Snoring intensity after a first session of soft palate radiofrequency: predictive value of the final result

International Consensus Statement on Obstructive Sleep Apnea

BACKGROUND

Evaluation and interpretation of the literature on obstructive sleep apnea (OSA) allows for consolidation and determination of the key factors important for clinical management of the adult OSA patient. Toward this goal, an international collaborative of multidisciplinary experts in sleep apnea evaluation and treatment have produced the International Consensus statement on Obstructive Sleep Apnea (ICS:OSA).

METHODS

Using previously defined methodology, focal topics in OSA were assigned as literature review (LR), evidence-based review (EBR), or evidence-based review with recommendations (EBR-R) formats. Each topic incorporated the available and relevant evidence which was summarized and graded on study quality. Each topic and section underwent iterative review and the ICS:OSA was created and reviewed by all authors for consensus.

RESULTS

The ICS:OSA addresses OSA syndrome definitions, pathophysiology, epidemiology, risk factors for disease, screening methods, diagnostic testing types, multiple treatment modalities, and effects of OSA treatment on multiple OSA-associated comorbidities. Specific focus on outcomes with positive airway pressure (PAP) and surgical treatments were evaluated.

CONCLUSION

This review of the literature consolidates the available knowledge and identifies the limitations of the current evidence on OSA. This effort aims to create a resource for OSA evidence-based practice and identify future research needs. Knowledge gaps and research opportunities include improving the metrics of OSA disease, determining the optimal OSA screening paradigms, developing strategies for PAP adherence and longitudinal care, enhancing selection of PAP alternatives and surgery, understanding health risk outcomes, and translating evidence into individualized approaches to therapy.

Histological Effects of Er:YAG Laser Irradiation with Snoring Handpiece in the Rat Soft Palate

OBJECTIVE

The aim of this study was to assess the effects of laser irradiation with a novel snoring handpiece on the histological structures of the soft palate in a rat model.

BACKGROUND

Snoring is a common problem and studies have shown that 20-50% of the population is affected. An apnea-hypopnea index of <5/h without daytime somnolence is documented as simple snoring. No snoring treatment should ever be attempted until a sleep study has been completed to rule out sleep apnea.

METHODS

Twenty adult Wistar rats, weighing 200-250 g, were used in this study. Rats were randomized into two groups: experimental group (n = 10) and control group (n = 10). Laser energy was delivered in a horizontal direction to the surface of the soft palate of each rat in the experimental group for 2 min with an Er:YAG laser (LightWalker AT; Fotona) with snoring handpiece (PS04) in a noncontact mode (1.15 W, 2 Hz, 1.5 J/cm(2)). The animals were sacrificed after 24 h, 1 week, 3 weeks, or 5 weeks. The soft palate of each rat was removed by excisional biopsy. The specimens underwent histological examination. Contractions and fibrosis were reported as grading from 1+ to 3+, while edema and hyperemia were evaluated according to the absence (0) or presence (1) of any changes. Statistical analysis was done with the Mann-Whitney U and Spearman's rho tests.

RESULT

A noticeable contraction of the soft palate occurred immediately after laser application. Inflammatory changes were observed histologically at 3 weeks postoperatively. Keratinization appeared after the procedure in both groups and decreased gradually. Statistically, there was a strong correlation among inflammation and time and also keratinization and time (p < 0.05).

CONCLUSIONS

The present study indicates that Er:YAG laser irradiation with snoring handpiece (PS04) causes acute shrinkage of the mucosa. This contraction decreases gradually but is still present at the end of fifth week.

Comparative effects of snoring sound between two minimally invasive surgeries in the treatment of snoring: a randomized controlled trial

Background

Minimally invasive surgeries of the soft palate have emerged as a less-invasive treatment for habitual snoring. To date, there is only limited information available comparing the effects of snoring sound between different minimally invasive surgeries in the treatment of habitual snoring.

Objective

To compare the efficacy of palatal implant and radiofrequency surgery, in the reduction of snoring through subjective evaluation of snoring and objective snoring sound analysis.

Patients and Method

Thirty patients with habitual snoring due to palatal obstruction (apnea-hypopnea index ≤15, body max index ≤30) were prospectively enrolled and randomized to undergo a single session of palatal implant or temperature-controlled radiofrequency surgery of the soft palate under local anesthesia. Snoring was primarily evaluated by the patient with a 10 cm visual analogue scale (VAS) at baseline and at a 3-month follow-up visit and the change in VAS was the primary outcome. Moreover, life qualities, measured by snore outcomes survey, and full-night snoring sounds, analyzed by a sound analytic program (Snore Map), were also investigated at the same time.

Results

Twenty-eight patients completed the study; 14 received palatal implant surgery and 14 underwent radiofrequency surgery. The VAS and snore outcomes survey scores were significantly improved in both groups. However, the good response (postoperative VAS ≤3 or postoperative VAS ≤5 plus snore outcomes survey score ≥60) rate of the palatal implant group was significantly higher than that of the radiofrequency group (79% vs. 29%, P = 0.021). The maximal loudness of low-frequency (40–300 Hz) snores was reduced significantly in the palatal implant group. In addition, the snoring index was significantly reduced in the radiofrequency group.

Conclusions

Both palatal implants and a single-stage radiofrequency surgery improve subjective snoring outcomes, but palatal implants have a greater effect on most measures of subjective and objective snoring. Multi-stage radiofrequency surgery was not tested.

Trial Registration

ClinicalTrials.gov NCT01955083