Single dose injection snoreplasty: investigation or treatment?

Australasian Sleep Association position statement on consensus and evidence based treatment for primary snoring

Primary snoring impacts a significant portion of the adult population and has the potential to significantly impair quality of life. The purpose of these guidelines is to provide evidence-based recommendations to assist Australasian practitioners in the management of adult patients who present with primary snoring without significant obstructive sleep apnoea. The Timetable, Methodology and Standards by which this Position Statement has been established is outlined in the Appendix S1. The main recommendations are: Weight loss, and reduced alcohol consumption should be recommended, where appropriate If clinical judgement dictates, benzodiazepine and opioid reduction or avoidance may be advised Positional therapy should be considered in supine dominant snorers In dentate patients, Mandibular advancement devices (MAD) should be recommended as a first line treatment following assessment by both an appropriate Dentist and Sleep physician Continuous positive airway pressure (CPAP) devices may be recommended in patients with primary snoring in those already committed to their use or willing to try Surgical treatment of primary snoring by an appropriately credentialled surgeon may be advised and includes nasal (adjunctive), palatal and other interventions This position statement has been designed based on the best available current evidence and our combined expert clinical experience to facilitate the management of patients who present with primary snoring. It provides clinicians with a series of both non-surgical and surgical options with the aim of achieving optimal symptom control and patient outcomes. This is the first such set of recommendations to be established within Australasia and has also been reviewed and endorsed by the Australasian Sleep Association.

Usefulness of snoreplasty in the treatment of simple snoring and mild obstructive sleep apnea/hypopnea syndrome - Preliminary report

THE AIM OF THE STUDY

To assess the effectiveness of sodium tetradecyl sulfate injection in the region of the soft palate to treat primary snoring and mild obstructive sleep apnea/hypopnea syndrome. Sodium tetradecyl sulfate, a preparation belonging to detergents, widely applied in Poland to treat varices by the method of compressive sclerotherapy was used in the study.

MATERIAL AND METHODS

The procedure of injected snoreplasty was performed in 21 patients, who were diagnosed with primary snoring or mild obstructive sleep apnea/hypopnea syndrome, based on subjective examination and polysomnography. Injected snoreplasty involves administration of sodium tetradecyl sulfate in the form of Fibrovein 1% or 3% preparation in the volume of 2ml, in the region of the soft palate. Injection of the preparation in the area of the soft palate induces the development of aseptic inflammation, which creates a scar which stiffens the soft palate and makes the tissues of this region less susceptible to vibrations.

RESULTS

The patients after injected snoreplasty reported a significant decrease in the intensity of snoring. The markedly shortened total time of snoring was found in check-up polysomnography performed six months after the procedure.

CONCLUSIONS

Injected snoreplasty is an effective procedure, especially, in patients manifesting persistent snoring. It is not indicated in the treatment of obstructive apneas during sleep. The advantages of this method are: minimal invasiveness, the low number of complications and slight pain.

Efficacy of submucosal sodium tetradecyl sulfate in the soft palate as a treatment of the mild obstructive sleep apnea syndrome: a pilot study

Background. As described by Mair et al. in 2001, snoreplasty, the application of sclerosant agents in the palate is a promising and cheap alternative to treat snoring. We decided to try this kind of therapy for the management of mild sleep apnea. Study Design. Experimental, longitudinal, prospective, nonrandomized, self-controlled pilot study. Methods. 11 patients were included, all of them with a polysomnographic study showing an Apnea-Hypopnea Index (AHI) from 5 to 20, and with a Müller maneuver showing only retropalatal collapse. Results. We found significant decrease in the number of apneas hypopneas and oxygen desaturation as well as in the snoring index (P < 0.05), although no differences were found in the number of arousals. Conclusion. Sclerosant agents might become a relevant part in the treatment of sleep apnea, in very well-selected patients.