The impact of pretreatment assessment of oropharynx on interstitial soft palate radiofrequency surgery outcome—a multi-center study in patients with habitual snoring

Systematic review of the different aspects of primary snoring

Primary snoring, also known as simple or non-apnoeic snoring, is regarded as the first stage of sleep disordered breathing without severe medical consequences for the snorer and co-sleeper. Although it is a highly prevalent phenomenon in the general population, our knowledge is limited because of the lack of a consensus on terminology. This systematic review of the aspects used in the definitions of simple/primary snoring was conducted to obtain an inventory of current practices and compare these definitions with the conceptual definition of the American Academy of Sleep Medicine. PubMed and Web of Science were searched from July 2016 onwards without any language limitations, and 362 references were obtained. After selection based on titles, 39 remained, among which 29 contained a definition or reference to a definition. In 69% of the studies, a cut-off <5 apnoea/Hypopnoea events per hour of sleep on the Apnoea-Hypopnoea Index was used. Despite this tendency, the cut-offs ranged from 0 to <15/h. Unfortunately, the cut-off and occasional requirements did not match the conceptual definition of the American Academy of Sleep Medicine. A consensus must be reached on an operational and clinically relevant definition based on the clear conceptual definition.

Is sleep apnea underdiagnosed in adult patients with osteogenesis imperfecta? -a single-center cross-sectional study

BACKGROUND

Patients with Osteogenesis imperfecta (OI) suffer from increased bone fracture tendency generally caused by a mutation in genes coding for type I collagen. OI is also characterized by numerous co-morbidities, and recent data from questionnaire studies suggest that these may include increased risk for sleep apnea, a finding that lacks clinical evidence from cohort studies. In this cross-sectional study, 25 adults with OI underwent clinical otorhinolaryngology examination as well as overnight polysomnography to address the question. The participants were aged between 19 and 77 years, and ten of them had mild clinical OI phenotype, seven had a moderately severe phenotype, and eight had a severe phenotype.

RESULTS

We found obstructive sleep apnea (apnea hypopnea index ≥5/h) in as many as 52% of the OI patients in the cohort. Unexpectedly, however, no correlation was present between sleep apnea and daytime sleepiness, experienced bodily pain, severity of OI, Mallampati score, or neck circumference.

CONCLUSIONS

Seeing that the usual predictors showed no association with occurrence of sleep apnea, we conclude that obstructive sleep apnea may easily be left as an undetected disorder in individuals with OI. Recurrent nocturnal hypoxia due to episodes of apneas can even affect bone metabolism, thereby further aggravating bone fragility in patients with OI.

The relationship of the uvula with snoring and obstructive sleep apnea: a systematic review

Currently, the relationship between uvula size and sleep-disordered breathing (snoring and obstructive sleep apnea) lacks data for objective interpretation. This study conducted a systematic review of the international literature for research describing the measurable characteristics of the uvula (i.e., size, length, width) and any association with snoring and obstructive sleep apnea (OSA). PubMED, Scopus, Google Scholar, Embase, and the Cochrane Library were each systematically searched from inception through November 15, 2016. We screened 1037 titles and abstracts. We conducted a full review of 54 downloaded articles. Sixteen articles met inclusion and exclusion criteria. The 16 studies included a total of 2604 patients. The selected articles included data and information for (1) normative data for uvular size in the control groups, (2) snoring and uvula size, (3) OSA and uvula size, and (4) overall uvula function. Our review noted variability in findings; however, in general, a uvular length > 15 mm was considered elongated and a uvular width > 10 mm was considered to be wide. The studies included in this systematic review reveal a relationship between uvula size, snoring, and OSA. Further, larger uvulas appear associated with more severe snoring and OSA. The direct correlation between uvula size and its relationship specifically to snoring and OSA remain as topics for future prospective research.

TranQuill sling snoreplasty for snoring: A single-arm pilot study for safety and effectiveness

OBJECTIVES/HYPOTHESIS

Determine safety and efficacy of the TranQuill Sling Snoreplasty (TSS) (Surgical Specialties Corp., Vancouver, BC, Canada) for the treatment of snoring in adults with benign snoring or mild obstructive sleep apnea.

STUDY DESIGN

Prospective, unblinded, single-center pilot study.

METHODS

From February 2014 to July 2014, 20 adult patients with chronic, disruptive snoring assessed by bed partner were recruited to undergo TSS. Subjects with apnea hypopnea index < 15, minimum oxygen saturation > 85%, and body mass index (BMI) < 32 were included. Outcomes were assessed comparing the results of quality-of-life questionnaires, bed partner-assessed snoring, pain visual analog scales, WatchPAT (Itamar Medical Ltd, Caesarea Ind. Park, Israel) home sleep studies, and flexible endoscopy at baseline and 90-day follow-up.

RESULTS

Thirteen males and seven females were enrolled. Average age was 49.1 (range 31-67) and BMI of 25.8 ± 2.66. TranQuill Sling Snoreplasty significantly reduced snoring symptom scores from 8.70 ± 4.27 to 6.42 ± 4.14, P = 0.012. Snoring visual analog scores demonstrated reduction of 17.8 mm (59.4 mm ± 22.1 to 41.6 mm ± 29.2), P = 0.0184. Thirty-five percent (7/20) of subjects reported complications related to the trial, with no serious adverse events.

CONCLUSION

TranQuill Sling Snoreplasty is a safe therapy that improves snoring symptoms in most adult subjects with benign snoring or mild sleep apnea. Further study is required to better identify patients likely to respond to the therapy.

Efficacy of radiofrequency treatment of the soft palate for patients with mild to moderate obstructive sleep apnea hypopnea syndrome: treatment protocol with nine lesions to the soft palate

PURPOSE

The study aimed at assessing the efficacy and safety of a radiofrequency treatment (RFT) protocol with nine lesions to the soft palate in the treatment of mild to moderate obstructive sleep apnea hypopnea syndrome (OSAHS).

METHODS

Twenty-eight mild to moderate OSAHS patients underwent two sessions of RFT (CelonLab ENT system) at the palatal level within the interval from 6 to 8 weeks. Nine lesions (power setting of 10 W) were made per session. The baseline and posttreatment polysomnography and clinical tests battery consisting of visual analogue scales (VAS), Sleep Apnea Quality of Life Index (SAQLI), Beck Depression Inventory--second edition (BDI-II), and Epworth sleepiness scale (ESS) were applied to assess the RFT outcomes.

RESULTS

Mild to moderate OSAHS patients demonstrated statistically significantly reduced posttreatment mean VAS values for most of the OSAHS-related complaints. A significant improvement in sleepiness (ESS score 6.7 ± 3.7 vs 8.5 ± 4.1, p < 0.01), depressivity (BDI-II score 7.5 ± 6.5 vs 13.1 ± 11.7, p < 0.01), and health-related quality of life (SAQLI score 5.3 ± 0.8 vs 4.7 ± 0.9, p < 0.01) was observed after the RFT. The mean AHI decreased from 13.7 ± 5.9 to 8.3 ± 4.9 points (p < 0.01) in the entire group of patients. According to Sher's criteria of success, 17 out of 28 (60.7 %) patients improved after RFT. No major complications were noted with RFT.

CONCLUSIONS

RFT protocol with nine lesions to the soft palate seems to be an effective and safe treatment modality associated with low morbidity in selected mild to moderate OSAHS patients.

Controlled trial of combined radiofrequency-assisted uvulopalatoplasty in the treatment of snoring and mild to moderate OSAS (pilot study)

PURPOSE

The aim of this study was to assess the efficacy of radiofrequency treatment (RFT) of the soft palate and combined radiofrequency-assisted uvulopalatoplasty (RF-UPP) in the treatment of snoring and mild to moderate obstructive sleep apnea/hypopnea syndrome (OSAHS).

METHODS

In the study group consisting of 32 snoring and mild to moderate OSAHS patients with excessive soft tissue of the soft palate or uvula, 13 patients underwent RFT of the soft palate and 19 patients underwent combined RF-UPP. The baseline and posttreatment polysomnography and clinical test battery consisting of Visual Analogue Scales (VAS), Lithuanian version of Sleep Apnea Quality of Life Index (SAQLI-LT), Spielberg's Trait-State Anxiety Inventory, Beck Depression Inventory-second edition (BDI-II), and Epworth Sleepiness Scale were applied to assess the treatment outcomes.

RESULTS

After a short-term follow-up of 2 to 3 months, the group of the RFT patients showed improvement in mean VAS snoring and SAQLI-LT scores, while the group of RF-UPP patients showed statistically significantly improvement in mean apnea-hypopnea index (AHI) (12.51 ± 7.66 vs. 7.88 ± 6.05, p < 0.05, β = 0.107), SAQLI-LT, and BDI-II scores. The group of RF-UPP patients had superior and statistically significant improvement compared to the RFT alone patients with regard to mean AHI (effect size 4.63 ± 4.65 vs. 0.95 ± 4.83, p < 0.05) and SAQLI-LT (effect size 0.75 ± 0.59 vs. 0.33 ± 0.40, p < 0.05) scores.

CONCLUSIONS

Combined RF-UPP showed to be effective in the treatment of snoring and mild to moderate OSAS overcoming the RFT alone.