positive pressure devices or surgical procedures, may reduce the signs of subclinical atherosclerosis in apneic patients.ObjectiveThe decrease of carotid intima-media thickness (CIMT) after treatment of OSA remains a highly controversial issue. Our purpose is to compare CIMT, which represents an early sign of atherosclerosis, before and at least 6 months after lateral pharyngoplasty in patients with OSA.Material and MethodsA total of 17 patients with OSA who underwent lateral pharyngoplasty were submitted to common carotid Doppler ultrasonography, 24-hour ambulatory blood pressure monitoring and type-1 polysomnography before and at least 6 months after surgery.ResultsThe median apnoea-hypopnoea index decreased from 22.6 to 5.9 (p<0.001). There were significant improvements in the arousal index, minimum oxyhaemoglobin saturation, Epworth sleepiness scale and reported snoring intensity. The surgical success rate (Shers criteria) obtained with the procedure was 76.4%. There was no significant variation in the mean CIMT after surgeries (right carotid artery, mean, 0.67 and 0.72 mm; left carotid artery, mean, 0.69 and 0.70 mm, pre- and postoperative, respectively, both p>0.05). Blood pressure measurements also did not significantly change.ConclusionNotwithstanding a significant improvement in OSA after lateral pharyngoplasty, there was no significant reduction in CIMT in a follow-up of 6 months.

Optimal application of soft-palate webbing flap pharyngoplasty combined with nasal surgery for surgical treatment of primary snoring and obstructive sleep apnea

BackgroundExcessive collapse of the soft palate and lateral pharyngeal wall narrowing are established causes of loud snoring and sleep apnea in subjects with obstructive sleep apnea (OSA). Therefore, delicate surgical techniques are needed to reshape the soft palate and create sufficient tension in the lateral pharyngeal wall. This study aimed to determine the therapeutic outcome and favorable indications of soft-palate webbing flap pharyngoplasty in subjects with OSA and primary snoring.MethodsA total of 174 subjects who underwent soft-palate webbing flap pharyngoplasty combined with uvulopalatal flap and septoturbinoplasty from August 2015 to February 2020 were included in this study. Medical records, including pre- and postoperative sleep parameters, were retrospectively reviewed. The primary outcome measure was the degree of improvement in AHI after surgery. Other outcomes were differences in surgical response rates, subjective visual analog score (VAS) for snoring, sleep quality, and complications.ResultsPolysomnographic results showed that apnea–hypopnea index (AHI) scores were significantly reduced from 39.6 ± 6.1 to 22.9 ± 3.6 following soft-palate webbing flap pharyngoplasty in 59 subjects, and overall success and response rates of this technique were analyzed with 71%. We found that the successful outcomes were observed in 50% of mild (n = 12) and 56% of moderate (n = 16) subjects with OSA subjects due to lateral pharyngeal wall collapse. The success rate of soft-palate webbing flap pharyngoplasty was relatively higher in subjects with mild and moderate OSA than those with severe OSA. Additionally, the mean VAS snoring scale was 4.7 and subjects’ primary snoring intensity significantly improved to 2.9 after soft-palate webbing flap pharyngoplasty. Subjective symptoms such as daytime sleepiness and sleep quality also showed improvement. Most complications were found to be minimal and improved by 1 month after the operation.ConclusionOur data demonstrate that soft-palate webbing flap pharyngoplasty is an effective treatment for OSA and primary snoring and may be a promising technique to reduce lateral pharyngeal wall collapse.

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.

Night-to-night variability in obstructive sleep apnea using peripheral arterial tonometry: a case for multiple night testing.

Night-to-night variability of obstructive sleep apnea severity is considerable and may depend on the diagnostic modality used. We investigated the night-to-night variability using peripheral arterial tonometry (PAT). Home sleep apnea testing was performed in 51 patients during 3 consecutive nights using PAT. Patients referred to our sleep clinic were screened and prospectively recruited for this study. All recordings were automatically and manually scored according to the PAT scoring guidelines. No systematic differences in PAT-derived apnea-hypopnea index (pAHI) were found between the nights. The night-to-night variability was comparable between manually and automatically scored data. pAHI varied in 35% of patients more than 10 events/h between the nights. The obstructive sleep apnea severity of 24% of patients was misclassified when using 1 night compared to the average of all nights. On average, pAHI varied by 57% from night to night. The variability of pAHI could partially be explained by the variability of time spent in the supine position with more time supine leading to a higher pAHI. On measuring a subsequent night, 12-14% of patients spontaneously fulfilled the commonly accepted criteria for treatment success without any intervention. With repeated recordings of PAT, we found no first night effect. However, there is considerable night-to-night variability similar to values found for polysomnography, which can partially be explained by the variability of time spent in the supine position. Obstructive sleep apnea severity was frequently misclassified due to the night-to-night variability. Our findings make a strong case for multiple testing in the diagnostic work-up of obstructive sleep apnea patients. Tschopp S, Wimmer W, Caversaccio M, Borner U, Tschopp K. Night-to-night variability in obstructive sleep apnea using peripheral arterial tonometry: a case for multiple night testing. J Clin Sleep Med. 2021;17(9):1751-1758.

Relation between grades of acquired nasopharyngeal stenosis and severity of obstructive sleep apnea symptoms

BackgroundNasopharyngeal stenosis (NPS) is a rare condition defined as the obstruction of the communication between the oropharynx and nasopharynx owing to scar contracture of the soft palate, tonsillar pillars, and posterior pharyngeal wall. NPS could be primary (attributed to a disease process such as rhinoscleroma) or secondary caused by prior surgery. In this study, we discuss the clinical manifestation of the acquired nasopharyngeal stenosis (NPS) and to investigate if there is a relation between the grade of the acquired NPS and the severity of obstructive sleep apnea (OSA) and patients’ symptoms. So, this cross-sectional study was conducted on patients who had post-surgical NPS of different grades. Then, the severity of snoring ± OSA and VAS of symptoms in those patients was assessed in different grades of the NPS, and the results were also statistically compared.ResultsWithin the included 22 patients, there were no statistical differences between grade 1 and in grade 2 as regards age (p = 0.0619) or sex (p = 0.21137). The mean AHI was significantly more (p = 0.004) in grade 2 NPS than grade 1 NPS. The VAS of difficult nasal breathing and dysphagia were significantly worse (p < 0.0001) in grade 2 NPS than in grade 1, while the VAS of snoring did not differ significantly (p = 0.3466) between grade 1 and grade 2 NPS.ConclusionGrade 2 NPS leads to significantly more severe AHI, dysphagia, and difficult nasal breathing than grade 1 NPS. But the difference in the grade of NPS did not cause differences in the snoring intensity.

The Relationship between Simple Snoring and Sleep Bruxism: A Polysomnographic Study.

Simple snoring is defined as the production of sound in the upper aerodigestive tract during sleep, not accompanied by other pathologies. Sleep bruxism (SB) refers to repetitive phasic, tonic, or mixed masticatory muscle activity during sleep. In this study, we investigated the relationship between simple snoring and SB in patients without obstructive sleep apnea (OSA). A total of 565 snoring subjects underwent polysomnography. After examination, individuals with OSA were excluded from the study group. Finally, 129 individuals were analyzed. The bruxism episode index was positively correlated with maximum snore intensity. Phasic bruxism was positively correlated with snore intensity in all sleep positions. Bruxers had a significantly decreased average and minimum heart rate compared with non-bruxers. Supine sleep position seemed to have a significant impact on snore intensity and SB. In summary, our study showed the relationship between SB, snore intensity, and body position. Phasic bruxism was positively correlated with snore intensity despite the body position, which is an interesting and novel finding.

Impact of Alcohol Consumption on Snoring and Sleep Apnea: A Systematic Review and Meta-analysis.

To systematically review the international literature for studies evaluating the effect of alcohol consumption on the occurrence and severity of snoring and obstructive sleep apnea and to use the available data to perform a meta-analysis. MEDLINE, Embase, The Cochrane Library, CINAHL/EBASCO, and Scopus. The protocol was registered in PROSPERO in March 2018. Following PRISMA guidelines, 2 independent researchers conducted a search from their inception through July 2018. Polysomnography (PSG) data were collected for sleep stages, apnea-hypopnea index (AHI), respiratory disturbance index, and/or lowest oxygen saturation (LSAT). Data concerning the frequency and severity of snoring intensity and sleep architecture were also collected. Only studies with PSG data were evaluated, with exclusion of studies with home sleep testing data. A multivariate regression and pooled analysis with forest plot was performed. A total of 1266 manuscripts were screened, and 13 manuscripts with 279 patients met inclusion criteria. Pooled analysis of AHI for control versus alcohol consumption revealed a mean difference (MD) of 3.98 events per hour (95% CI, 3.27 to 4.68; P < .001). Pooled analysis of LSAT for control versus alcohol consumption revealed an MD of -2.72% (95% CI, -3.69 to -1.76; Z score, 5.53; P < .00001). Alcohol consumption is associated with worsening severity of snoring, altered sleep architecture, AHI, as well as lowest oxygen saturation among patients susceptible to snoring and obstructive sleep apnea.

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.

Effects of respiratory muscle therapy on obstructive sleep apnea: a systematic review and meta-analysis

The purpose of this study is to conduct a systematic review and meta-analysis evaluating the effects of respiratory muscle therapy (ie, oropharyngeal exercises, speech therapy, breathing exercises, wind musical instruments) compared with control therapy or no treatment in improving apnea-hypopnea index ([AHI] primary outcome), sleepiness, and other polysomnographic outcomes for patients diagnosed with obstructive sleep apnea (OSA). Only randomized controlled trials with a placebo therapy or no treatment searched using PubMed, EMBASE, Cochrane, and Web of Science up to November 2018 were included, and assessment of risk of bias was completed using the Cochrane Handbook. Nine studies with 394 adults and children diagnosed with mild to severe OSA were included, all assessed at high risk of bias. Eight of the 9 studies measured AHI and showed a weighted average overall AHI improvement of 39.5% versus baselines after respiratory muscle therapy. Based on our meta-analyses in adult studies, respiratory muscle therapy yielded an improvement in AHI of -7.6 events/h (95% confidence interval [CI] = -11.7 to -3.5; P ≤ .001), apnea index of -4.2 events/h (95% CI = -7.7 to -0.8; P ≤ .016), Epworth Sleepiness Scale of -2.5 of 24 (95% CI= -5.1 to -0.1; P ≤ .066), Pittsburgh Sleep Quality Index of -1.3 of 21 (95% CI= -2.4 to -0.2; P ≤ .026), snoring frequency (P = .044) in intervention groups compared with controls. This systematic review highlights respiratory muscle therapy as an adjunct management for OSA but further studies are needed due to limitations including the nature and small number of studies, heterogeneity of the interventions, and high risk of bias with low quality of evidence.