Can mandibular advancement devices be a satisfactory substitute for short term use in patients on nasal continuous positive airway pressure?

BACKGROUND: Mandibular advancement devices (MADs) can successfully control both snoring and obstructive sleep apnoea (OSA). Many patients on nasal continuous positive airway pressure (NCPAP) for OSA would like a more portable alternative, even if only temporarily. This study assesses what proportion of patients with OSA already on NCPAP can successfully use a MAD for short periods (up to 1 month) as a temporary alternative to NCPAP. METHODS: Fifty patients with OSA, already on NCPAP for at least 3 months, were recruited by invitation. They were provided with a simple fixed MAD estimated to provide 75% of maximum mandibular protrusion. Sleep studies using a portable home recorder were performed on and after three nights without NCPAP to provide control data. Following acclimatisation to the MAD, sleep studies were also planned after 3, 7, and 28 days while using the MAD. If their overnight >4% SaO(2) dips per hour deteriorated to >20 or the Epworth sleepiness score (ESS) rose to >9 (or increased by >4 over baseline) on nights 3 or 7, they were then deemed to have failed the trial and were withdrawn. RESULTS: Of the 50 patients entered, one had inadequate teeth for a MAD and 31 gave up trying to use the device during the acclimatisation period because of side effects. Of the 18 prepared to use the device, two patients failed at night 3, five at night 7, and two at night 28. Thus, nine patients remained controlled by our criteria at night 28. On average, sleep study indices while using the MAD were poor compared with the night on NCPAP. CONCLUSIONS: Simple MADs are poorly tolerated by patients with OSA already on NCPAP. OSA was adequately controlled by our criteria in 32% of those recruited for the equivalent of a weekend, in 22% for 1 week, and in 18% for up to 1 month. Better tolerated devices would be likely to improve on these figures.     

Automatic nasal continuous positive airway pressure titration in the laboratory: patient outcomes

BACKGROUND: Manual titration of nasal continuous positive airway pressure (NCPAP) treatment for obstructive sleep apnoea (OSA) is time consuming and expensive. There are now "intelligent" NCPAP machines that try to find the ideal pressure for a patient by monitoring a combination of apnoeas, hypopnoeas, inspiratory flow limitation, and snoring. Although these machines usually find similar pressures to skilled technicians, it is not clear if their use in the sleep laboratory influences subsequent acceptance by patients. This study addresses this question. METHODS: One hundred and twenty two patients undergoing a trial of NCPAP were randomly allocated to either manual or automatic (Horizon, DeVilbiss) titration of pressure during their first night on NCPAP in a hospital sleep laboratory. The primary outcome (available on 112 patients) was the acceptance of NCPAP or otherwise six weeks following the initial titration night. Baseline indicators of severity were compared between the groups, as were the pressures selected and the subsequent improvement in the sleepiness of the patients. RESULTS: The initial severity of OSA was not significantly different in the two groups and the mean (SD) NCPAP pressures were similar (manual 8.7 (2.5) cm H2O, automatic 8.2 (2.1) cm H2O). The percentage of patients successfully established on CPAP at six weeks was 64% and 73% for the manual and automatic groups, respectively; 13% and 2%, respectively, in the manual and automatic groups had given up completely (p < 0.05), and there were about equal numbers (23% versus 25%) in the two groups who were still undecided. CONCLUSIONS: The substitution of automatic NCPAP titration for manual titration during the first night of NCPAP in patients with OSA does not reduce the number accepting the treatment at six weeks and may slightly improve it. This has important cost saving potential.


     

Resolution of nocturnal enuresis in snoring children after treatment with nasal budesonide

Nocturnal enuresis has been associated with obstructive sleep apnea-hypopnea and may resolve after adenotonsillectomy. Nasal corticosteroids have improved symptoms and polysomnography findings in children with snoring. Two children with primary nocturnal enuresis, chronic nasal obstruction, and loud snoring underwent polysomnography. The apnea-hypopnea index was 4.9 and 7.3 episodes/hr, and the oxygen desaturation of hemoglobin index was 4.6 and 5.2 episodes/hr. After administration of budesonide, the frequency of snoring decreased, the polysomnography findings improved, and the enuresis resolved completely. Six months after treatment, both children were still dry at night. Administration of nasal corticosteroids is associated with resolution of enuresis in children with mild obstructive sleep-disordered breathing.     

Radiofrequency versus LAUP for the treatment of snoring.

OBJECTIVE: To compare efficacy and tolerance of controlled temperature radiofrequency and laser-assisted uvulopalatopharyngoplasty (LAUP) for the treatment of snoring. METHODS: This was a prospective, nonrandomized study on 30 patients who snored. All patients had a sleep night study. Only patients with simple snoring or mild sleep apnea and soft palate obstruction were included. Efficacy was subjectively evaluated by the bed partner 2 months after the last treatment. Tolerance was estimated daily by the patient during 18 first postoperative days. Discomfort, pain, medication intake, diet, and number of days off from work were assessed. RESULTS: Both treatments were effective on snoring. Mean discomfort and pain as well as mean intake of analgesics were significantly greater with laser-assisted uvulopalatopharyngoplasty. CONCLUSION: Controlled temperature radiofrequency was as effective as laser-assisted uvulopalatopharyngoplasty on snoring on a short-term basis but was better tolerated.     

Acoustical analysis of pediatric snoring: what can we learn?

OBJECTIVE: Evaluate a database of pediatric patients who underwent snoring acoustical analysis for associations between snoring measurements, demographics, and obstructive sleep apnea/hypopnea syndrome (OSAHS) severity. STUDY DESIGN AND SETTING: A database of pediatric patients who underwent home testing with a polysomnogram device (SNAP Test, Glenview, IL) that includes acoustical snoring analysis was reviewed. RESULTS: Four hundred fifty-six patients were included (mean age, 6.87 years). Four hundred twenty-nine (94.1%) patients had measurable snoring. Snoring index (events/hr) (r = 0.2073; P < 0.0001) and maximal loudness (dB) (r = 0.2218; P < 0.0001) were directly proportional to the apnea/hypopnea index. Among patients without OSAHS (apnea index <1), increasing snoring index (r = -0.2102; P < 0.0001) and volume (P < 0.005 ANOVA) were associated with increasing oximetry desaturation events. CONCLUSION: The majority of children evaluated had objective snoring. Increasing snoring index and loudness are associated with increased severity of OSAHS. In the absence of OSAHS, increasing snoring is associated with oxygen desaturations. SIGNIFICANCE: Pediatric snoring is objectively related to OSAHS severity.     

Palatal implants for the treatment of snoring: long-term results.

OBJECTIVE: To evaluate the safety and long-term effectiveness of a new treatment for snoring using permanent palatal implants. STUDY DESIGN: Prospective study with 35 patients referred to the clinic for the treatment of snoring. The patients were followed for 1 year, and a sleep analysis was performed and repeated at 360 days. During the procedure, 3 braided polyethylene terephthalate implants were placed in the palate of each patient. RESULTS: The average duration for nonnarcotic analgesics was 1.3 days. No adverse events were observed. The mean snoring intensity was reduced from 7.1 at baseline to 4.8 at 1 year (P < 0.001). Bed partner satisfaction rate was very high at 70.6% after 1 year. Six patients (17.8%) experienced a total of 9 partial extrusions. CONCLUSIONS: The palatal implant system is safe, and the effectiveness in treating snoring is comparable to other surgical methods. Advantages are virtually no tissue damage and minimal patient discomfort as a result of one standardized, low-cost procedure. EBM rating: C-4.     

Comparative study of four radiofrequency generators for the treatment of snoring.

OBJECTIVE: To compare the efficacy and safety of four radiofrequency generators (Ellman, Select Sutter, Coblator, Somnus) for the treatment of simple snoring. MATERIALS AND METHODS: Multicenter, randomized, prospective single-blind study on 120 selected patients with simple snoring (apnea/hypopnea index <10/h of sleep). Snoring sound intensity was measured on a visual analog scale and the partner's short-term satisfaction rate was evaluated after two treatment sessions maximum. Discomfort, pain, and medication intake were compared. RESULTS: Radiofrequency decreased the snoring sound intensity from 7.9 +/- 1.7 to 4.4 +/- 2.7 (P < 0.0001). The four radiofrequency generators had a statistically comparable efficacy. The Ellman generator caused less discomfort and required less anti-inflammatory drugs. CONCLUSION: Despite different technical characteristics, the four generators had a comparable efficacy with good safety. The Ellman generator induced the least discomfort.     

Predictors and prevalence of obstructive sleep apnoea and snoring in 1001 middle aged men.

One thousand and one men, aged 35-65 years, were identified from the age-sex register of one group general practice. Over four years 900 men were visited at home and asked questions about symptoms potentially related to sleep apnoea and snoring. Height, weight, neck circumference, resting arterial oxygen saturation (SaO2), and spirometric values were also determined. All night oximetry was then performed at home and the tracing analysed for the number of dips in SaO2 of more than 4%. Subjects with more than five dips of 4% SaO2 or more per hour were invited for sleep laboratory polysomnography. Seventeen per cent of the men admitted to snoring "often." Multiple linear regression techniques identified and ranked neck circumference (r2 = 7.2%), cigarette consumption (r2 = 3.4%), and nasal stuffiness (r2 = 2%) as the only significant independent predictors of snoring. Together these account for at least a sixfold variation in the likelihood of being an "often" snorer. Forty six subjects (5%) had greater than 4% SaO2 dip rates of over five an hour and 31 of these had full sleep studies. Three subjects had clinically obvious and severe symptomatic obstructive sleep apnoea, giving a prevalence of three per 1001 men (0.3%; 95% confidence interval 0.07-0.9%). Eighteen men had obstructive sleep apnoea only when supine and in 10 the cause of the SaO2 dipping on the original home tracing was not elucidated. The greater than 4% SaO2 dip rates correlated with the history of snoring. Multiple linear regression techniques identified and ranked neck circumference (r2 = 7.9%), alcohol consumption (r2 = 3.7%), age (r2 = 1%) and obesity (r2 = 1%) as the only significant independent predictors of the rate of overnight hypoxic dipping. This study shows that snoring in this randomly selected population correlates best with neck size, smoking, and nasal stuffiness. Obstructive sleep apnoea, defined by nocturnal hypoxaemia, correlates best with neck size and alcohol, and less so with age and general obesity.     

Palatal implants for primary snoring: short-term results of a new minimally invasive surgical technique.

OBJECTIVE: To determine the safety and efficacy of a new soft palate implant procedure for the reduction of snoring. STUDY DESIGN AND SETTING: Fifteen healthy patients with primary snoring due to palatal flutter were enrolled into this prospective study after clinical and endoscopic examination and polysomnography. The average age of the patients was 41.2 +/- 8.6 years with a body mass index of 26.2 +/- 2.5 kg/m2. The Anti-Snoring Device consists of a delivery tool with a cylindrical implant of braided polyester filaments. Under local anesthesia, three implants intended for permanent implantation were placed into the soft palate. Snoring-related symptoms were assessed by visual analogue scales (VAS), polysomnography, and the SNAP system at baseline and 90 days postoperatively. RESULTS: All implants were placed without complications. Only minor discomfort was reported in four cases within the first three days postprocedure. At the 90-day follow-up snoring was reduced from 7.3 +/- 1.6 to 2.5 +/- 2.1 (VAS, P < 0.01) and from 347 +/- 239 to 264 +/- 168 snoring sounds/hour (SNAP, P > 0.05). Polysomnography did not show any deterioration of sleep or breathing. Speech, swallowing, and taste were unchanged. CONCLUSION: The Anti-Snoring Device is a new surgical tool offering a simple and minimally invasive procedure. Our data demonstrate that the treatment is safe and effective with good patient acceptance. Further patient follow-ups are needed to evaluate the long-term results.     

Uvulopalatal flap for snoring on an outpatient basis.

OBJECTIVE: Snoring is now seen as one end of a spectrum of sleep-related breathing disorders, and in its extreme form, snoring can cause obstructive sleep apnea syndrome. Since the introduction of uvulopalatopharyngoplasty, many other procedures have been introduced to alleviate palatal abnormalities seen in patients with obstructive sleep apnea syndrome. A reversible uvulopalatal flap (UPF) achieves the same results as the uvulopalatopharyngoplasty but with less postoperative discomfort. The purpose of this study was to assess the safety and efficacy of UPF for the treatment of simple snoring on an outpatient basis. METHODS: UFP was performed on an outpatient basis under local anesthesia. The mucosa on the lingual surface of the uvula and soft palate was removed with cold knife dissection. The uvular tip was amputated. The uvula was reflected back toward the soft palate and sutured. Most of the patients were male with simple snoring by history and confirmed by polysomnographic study. Data on patients were compared from preoperative to postoperative assessment points. Statistic analysis was performed. RESULTS: Fifty-six patients tolerated the procedure well, and it was performed in an average of 20 minutes. Patients had a mean age of 48 years and a mean body mass index of 26.5 kg/m(2). The mean follow-up was 14 months (range, 12 to 20 months). Significant improvement was observed in snoring scale (8.2 +/- 3.4 versus 2.6 +/- 1.4, P < 0.05). Mean snoring index decreased from 245.8 +/- 40.8 to 42.5 +/- 20.7 events/hr (P < 0.001). The correlations between the changes in the subjective and objective snoring assessments were statistically significant. Postoperative complications included transient nasal regurgitation (4%) and foreign body sensation (2%). Bleeding, dysphagia, infection, and nasopharyngeal stenosis were not observed. Most patients had mild to moderate pain (visual analog scale, 相似文献   

Predictors of loud snoring in persons with spinal cord injury

BACKGROUND: Predictors of loud snoring were examined in a cohort of 197 persons with chronic spinal cord injury (SCI) recruited by advertisement and from a Veterans Affairs Medical Center SCI Service. METHODS: Data were collected on age, marital status, antispasticity medications, duration of injury, level and completeness of injury, stature, and weight. Body mass index (BMI) was calculated for all participants. A health questionnaire was used to collect data on snoring and respiratory history. Habitual snorers were defined as those who reported loud snoring more than 1 night per week. RESULTS: The mean age (+/- SD) was 51.2 +/- 14.8 years, and 84 of 197 (42.6%) were habitual snorers. The most obese research subjects, regardless of antispasticity medication use, were more likely to report snoring, but the risk of snoring was greatest among subjects who were obese and used antispasticity medication. Subjects who used antispasticity medication and had a BMI above the median (> or = 25.3 kg/m2) had a 7-fold risk of reporting snoring compared with subjects below the median who did not use antispasticity medication (P = .001). The greatest risk occurred in those who used diazepam alone or baclofen and diazepam together and had a BMI at or above the median. Subjects who used these medications and had a BMI below the median did not have a significantly increased risk. Neurological motor completeness, level of injury, age, and years since injury were not significant predictors of snoring. CONCLUSION: Because snoring is a marker for obstructive sleep apnea (OSA), the data suggest that in obese individuals with SCI, the use of antispasticity medications may be a risk factor for OSA.     

Randomised prospective parallel trial of therapeutic versus subtherapeutic nasal continuous positive airway pressure on simulated steering performance in patients with obstructive sleep apnoea

BACKGROUND: Obstructive sleep apnoea (OSA) impairs vigilance and may lead to an increased rate of driving accidents. In uncontrolled studies accident rates and simulated steering performance improve following treatment with nasal continuous positive airway pressure (NCPAP). This study seeks to confirm the improvement in steering performance in a randomised controlled trial using subtherapeutic NCPAP as a control treatment. METHODS: Fifty nine men with OSA (Epworth Sleepiness Score (ESS) of > or =10, and > or =10/h dips in SaO(2) of >4% due to OSA) received therapeutic or subtherapeutic NCPAP ( approximately 1 cm H(2)O) for one month. Simulated steering performance over three 30-minute "drives" was quantified as: standard deviation (SD) of road position, deterioration in SD across the drive, length of drive before "crashing", and number of off-road events. The reaction times to peripheral target stimuli during the drive were also measured. RESULTS: Subtherapeutic NCPAP did not improve overnight >4% SaO(2) dips/h compared with baseline values, thus acting as a control. The SD of the steering position improved from 0.36 to 0.21 on therapeutic NCPAP, and from 0.35 to 0.30 on subtherapeutic NCPAP (p = 0.03). Deterioration in SD of the steering position improved from 0.18 to 0.06 SD/h with therapeutic NCPAP and worsened from 0.18 to 0.24 with subtherapeutic NCPAP (p = 0.04). The reaction time to target stimuli was quicker after therapeutic than after subtherapeutic NCPAP (2.3 versus 2.7 seconds, p = 0.04). CONCLUSIONS: Therapeutic NCPAP improves steering performance and reaction time to target stimuli in patients with OSA, lending further support to the hypothesis that OSA impairs driving, increases driving accident rates, and that these improve following treatment with NCPAP.     

Palatal implants for the treatment of snoring: Long-term results

Objectives: The purpose of this study was to evaluate the safety and long-term effectiveness of a new treatment for snoring using permanent palatal implants.Methods: In this prospective study, the population was comprised of 34 patients that were referred to the clinic for the treatment of habitual snoring. The patients had a baseline medical examination, and evidence of snoring-related symptoms and signs were collected. The patients were followed for 1 year, and an overnight sleep analysis was performed and repeated at 360 days. During the procedure, 3 braided PET implants were placed in the palate of each patient with a delivery device under local anesthesia.Results: The average time for the procedure was 8 minutes. Twenty-four percent of the patients needed no postoperative analgesics, and the average duration for nonnarcotic analgesics was 1.3 days postprocedure. No adverse events were observed. The mean snoring intensity was reduced from 7.1 at baseline to 4.8 at 1 year (P < 0.001). The bed partner satisfaction rate was very high at 70.6% after 1 year. The Epworth Sleepiness Score (ESS) saw a statistically significant drop from 9.3 to 4.6 at 1 year (P < 0.001). Six patients (17.8%) experienced a total of 9 partial extrusions.Conclusions: The palatal implant system is safe and associated with very low patient morbidity. The effectiveness in treating snoring is comparable to other surgical methods and can be further improved by more careful patient selection. The advantages are virtually no tissue damage and minimal patient discomfort as a result of one standardized, low-cost procedure.     

Injection snoreplasty: how to treat snoring without all the pain and expense.

OBJECTIVE: We introduce Injection Snoreplasty: an innovative, safe, and effective palatal snoring procedure with minimal cost and discomfort to the patient. A well-described sclerotherapy agent, Sotradecol, is injected into the soft palate to reduce/eliminate palatal flutter snoring. STUDY DESIGN AND SETTING: Twenty-seven patients with a diagnosis of palatal flutter snoring (respiratory disturbance index less than 10) by sleep study were enrolled in the protocol. Office treatment sessions were performed 6 to 8 weeks apart. Success was judged by subjective improvement in snoring and objective evidence of palatal stiffening/scarring. RESULTS: Twenty-five (92%) of 27 patients reported significant decrease in snoring. There were no significant postinjection complications. Visual analog pain scale confirmed minimal discomfort. Most patients received more than 1 treatment (average, 1.8) in order to receive optimal palatal stiffening. CONCLUSION/SIGNIFICANCE: Injection Snoreplasty is a simple, safe, and effective office treatment for primary snoring. Advantages over current snoring procedures include simplicity, low cost, decreased posttreatment pain levels, and minimal/no convalescence.     

Self reported snoring and daytime sleepiness in men aged 35-65 years.

BACKGROUND: It has been suggested that snoring alone, without conventional sleep apnoea or hypopnoea, may disrupt sleep and produce substantial daytime hypersomnolence. This study addresses this potential relationship. METHOD: Eight hundred and fifty men, aged 35-65 years, drawn from one general practice were visited at home and asked a range of questions potentially related to sleepiness, snoring, and sleep apnoea; these included inquiries about alcohol and cigarette consumption, nasal stuffiness, shift work, hypnotic or other drug use, and medical diagnoses. In addition, measurements of height, weight, and overnight arterial oxygen saturation were made. The relation between snoring and sleepiness, with allowance made for potentially confounding variables, including sleep apnoea, was assessed by multiple logistic regression. RESULTS: Positive answers to all questions about sleepiness were correlated significantly with self reported snoring. After potentially confounding variables and any sleep apnoea had been controlled for, positive answers to four questions about inappropriate drowsiness or sleepiness were independently related to snoring. For example, the odds ratio of admitting to "having almost had two or more car accidents while driving due to sleepiness" was 5.8 (95% confidence intervals: 2.7-12.5) in an "often" snorer. CONCLUSIONS: Although epidemiological associations such as this do not prove a causal relation, the study suggests that snoring (without classical sleep apnoea) may sometimes reduce sleep quality sufficiently to produce substantial daytime drowsiness.     

Palatal implants for the treatment of snoring and obstructive sleep apnea/hypopnea syndrome.

OBJECTIVE: Randomized, double-blinded, placebo-controlled, clinical trial to determine the effectiveness of palatal implants for treatment of mild/moderate obstructive sleep apnea/hypopnea syndrome (OSAHS). STUDY DESIGN AND SETTING: Sixty-two non-obese adults with history of snoring, daytime sleepiness, and mild/moderate OSAHS, were randomized to receive palatal implants (n = 31) or placebo procedure (n = 31). Complete follow-up including quality of life (QOL, SF-36), snoring visual analog scale (VAS), and Epworth Sleepiness Scale (ESS) data were obtained in 62 patients. Seven patients refused follow-up polysomnography for a total of 55 patients (29 implant and 26 placebo). RESULTS: The treatment group (change in score of -7.9 +/- 7.7) was significantly improved compared with the placebo group (change in score of 0.9 +/- 4.3) for apnea/hypopnea index (AHI) (P < 0.0001), QOL, SF-36 (P < 0.0001), snoring VAS (P < 0.0001), and ESS (P = 0.0002). CONCLUSIONS: Palatal implants improve AHI, QOL, snoring intensity, and daytime sleepiness for selected patients with mild/moderate OSAHS.     

Intranasal corticosteroid therapy for obstructive sleep apnoea in patients with co-existing rhinitis

BACKGROUND: Increased nasal airflow resistance (NAR) may contribute to the pathophysiology of obstructive sleep apnoea syndrome (OSAS) but studies investigating the effects of relieving nasal obstruction in OSAS have produced differing results. There are no reports of intranasal corticosteroid therapy in adult OSAS patients with reversible nasal obstruction. METHODS: We evaluated an intranasal corticosteroid, fluticasone propionate, in 24 consecutive snorers with associated rhinitis using a randomised, placebo controlled, crossover design. Patients underwent polysomnography, snoring noise, and NAR measurements at baseline and after each 4 week treatment period. RESULTS: Twenty three patients completed the protocol and were divided into an apnoeic group (group A; 13 patients) and a non-apnoeic snoring group (group S; 10 patients) based on an apnoea-hypopnoea frequency (AHI) of > or =10/h or <10/h. AHI was significantly lower following treatment with fluticasone than with placebo in the total population (median (quartile range) 11.9 (22.6) v 20 (26.3); p<0.05) and in group A (23.3 (21.3) v 30.3 (31.9); p<0.05). Median (95% confidence interval) within subject differences for AHI were -3.2 (-17.7 to -0.2) in the total population and -6.5 (-29.5 to 1.8) in group A. NAR was also lower on fluticasone (2.74 (1.21) v 3.27 (1.38), p<0.01), within subject difference being -0.45 (95% CI -0.87 to -0.21). The changes in AHI and NAR in group A were significantly correlated (r=0.56; p<0.05). Snoring noise and sleep quality were unchanged but daily diary records indicated subjective improvements in nasal congestion and daytime alertness with fluticasone (p<0.02). CONCLUSIONS: Intranasal fluticasone is of benefit to some patients with OSAS and rhinitis. The data suggest that this form of nasal obstruction may contribute to the pathophysiology of OSAS.     

Acoustical analysis of snoring: can the probability of success be predicted?

PURPOSE: Palatal flutter snoring is the most common form of snoring. However, other types of snoring do exist. Does identifying palatal snoring beforehand translate into improved subjective treatment success with palatal stiffening procedures? METHODS: Fifty-three patients presenting with snoring were evaluated with a commercially available device. The proportion (%) and magnitude of palatal flutter (dB) were quantified. Patients then underwent a palatal stiffening procedure and subjective success/failure was assessed. RESULTS: Overall subjective treatment success was 85% (45 of 53). The percent palatal flutter was the most predictive of success (area under ROC = 0.8556, 95% CI = .7428-.9683). Patients exceeding 68% palatal flutter had a 95% (39 of 41) success rate (P = 0.001, Fisher's exact) and an adjusted odds ratio of treatment success of 25.2 (95% CI = 3.22-196, P = 0.002). CONCLUSION: Palatal stiffening treatments are successful in the majority of patients. However, identifying patients with predominant palatal flutter snoring significantly increases the probability of subjective treatment success. EBM rating: B-2b.     

Evaluation of potential predictors of outcome of laser-assisted uvulopalatoplasty for snoring.

OBJECTIVE: Laser-assisted uvulopalatoplasty (LAUP) is a common treatment for snoring, but up to 50% of patients obtain little or no sustained benefit. We investigated whether pre-operative measurements from lateral cephalometry, acoustic rhinometry, analysis of snoring sounds, and body mass index (BMI) could predict which snorers benefited from LAUP. STUDY DESIGN AND SETTING: Fifty-five snoring patients were assessed pre- and 6 months post-LAUP. Snoring severity was assessed by objective sound level recorded during polysomnography, and a Snoring Symptoms Inventory (SSI) questionnaire. RESULTS: The outcome of surgery was assessed by changes in objective sound measurements and in SSI, 6 months after LAUP. CONCLUSIONS: Relationships between the predictive measurements and outcome were at best only weak and none had sufficient predictive value to be useful in clinical practice.     

Habitual snoring with and without obstructive sleep apnoea: the importance of cephalometric variables.

BACKGROUND: The obstructive sleep apnoea syndrome is characterised by an increased apnoea-hypopnoea index and a reduction in the minimal arterial oxygen saturation (SaO2) values during sleep. The extent to which these variables can be predicted by cephalometric and otorhinolaryngological variables was tested. METHODS: One hundred consecutive habitual snorers (84% male), with a mean (SD) age of 50.1 (10.1) years, were studied. The 45 patients with less severe sleep apnoea, with an apnoea-hypopnoea index of 10 or less (group A), were compared with the 55 with an index above 10 (group B). RESULTS: Body mass index, some cephalometric variables, and some otorhinolaryngological variables differed significantly between group A and group B, in particular the soft tissue measures PNS-P (posterior nasal spine to palate), MP-H (mandibular plane to hyoid bone), degree of oropharynx stenosis, and tongue size. In a multiple regression correlation analysis MP-H, SNB (angle from sella to nasion to subspinale point), SNA (angle from sella to nasion to supramentale point), PAS (posterior airway space), tongue size, and body mass index contributed significantly to the equation explaining the severity of sleep apnoea. Nevertheless, these variables together explained only 33% of the variance of the apnoea-hypopnoea index in the total sample; they were more important for patients with moderate to severe stages of the disease. CONCLUSION: The lack of association between cephalometric variables and mild sleep apnoea suggests that the differences in these variables (soft tissue measures) may be the consequence rather than the cause of habitual snoring and the obstructive sleep apnoea syndrome.