[Sk2 guidelines"diagnosis and therapy of snoring in adults" : compiled by the sleep medicine working group of the German Society of Otorhinolaryngology, Head and Neck Surgery]

Snoring - An Acoustic Definition

Objective- The distinction of snoring and loud breathing is often subjective and lies in the ear of the beholder. The aim of this study is to identify and assess acoustic features with a high suitability to distinguish these two classes of sound, in order to facilitate an objective definition of snoring based on acoustic parameters. Methods- A corpus of snore and breath sounds from 23 subjects has been used that were classified by 25 human raters. Using the openSMILE feature extractor, 6 373 acoustic features have been evaluated for their selectivity comparing SVM classification, logistic regression, and the recall of each single feature. Results- Most selective single features were several statistical functionals of the first and second mel frequency spectrum-generated perceptual linear predictive (PLP) cepstral coefficient with an unweighted average recall (UAR) of up to 93.8%. The best performing feature sets were low level descriptors (LLDs), derivatives and statistical functionals based on fast Fourier transformation (FFT), with a UAR of 93.0%, and on the summed mel frequency spectrum-generated PLP cepstral coefficients, with a UAR of 92.2% using SVM classification. Compared to SVM classification, logistic regression did not show considerable differences in classification performance. Conclusion- It could be shown that snoring and loud breathing can be distinguished by robust acoustic features. The findings might serve as a guidance to find a consensus for an objective definition of snoring compared to loud breathing.

Intraoral electrical muscle stimulation in the treatment of snoring

The tone of the intraoral und pharyngeal muscles of the upper airway is of particular importance for the development of snoring. By increasing the tone with electrical stimulation, a reduction in snoring may be achieved. The aim of the study was to record the effects of intraoral muscle stimulation during the day on snoring at night. The prospective bi-centric study included 16 patients with snoring and mild obstructive sleep apnoea (Apnoea Hypopnoea Index [AHI] < 15, BMI < 32). After initial polygraphy, snoring was monitored over 2 weeks (baseline) using a visual analogue scale (VAS; 0-10). This was followed by a 6-week treatment phase (2 × 20 min daily) with an intraoral electrical stimulation device. During and up to 2 weeks after therapy, snoring intensity in addition to use and potential side effects were documented on a daily basis. Three patients discontinued therapy because of technical problems. The 13 remaining patients (11 male/2 female, BMI 26.9 ± 3.2, AHI 9.3 ± 4.6) underwent per-protocol analysis. The mean snoring score was reduced from 5.6 ± 1.1 (baseline) to 3.2 ± 2.7 (after therapy) and remained stable until 2 weeks after treatment (3.3 ± 2.4). In 7 patients (53.9%) the score was reduced by more than 50%. Patients with an AHI < 10 responded better to therapy. No unexpected events occurred. In the present pilot study, the first signs of the effectiveness of intraoral muscle stimulation in snoring patients were shown. In addition to a technical improvement of the stimulator, carrying out controlled trials and assessing potential influencing factors on the success of therapy are necessary.

Among middle-aged adults, snoring predicted hypertension independently of sleep apnoea

Objective

While the link between obstructive sleep apnoea (OSA) and hypertension is well established, the relationships between snoring, OSA, and hypertension remain unclear. This study aimed to evaluate the association between hypertension and snoring independently of OSA.

Methods

Adults with sleep difficulties underwent a one-night polysomnographic sleep assessment, including a thorough assessment of apnoea and snoring. Upon waking, blood pressure was measured, the measurement repeated after 15 min, in a resting position. Anthropometric data were recorded. Hypertension was defined as blood pressure ≥140/90 mmHg or the use of antihypertensive medications.

Results

The study enrolled 181 adults (mean age 48.8 years; 119 males). Snoring, apnoea, blood pressure and anthropometric dimensions were highly associated. Patients with hypertension had higher levels of snoring and apnoea, as well as indicators of excess weight. Snoring was the most robust predictor of hypertension.

Conclusions

Snoring is a risk factor for hypertension independently of apnoea and anthropometric dimensions. While the presence of snoring is not able to replace a thorough polysomnographic evaluation of the apnoea-hypopnoea index and OSA, snoring as an acoustic signal is easily detectable. The early identification and management of snoring may reduce cardiovascular risk.

Comparative Effectiveness of the Different Treatment Modalities for Snoring

Objective

To evaluate what effects treatments of sleep-disordered breathing have on snoring and sleepiness: snoring surgery including osteotomies, mandibular advancement device (MAD), and continuous positive airway pressure (CPAP).

Study Design

Single-institution prospective comparative effectiveness trial.

Setting

University-affiliated secondary care teaching hospital.

Subjects and Methods

We prospectively studied 224 patients presenting with snoring at our department. All patients underwent detailed evaluation, including symptom questionnaires, clinical examination, polysomnography, and drug-induced sleep endoscopy. Based on these results, a treatment was proposed after multidisciplinary consultation. Treatment was evaluated through 4 questionnaires before treatment and 6 weeks and 6 months after. Treatment success was defined as a global snoring visual analog scale score ≤3 at 6 months.

Results

A total of 195 patients complied with full workup and were proposed treatment. The mean age was 46 ± 11 years; the mean body mass index, 27 ± 4; and the median apnea-hypopnea index, 10.0 (interquartile range, 4.7-20.1). After discussion, 116 (59.5%) patients agreed to start treatment (46%, surgery; 26% MAD; 28% CPAP). All symptom scores, including Epworth Sleepiness Scale, decreased significantly for all treatments at 6 weeks and 6 months. Treatment was successful in 67% of the surgery patients, 67% of the MAD group, and 76% of the CPAP group. Only 6.7% reported an unchanged snoring score in the surgery group, compared with 13.6% in the MAD group and 9.6 % in the CPAP group.

Conclusion

Multidisciplinary agreed-on treatment of snoring is effective across the proposed treatments.