Tratamiento del paciente con ronquidos simples

Efficacy of pillar implants to reduce snoring and daytime sleepiness

OBJECTIVE

To measure the efficacy of pillar implants in reducing snoring.

MATERIALS AND METHODS

A total of 30 adult patients who underwent pillar implants were assessed preoperatively and at 1, 3, 6 and 12 months after the implantation. Improvement was measured using snoring frequency, visual analog scale for snoring loudness, and Epworth sleepiness scale for daytime sleepiness.

RESULTS

The mean snoring frequency, loudness and Epworth score were reduced from 6.9, 9.2 and 7.4 at the baseline to 5, 5.9 and 5.6, respectively, at 12 months postoperatively (all p < 0.03). The partial implant extrusion rate was 6.7%.

CONCLUSION

We suggest that a pillar implant procedure should be considered before proceeding to more morbid surgeries in patients with snoring and daytime sleepiness.

Prevalence of Sleep-Disordered Breathing During Routine Electroencephalogram (EEG): A Hospital-Based Descriptive Study

Sleep-disordered breathing (SDB) in adults is a common condition that is associated with a range of medical problems including hypertension, cardiovascular complications, and increase of seizure frequency in susceptible individuals. Polysomnography (PSG) is considered the gold standard measure in the diagnosis of SDB. This is an observational study on the frequency of SDB in adult patients referred for routine EEG. We found that routine EEG was capable of detecting moderate to severe symptoms of SDB in 14% of adult patients (95% confidence interval = 8.1-19.9%). The state of sleep during a routine EEG recording could help in assessing a SDB pattern and could provide an opportunity for further diagnostic sleep consultation if the patient has not previously reported problems with sleep or if SDB was not considered by the referring physician. This study underscores the need for a practice approach to ensure that patients suffering from SDB are properly referred to a sleep specialist. In the context of this report, some training and experience in PSG can be an added advantage for EEG technologists in the detection of SDB.

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.

Effects of Oropharyngeal Exercises on Snoring: A Randomized Trial

BACKGROUND

Snoring is extremely common in the general population and may indicate OSA. However, snoring is not objectively measured during polysomnography, and no standard treatment is available for primary snoring or when snoring is associated with mild forms of OSA. This study determined the effects of oropharyngeal exercises on snoring in minimally symptomatic patients with a primary complaint of snoring and diagnosis of primary snoring or mild to moderate OSA.

METHODS

Patients were randomized for 3 months of treatment with nasal dilator strips plus respiratory exercises (control) or daily oropharyngeal exercises (therapy). Patients were evaluated at study entry and end by sleep questionnaires (Epworth Sleepiness Scale, Pittsburgh Sleep Quality Index) and full polysomnography with objective measurements of snoring.

RESULTS

We studied 39 patients (age, 46 ± 13 years; BMI, 28.2 ± 3.1 kg/m2; apnea-hypopnea index (AHI), 15.3 ± 9.3 events/h; Epworth Sleepiness Scale, 9.2 ± 4.9; Pittsburgh Sleep Quality Index, 6.4 ± 3.3). Control (n = 20) and therapy (n = 19) groups were similar at study entry. One patient from each group dropped out. Intention-to-treat analysis was used. No significant changes occurred in the control group. In contrast, patients randomized to therapy experienced a significant decrease in the snore index (snores > 36 dB/h), 99.5 (49.6-221.3) vs 48.2 (25.5-219.2); P = .017 and total snore index (total power of snore/h), 60.4 (21.8-220.6) vs 31.0 (10.1-146.5); P = .033.

CONCLUSIONS

Oropharyngeal exercises are effective in reducing objectively measured snoring and are a possible treatment of a large population suffering from snoring.

TRIAL REGISTRY

ClinicalTrials.gov; No.: NCT01636856; URL: www.clinicaltrials.gov.

Snoring-induced nerve lesions in the upper airway

The prevalence of habitual snoring is extremely high in the general population, and is reported to be roughly 40% in men and 20% in women. The low-frequency vibrations of snoring may cause physical trauma and, more specifically, peripheral nerve injuries, just as jobs which require workers to use vibrating tools over the course of many years result in local nerve lesions in the hands. Histopathological analysis of upper airway (UA) muscles have shown strong evidence of a varying severity of neurological lesions in groups of snoring patients. Neurophysiological assessment shows evidence of active and chronic denervation and re-innervation in the palatopharyngeal muscles of obstructive sleep apnoea (OSA) patients. Neurogenic lesions of UA muscles induced by vibration trauma impair the reflex dilation abilities of the UA, leading to an increase in the possibility of UA collapse. The neurological factors which are partly responsible for the progressive nature of OSAS warrant the necessity of early assessment in habitual snorers.

[Sleep respiratory disorders, non-invasive ventilation and critical care in Archivos de Bronconeumología (June 2008-November 2009)]

The present study analyses the works published in Archivos de Bronconeumología from June 2008 to November 2009 that mention sleep disorders, non-invasive ventilation and critical care. The methodology used was to analyse the objectives of the works submitted, with their main results and the conclusions suggested by the authors, often putting forward the possibility of conducting new research studies. The review no only includes original articles but is also a reflection on the editorials, special articles and review works.