Snoring Problems Research Articles

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.

Self-reported sleep status and influencing factors: a web-based national cross-sectional survey in China

Objectives To investigate self-reported sleep duration, sleep timing, sleep status and influencing factors in the Chinese population. Methods This web-based cross-sectional survey was conducted in 2022, covering 31 provinces (91%) in China. 11,000 questionnaires were collected, of which 8970 were valid for analysis. Self-reported sleep habits, problems and quality were investigated. Good or fair sleep ratings, enough duration, regular, with no sleep disturbances and <30 min sleep latency was defined as a composite variable: ‘Good sleep’. Factors influencing sleep patterns and ‘Good sleep’ were analyzed by multivariate logistic regression. Results Most participants sleep less than 7 h per night (55.13%), usually go to bed at 10–12 pm (47.99%), wake up at 6–8 am (49.86%), and take less than 30 min to fall asleep (66.30%) with regular sleep schedule (76.01%). Only 12.36% have ‘Good sleep’. In the past 3 months, 46.80% of the participants reported symptoms of insomnia, and 21.54% had snoring problems. Among the adults, the young, males, college students, freelancers, and those who resided in urban areas and pandemic-free areas slept later, and the northerners woke up earlier. The adults with low-moderate and moderate income and the minors at elementary and middle school slept earlier and woke up earlier. Mid-aged adults who often napped at noon were more likely to have ‘Good sleep’ than any other age group, and urban dwellers with the same habit were more likely to have ‘Good sleep’ than people dwelled in other regions. While people who slept late, woke up too early or too late, slept too little or too much, resided at GMT 7–8 area or pandemic area, had high income, or took up some occupations (entrepreneurs/individuals, professionals, manual and non-manual workers, housewives) were less likely to get a ‘Good sleep’. Conclusions The national survey provided a sleep profile of the Chinese population. Both socio-economic status and personal sleep hygiene habits had an impact on ‘Good sleep’.

E12 Sleep disturbance among Juvenile idiopathic arthritis patients

Abstract Background Juvenile idiopathic arthritis (JIA) is a common pediatric condition that is often associated with chronic pain and physical disability. Moreover, it is also comorbid with sleep problems which considerably affects the patient’s daily functioning [1]. Objectives The aim of this study was to assess sleep disturbances among JIA patients. Methods We conducted a cross-sectional study including patients with JIA according to the International League of Associations for Rheumatology (ILAR). Sociodemographic data as well as disease characteristics were collected. Sleep disturbance was assessed by two questionnaires: the BEARS Sleep Screening algorithm and PROMIS sleep disturbance short form according to the age of the patients (&amp;lt;18 years old, &amp;gt;18 years old respectively). The BEARS is an instrument divided into major sleep domains: bedtime problems, excessive daytime sleepiness, awakenings during the night, regularity and duration of sleep and snoring. PROMIS is an 8-item questionnaire that assess sleep quality. A higher T score corresponds to a poorer the sleep quality. Results The study included 31 patients. The mean age of the participants was 28.67 years [9–45 years]. There was a female predominance: 35.5% males vs 64.5% females. The mean age at onset was 6.6 years [2–13] and the mean disease duration was 256.5 months [36–444]. The distribution of the different subtypes was as follows: Enthesitis-related arthritis (n = 4), RF-positive polyarthritis (n = 10), RF-negative polyarthritis (n = 6), oligoarthritis (n = 7) and systemic arthritis (n = 4). Nineteen patients were receiving corticosteroids. Disease-modifying anti-rheumatic drugs were used by 18 patients: methotrexate (n = 11), sulfasalazine (n = 3), leflunomide (n = 4), biologics (n = 13). Twelve patients developed complications: coxitis (n = 11), growth retardation (n = 9), uveitis (n = 4). The majority of the respondents (90.3%) reported using screens daily before going to sleep. Among patients aged &amp;lt;18 years, 2 had an individual bedroom while 8 shared theirs with their siblings. Among the ten patients who answered the BEARS Sleep Screening algorithm, 40% had an excessive daytime sleepiness, 20% had night awakenings and 30% suffered from a snoring problem. Regularity and duration of sleep was respected in 6 out of the 10 patients. The most common bedtime problem mentioned were refusal to go to bed (73%) as well as bedtime stalling (23%). As for the PROMIS form, the mean score was 55.52 [27–66]. None to slight, mild, moderate and severe sleep disturbance were found in 16.1%, 19.3% and 6.4% of cases respectively. There was a significant association between poor sleep quality and higher disease activity (DAS28 ESR) (P &amp;lt; 0.043). However, we did not find a significant association between the sleeping disturbances and age at onset (P = 0.08), disease duration (P = 0.073), the CHAQ score (P = 0.059), corticosteroid use (P = 0.063) and the screen use (P = 0.092). Conclusion This study highlights the high prevalence of sleep disturbance among JIA patients which may affect their physical, emotional and cognitive well-being. It is important to screen for sleep problems for a better management of the disease. [1] Owens J. Classification and epidemiology of childhood sleep disorders. Prim Care 2008; 35(3):533–46

Erbium:Yttrium Aluminum Garnet (Er:YAG) Laser: A Minimally Invasive Treatment Method in Selected Patients with Impaired Breathing During Sleep-The Assessment of Treatment Effectiveness After 4 Years.

Objective: The aim of this study was to assess the long-term outcomes of nonablative Er:YAG laser treatment for snoring. Background data: Nonablative Er:YAG laser treatment has been shown to improve subjective quality of sleep without serious adverse effects, but long-term data are lacking. Materials and methods: Twenty-four patients with snoring problems due to soft palate hypertrophy were treated with three treatment procedures with Er:YAG laser performed at 2-week intervals. Subjective (questionnaires) and objective (polygraph) outcome measures were assessed at baseline, 3 months, and 4 years after the final laser treatment. Results: Twenty patients returned for the 4 years follow-up. The significant improvement in subjective sleep outcomes observed 3 months after Er:YAG laser treatment was still significant 4 years after treatment. No significant improvement or deterioration in objective polygraph outcome measures was observed during the 4 years of follow-up in our study. No side effects of laser treatment were observed. Conclusions: The Er:YAG laser treatment presents a safe and well-tolerated snoring treatment alternative for patients with airway obstruction in the oropharynx with improvement in subjective sleep outcomes lasting up to 4 years.

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.

0349 Robust inter-beat interval estimation algorithm using clustering method

Abstract Introduction The heart rate is a basic indicator of the state of the human body and therefore it is important to measure the heart rate continuously, reliably, and accurately. However, it is difficult to measure the heart rate in various environments due to the limitations of Contact sensors, such as ECG. Therefore, heart rate measurement using non-contact sensors such as PVDF, Radar, and cameras has been widely studied. Among these non-contact sensors to measure the heart rate, the PVDF sensor, installed under a bed or chair, can measure the heart rate from the J-peak of Ballistocardiograph (BCG). However, it is challenging to accurately measure the heart rate due to noise-induced by the external environment. To overcome these challenges in this study, we have proposed a new algorithm for accurate heart rate measurement using PVDF sensor. The proposed algorithm includes estimators and clustering techniques to estimate the beat-to-beat of BCG signals. Methods In order to continuously estimate inter-beat interval, basic, auto-correlation, average magnitude difference function, maximum amplitude pairs, and a Bayesian approach are used to obtain basic information to calculate inter-beat interval. Auto-correlation is an estimator that estimates heart rate intervals by calculating for all discrete lags. The average magnitude difference function (AMDF), which is often used for pitch tracking, also calculates for discrete lags like auto-correlation. If the waveforms of BCG are similar, the calculated value with AMDF is small. Therefore, the reciprocal of the ADMF output is used to take the larger value for the most likely interval. This is a complementary relationship from auto-correlation because the noise characteristics are different. Maximum amplitude pairs is an estimator used for indirect peak detectors with the amplitude information of the signal. The estimated IBI was determined by combining the estimation results of three estimators with a Bayesian approach. After the estimated IBI was obtained, continuously estimated inter-beat intervals were clustered into locally similar values. The inter-beat interval values were determined by voting for the most estimated interval value in the clustered sets.All inter-beat intervals estimated by the Bayesian method have their own probability density function and the confidence value was calculated using the difference between the largest peak and the second largest peak of the probability density function. By excluding inter-beat intervals with low confidence values, the accuracy of the estimation was improved. After, the final continuous inter-beat intervals were calculated by performing the ectopic beats removal algorithm and interpolation. Results To evaluate the performance, BCG data from PVDF sensor was simultaneously measured with PSG. The PSG datasets consisted of three male patients with moderate sleep apnea, a patient with snoring problems, and a normal person. Because of the difference in timing between the peak signal of ECG and that of BCG, less than 1 HR count was allowed when the inter-beat intervals were converted to HR. When the 21-hour inter-beat intervals were compared, the difference in HR was less than 1 in 91.4%. The rest 8.6% had a difference of 1 HR or more, and it was confirmed that 6.9% of them were caused by movement, and the remaining 1.7% were caused by a temporary failure of the sensor. Conclusion The proposed algorithm showed better coverage by 18.71% compared to the coverage of 72.69% from the previous study. It was confirmed that the proposed algorithm provides a more accurate heart rate than previous studies, and the measured inter-beat intervals will be used to estimate, not only the heart rate but also the sleep stage in the future. Support (If Any)

Effect of sinus opacification on the severity of obstructive sleep apnea.

The association between rhinosinusitis and obstructive sleep apnea (OSA) remains unclear. Here, we aimed to elucidate the association between sinus opacification and OSA severity. Patients with snoring problems who visited our clinic from April 2018 to December 2020 were retrospectively enrolled. Among these patients, we included those who underwent a physical examination, overnight polysomnography, and osteomeatal-unit computed tomography. We evaluated the association between apnea-hypopnea index (AHI) and Lund-Mackay score (LMS). LMS ≥ 5 was considered indicative of sinus opacification. Among the 122 patients included in the study,LMS exhibited an increasing trend based on OSA severity. The LMS in the moderate OSA group was significantly higher than that in the no OSA group (P = 0.002), and the LMS in the severe OSA group was significantly higher than that in the no OSA (P < 0.001) and mild OSA (P = 0.006) groups. A correlation analysis revealed that AHI was significantly associated with body mass index (BMI) (r = 0.367, P < 0.001) and LMS (r = 0.255, P = 0.005). A multivariate analysis revealed that sinus opacification was associated with moderate and severe OSA [Adjusted odds ratio = 11.986 (P = 0.005) and 3.756 (P = 0.044), respectively] after adjusting for age, sex, BMI, smoking, hypertension, atopy, tonsil size, and palatal position. The effect of sinus opacification on OSA severity was comparable to that of overweight. Sinus opacification may increase OSA severity since moderate and severe OSA is independently associated with it.

SLEEP APNEA ASSOCIATED COMORBIDITIES AND MORTALITY IN AN OLDER VETERAN POPULATION

Evidence continues to mount that sleep apnea (SA) occurs in 10-25% of Americans and is associated with significant morbidity and mortality (Schulman 2018). Among veterans, SA has been reported four times more often as compared to other non-veteran cohorts. (Wong 2015). The risk of developing dementia is increased in older individuals with OSA (Shastri, Bangar, & Holmes, 2015). The prevalence and characteristics of older adults with dementia and sleep apnea is not well known and long-term population-based studies on mortality have been lacking. Recent studies have reported overall mortality rates of 19%, in those individuals with SA, an increased rate of 1.5-3 times the mortality rate as compared to those individuals those without SA. Current recommendations support SA screening of high risk individuals including those with symptoms of snoring, fatigue, memory and concentration problems and mood changes. (Krist 2018). Despite a large number of older adults with suspected SA and comorbidities, the majority are not screened, referred, diagnosed and treated. In this VA pilot study of outpatient older male veterans with dementia and SA, N=195, mean age 75.83 years, SD=9.1, 51.3% were white, 37.5% were black. Frequently found comorbidities were: hypertension 88%, congestive heart failure 41%, Diabetes. 62% and, stroke 21%. Of note, among those who died, SA was significantly related to congested heart failure (r=.32, p<.001) and COPD (r=.40, p<.001). The overall mortality rate of 27% was higher than previous reports. Further investigation is needed to better understand the relationship between comorbidities, and SA, screening, treatment and mortality.

Analysis of sleep quality and related factors among children in Beijing

Objective: To investigate the sleep quality of children in Beijing and to analyze the related factors. Methods: The data were collected from the survey of 3-14 years old children in 7 urban districts of Beijing in 2015. By using multi-stage stratified cluster random sampling method, 26 kindergartens and primary and secondary schools in 7 districts and counties, including Xicheng, Chaoyang, Changping, Shunyi, Fangshan, Huairou and Mentougou, were randomly selected, with a total of 11 420 children. Children's sleep status was investigated with Children's Sleep Questionnaire (PSQ), and the proportion of children with sleep quality problems when the PSQ score was greater than 7. Various sleep related factors were investigated with self-made questionnaire. A multilevel model was used to analyze the relationship between PSQ score and related factors. Results: The average PSQ score of the children was 3.60±2.69. The proportion of children with sleep quality problems was 8.87%(816/9 198). Multilevel model analysis showed that the younger the children, the higher the PSQ score (<6 years old vs. 6~12 years old vs. >12 years old: 3.94±2.58 vs. 3.58±2.66 vs. 3.30±2.84, F=33.015, P<0.001); male PSQ score higher than female (3.89±2.75 vs. 3.30±2.60, t=10.560, P<0.001); and snoring, obesity, father/mother snoring, playing games before bed, surfing the internet, eating and other factors were statistically related to PSQ. Conclusions: Sleep quality of children in Beijing should not be neglected, especially preschool children with high PSQ scores. Parents should pay attention to children's snoring problems and try to reduce some pre-sleep behaviors that may affect sleep quality.

Minimally invasive erbium laser treatment for selected snorers

The aim of this paper is to present our results and experience in the treatment of snoring using the non-ablative Erbium: Yttrium Aluminum Garnet (Er:YAG) laser. Twenty-four patients (18 male and 6 female) with snoring problems due to soft palate hypertrophy were treated with 3 treatment procedures with Er:YAG 2940-nm laser (long pulse mode, 10 Hz, fluence 1.8–2.0 J/cm2) performed at 2-week intervals. The treatment procedures were performed in outpatient settings. One treatment session lasts 15–20 min. Subjective (questionnaires) and objective (polygraph) outcome measures were assessed at baseline and 3 months after the final laser treatment. Wilcoxon Signed Rank was used to compare before and after scores. All polygraph variables showed some improvement 3 months after the end of treatment; however, only the reduction of the number of hypopnea episodes per hour was statistically significant (p = 0.034). In 13/24 patients, snoring time accounted for less than 5% of the sleep time after the treatment compared to 6/24 patients at baseline. The questionnaire survey showed statistically significant improvement in the quality of sleep and life of the patients as well as their partners after Er:YAG treatment (p < 0.001). The assessment of daytime sleepiness using the Epworth scale also improved 3 months after the end of treatment (p = 0.010). Based on our observations, the treatment of snoring with the Er:YAG laser is an effective and non-invasive therapeutic method. Further studies with long-term follow-up and a control group are warranted to confirm the promising results obtained in case series.

Investigaion on influencing factors and maternal awareness and knowledge of obstructive sleep apnea syndrome

Objective To investigate maternal awareness and knowledge of obstructive sleep apnea syndrome (OSAS) and their compliance with polysomnography monitoring in snoring gravidas. Methods This study enrolled 589 volunteered gravidas who were treated at the 908th Hospital of Chinese People's Liberation Army Joint Logistic Support Force or Maternal and Child Health Hospital of Jiangxi Province from April 2016 to April 2017. The maternal knowledge of OSAS (0 point: complete lack of knowledge of OSAS; 1 to 4 points: with partial knowledge of OSAS; 5 points: correct understanding of OSAS) and the way of obtaining this knowledge were studied using a self-designed questionnaire. Influencing factors, including gestational weeks, educational background, snoring and high-risk pregnancy, were also analyzed. Chi-square test was used for statistical analysis. Results The 589 gravidas had few knowledge of OSAS and only 11 of them [1.9% (11/589)] were able to fully understand OSAS (5 points). The proportion of women who were completely lack the knowledge of OSAS (0 point) in those less-educated women was higher than in those well-educated group [61.9% (78/126) vs 52.0% (241/463), χ2=3.873, P=0.049]. Among the gravidas who were unaware of their snoring condition, those completely lack the knowledge of OSAS (0 point) accounted for 67.0% (209/312), which was higher than the percentage among gravidas knowing they had or did not have snoring problem [35.6% (21/59), 40.8% (89/218); χ2=20.755, 35.687; both P 0.05). Of 59 gravidas with snoring, only 15 (25.4%) accepted polysomnography monitoring. Eight out of the 589 gravidas (1.4%) were diagnosed with OSAS during pregnancy. Conclusions Gravidas have poor knowledge and awareness of OSAS, especially those with low educational background and not knowing their snoring condition, resulting in poor compliance with polysomnography monitoring and low diagnostic rate of OSAS during pregnancy. Key words: Pregnant women; Pregnancy complications; Sleep apnea syndromes; Awareness; Surveys and questionnaires

Sleep bruxism and sleep disorders in adolescents

Sleep Bruxism, the sleep-related movement disorder of tooth grinding and clenching, is highly reported in pediatrics with a prevalence of up to 40 % during childhood and adolescence. The precise etiology of sleep bruxism remains unknown, but it may involve genetic and psychosocial components (such as anxiety and stress). Clinicians should be aware that quite often sleep bruxism is associated with other disorders, such as snoring, sleep-disordered breathing, sleep complaints, and behavioral problems. These comorbidities should be investigated, because they may be severe and prolonged if they are not treated. SB may lead to morning jaw muscle soreness or pain, headache, masticatory muscle hypertrophy, temporomandibular disorders, and tooth wear. Especially in pediatrics, sleep bruxism is usually managed with conservative therapies, such as sleep hygiene, behavioral modifications, biofeedback, familial counseling and, only in cases of severe tooth wear or other serious possible consequences of SB, soft occlusal splints.

Examinations of acoustic signals of patients having snoring problem

The idea of the application for the preclinical diagnosis of breathing disorders during sleeping, on the basis of acoustic signal recording, is presented in the hereby paper. Research on the algorithm allowing to draw conclusions concerning breathing disorders was preceded by the experiment, of recording acoustic signals of the representative group of patients during their pharmacological sleep. Combining sound signals properties with knowledge of the experienced medical practitioner, supported by the results of the advanced medical diagnosis, should made possible the development of the tool for assessing breathing disorders (especially sleep apneas) on the basis of sound signals of patients having breathing disorders. This paper is focused on problems related to the main activities leading to the development of the efficient algorithm of assessing patient’s condition: experimental recording and methods of acoustic signals analysis. Further research stages will contain the implementation of the obtained results for the needs of the mobile application development.

Роль врача-оториноларинголога в решении проблемы храпа и синдрома обструктивного апноэ сна

Роль врача-оториноларинголога в решении проблемы храпа и синдрома обструктивного апноэ сна

The prevalence of OSA in snorers presenting with various chief complaints: a pilot study

Aims:The incidence of obstructive sleep apnea (OSA) in snoring patients is reported in the literature to range from 20% to 70%. The aim of this study was to obtain exact data on the percent of snorers who have OSA, and to classify them as having normal, mild, moderate, or severe sleep apnea.Methodology:There were 273 patients who came into the senior author’s office with sleep disorder breathing problems. They suffered with various sleep problems. All 273 patients also had a snoring problem. None of the 273 patients had ever had a sleep test, or polysomnograph (PSG).All 273 required a PSG for evaluation of their sleep problem. They were referred to a certified sleep lab local to them. When the results of the PSG came back, the authors were able to classify them as having normal, mild, moderate, or severe sleep apnea.Results:The results of the 273 PSGs showed the following: 12 patients (4%) had PSGs of apnoea–hypopnoea index (AHI)<5 (normal), 57 patients (21%) had PSGs with AHIs 5–<15 (mild), 79 patients (29%) had PSGs with AHIs 15–<30 (moderate), 119 patients (44%) had PSGs 30 or >30 (severe), and 6 patients (2%) had PSGs >100 (severe).Conclusions:Based on this study, of 273 patients who snored, the incidence of OSA is high. Ninety-six percent of the patients suffered with mild to severe sleep apnea. This malady, which can be very serious and degenerating, could be much more prevalent than previously believed. Additional research is needed to verify these figures.

Obstructive sleep apnea and snore treatment with tongue stabilizer device: randomized clinical trial, preliminary data

Introduction Obstructive sleep apnea (OSA) treatment with intra-oral devices can be effective especially in mild/moderate OSA. The tongue retention devices (TRDs) demonstrated significantly respiratory events reduction during sleep and improved sleep quality. Objective. Evaluate the efficacy of TRDs in the treatment of OSA. Materials and methods We included patients with OSA treated in outpatient clinic Neuro-Sono Sleep Center, Neurology Department, Escola Paulista de Medicina, Sao Paulo, Brazil. Patients with mild or moderate OSA on polysomnography were randomized to start treatment with one of two types of interventions: TRD or dental splint (placebo). Patients were treated for four weeks and then the second polysomnography was performed using the interventions that were randomly allocated. This study continues under blinding and interventions are referred to as A or B, to keep the allocation concealment. Results We consecutively included 75 patients, of whom 15 did not meet the inclusion criteria and 18 did not attend for evaluations. Forty-two patients were randomized. Twenty-one began treatment with device A and 21 with device B. There were 7 dropouts in total. Among the patients who used device A, only one patient showed no snoring at the end of treatment, compared to 9 patients in group B (p = 0.008). In the intra- group analysis, for intervention with device A, there was no difference in mean AHI at baseline and at the endpoint, and for device B, the mean AHI decreased from 18.4 to 12.1 events/h (p = 0.05). In the inter group analysis, there was no significant difference in mean AHI between the two devices, but 44% of patients who used device B decreased AHI to less than 10 events/ hour, compared to zero in the group with device A. Conclusion Intervention with devices A and B showed statistically significant differences, but the effect of the interventions with both devices appear to be discrete, and device B seems more effective in solving snoring problems. Acknowledgements Supported by FAPESP 2009/16758–4, 2010/02633–2, #2010/06188–3.

S2k-Leitlinie „Diagnostik und Therapie des Schnarchens des Erwachsenen“

These guidelines aim to facilitate high quality medical care of adults with snoring problems. The guidelines were devised for application in both in- and outpatient environments and are directed primarily at all those concerned with the diagnosis and therapy of snoring. According to the AWMF three-level concept, these represent S2k guidelines.A satisfactory definition of snoring does not currently exist. Snoring is the result of vibration of soft tissue structures in narrow regions of the upper airway during breathing while asleep. Ultimately, these vibrations are caused by the sleep-associated decrease in muscle tone in the area of the upper airway dilator muscles. A multitude of risk factors for snoring have been described and its occurrence is multifactorial. Data relating to the frequency of snoring vary widely, depending on the way in which the data are collected. Snoring is usually observed in middle-aged individuals and affected males predominate. Clinical diagnosis of snoring should comprise a free evaluation of the patient's medical history. Where possible this should also involve their bed partner and the case history can be complimented by questionnaires. To determine the airflow relevant structures, a clinical examination of the nose should be performed. This examination may also include nasal endoscopy. Examination of the oropharynx is particularly important and should be performed. The larynx and the hypopharynx should be examined. The size of the tongue and the condition of the mucous membranes should be recorded as part of the oral cavity examination, as should the results of a dental assessment. Facial skeleton morphology should be assessed for orientation purposes. Technical examinations may be advisable in individual cases. In the instance of suspected sleep-related breathing disorders, relevant comorbidities or where treatment for snoring has been requested, an objective sleep medicine examination should be performed. Snoring is not-at least as we currently understand it-a disease associated with a medical threat; therefore there is currently no medical necessity to treat the condition. All overweight patients with snoring problems should strive to lose weight. If snoring is associated with the supine position, positional therapy can be considered. Some cases of snoring can be appropriately treated using an intraoral device. Selected minimally invasive surgical procedures on the soft palate can be recommended to treat snoring, provided that examinations have revealed a suitable anatomy. The choice of technique is determined primarily by the individual anatomy. At an appropriate interval after the commencement or completion a therapeutic measure, a follow-up examination should be conducted to assess the success of the therapy and to aid in the planning of any further treatments.

Alternating sleeping arrangements as a coping strategy for snorers and their bed partners—A prospective study

Background: Despite overwhelming evidence for gender differences in sleep quality as well as gender-specific changes of sleep parameters with respect to habitual sleeping arrangements, studies on snorers and their bed partners have ignored the influence of individual quality of sleep as a potential co-factor. Objective: The objective of this study was to record subjective and objective sleep parameters and to analyze the effects of alternating of sleeping arrangements in snorers and their bed partners. Methods: Habitual snorers and their bed partners were recruited via newspaper articles not stating the exact purpose of the study. Both filled out a 90-day sleep diary. During this time, we recorded subjective and objective sleep parameters in the snorers and their bed partners via wrist actigraphy and sleep diaries for 14 days. For statistical analysis, we used two-sided t-tests and Spearman’s Rho. Results: The dataset included 45 snorers (11 females) and 45 bed partners (34 females) with a mean age of 47 ± 13 and 43 ± 12 years. Screening for sleep apnea yielded snoring without OSAS, mild-, moderate- and severe OSAS in 27 (60%), eight (18%), three (7%) and six (15%) snorers. PSQI total scores were significantly lower in snorers than in bed partners (4 ± 2 vs. 6 ± 4, p = 0.002). We could not find a significant correlation between subjective and objective sleep latency and efficiency. Couples who changed their sleeping arrangement were significantly younger than those who habitually slept alone or together (p = 0.01). Subjective sleep parameters of snorers or bed partners were not related to the number of consecutive nights spent either together or apart. Conclusions: Our study confirmed the weak correlation of subjective and objective sleep parameters in pairs with snoring problems. Couples changing their sleeping arrangement were the youngest among the whole group, but their separation of sleeping arrangements did not improve subjective sleep parameters.

Obstructive Sleep Apnoea and Its Association with Left Ventricular Function and Aortic Root Parameters in Newly Diagnosed, Untreated Patients: A Prospective Study

This prospective study investigated whether untreated obstructive sleep apnoea-hypopnoea syndrome (OSAHS), which is strongly associated with cardiovascular disease, is a risk factor for left ventricular (LV) systolic and diastolic dysfunction and aortic root dilatation. Ninety consecutive patients with breathing and snoring problems, including 64 with newly diagnosed, untreated OSAHS, were classified into four groups based on their apnoea-hypopnoea index (AHI). All participants underwent overnight polysomnographic and complete echocardiographic examinations, and LV systolic, diastolic and aortic measurements were compared. Body mass index was the only demographic characteristic that significantly increased as the severity of OSAHS (AHI) increased and it significantly correlated with AHI. Patients with a higher AHI had a significantly higher aortic root diameter and aortic stiffness index, and significantly lower aortic strain. The LV diastolic parameters were least favourable in patients with more severe OSAHS. The LV ejection fraction did not differ significantly between groups. It was concluded that LV diastolic function and aortic elastic parameters deteriorate with OSAHS.

Cephalometric Comparison of Pharyngeal Airway in Snoring and Non-Snoring Patients

To compare the skeletal and the airway structures of the non-snoring individuals with simple snoring and patients with obstructive sleep apnea (OSA). The first group consisted of 20 simple snoring cases (mean age: 37.5±8.05 years; max: 50 years, min: 21 years), the second group consisted of 20 OSA cases (mean age: 40.0±8.28 years; max: 54 years, min: 27 years) and the third group consisted of 20 individuals without any respiration problems (mean age: 29.6±3.20 years; max: 35 years, min: 24 years). In the cephalometric films, 4 skeletal and 14 airway space measurements were done. The control group and the study groups were compared using the Dunnett t test, and the groups with snoring problems were compared using the Bonferroni test. No statistically significant differences were found between the three groups in skeletal measurements. The OSA and simple snoring groups showed no significant differences in airway measurements. The OSA group showed significantly increased soft palate angulation when compared with the control group (P<.05). Soft palate length, soft palate thickness and soft palate height were significantly higher in the OSA samples than in the control group (P<.001). Pharyngeal spaces in the soft palate area had the significantly lowest values in the OSA group. Inferior pharyngeal space distances in the control group were greater than in both study groups. The OSA group showed the most inferiorly positioned hyoid bone and the difference between OSA and control groups was significant (P<.01). The decreased airway dimension in the soft palate area due to increased soft palate volume must be taken into consideration in treatment planning of OSA patients.