Objective benefit of laser palatoplasty for non-apnoeic snoring

The Annoying Nature of Snoring Sounds Is Not Only about Intensity: A Pilot Study on Exposed Test Subjects

This study aims to assess (i) which acoustic characteristics of snoring sounds are associated with the annoying nature of snoring sounds; (ii) whether listeners’ heart rates correlate with their perceived annoyance; and (iii) whether perceived annoyance is different between listeners with different experiences with their bedpartners’ snoring sounds. Six snoring epochs with distinct acoustic characteristics (viz., reference, high pitch, high intensity, short interval, irregular intensity, and irregular intervals) were collected from snoring patients. Twenty physicians and technicians were involved in the healthcare of snoring patients, and were divided into three groups based on personal experience with their bedpartners’ snoring sounds (viz., non-snoring, snoring but not annoying, and snoring and annoying). The test subjects listened to each epoch and rated its level of annoyance. Listeners’ heart rates were also recorded during the test using a finger plethysmograph. Within the limitations of this study, it was found that, compared with other snoring sounds, snoring sounds with high intensity and irregularity were associated with higher perceived annoyance. However, higher perceived annoyance of snoring sound was not reflected in heart rate-related parameters. In addition, listeners’ personal experiences do not seem to affect their perceived annoyance.

Evaluation of Potential Predictors of Outcome of Laser-Assisted Uvulopalatoplasty for Snoring

OBJECTIVE: Laser-assisted uvulopalatoplasty (LAUP) is a common treatment for snoring, but up to 50% of patients obtain little or no sustained benefit. We investigated whether pre-operative measurements from lateral cephalometry, acoustic rhinometry, analysis of snoring sounds, and body mass index (BMI) could predict which snorers benefited from LAUP.

STUDY DESIGN AND SETTING: Fifty-five snoring patients were assessed pre- and 6 months post-LAUP. Snoring severity was assessed by objective sound level recorded during polysomnography, and a Snoring Symptoms Inventory (SSI) questionnaire.

RESULTS: The outcome of surgery was assessed by changes in objective sound measurements and in SSI, 6 months after LAUP.

CONCLUSIONS: Relationships between the predictive measurements and outcome were at best only weak and none had sufficient predictive value to be useful in clinical practice.

EBM rating: C-4

The acoustics of snoring

Snoring is a prevalent disorder affecting 20-40% of the general population. The mechanism of snoring is vibration of anatomical structures in the pharyngeal airway. Flutter of the soft palate accounts for the harsh aspect of the snoring sound. Natural or drug-induced sleep is required for its appearance. Snoring is subject to many influences such as body position, sleep stage, route of breathing and the presence or absence of sleep-disordered breathing. Its presentation may be variable within or between nights. While snoring is generally perceived as a social nuisance, rating of its noisiness is subjective and, therefore, inconsistent. Objective assessment of snoring is important to evaluate the effect of treatment interventions. Moreover, snoring carries information relating to the site and degree of obstruction of the upper airway. If evidence for monolevel snoring at the site of the soft palate is provided, the patient may benefit from palatal surgery. These considerations have inspired researchers to scrutinize the acoustic characteristics of snoring events. Similarly to speech, snoring is produced in the vocal tract. Because of this analogy, existing techniques for speech analysis have been applied to evaluate snoring sounds. It appears that the pitch of the snoring sound is in the low-frequency range (<500 Hz) and corresponds to a fundamental frequency with associated harmonics. The pitch of snoring is determined by vibration of the soft palate, while nonpalatal snoring is more 'noise-like', and has scattered energy content in the higher spectral sub-bands (>500 Hz). To evaluate acoustic properties of snoring, sleep nasendoscopy is often performed. Recent evidence suggests that the acoustic quality of snoring is markedly different in drug-induced sleep as compared with natural sleep. Most often, palatal surgery alters sound characteristics of snoring, but is no cure for this disorder. It is uncertain whether the perceived improvement after palatal surgery, as judged by the bed partner, is due to an altered sound spectrum. Whether some acoustic aspects of snoring, such as changes in pitch, have predictive value for the presence of obstructive sleep apnea is at present not sufficiently substantiated.

Effectiveness and side effects of one-stage laser-assisted uvuloplasty in primary rhonchopathy

The aim of this study is to evaluate the results of laser-assisted uvuloplasty (LAUP) in terms of effect on snoring and side effects. The case report study is based on the analysis of questionnaires with a visual analog scale (VAS) describing the severity of snoring before and 6-26 months after operation and questions regarding postoperative course. The group of patients consisted of 73 patients with primary rhonchopathy. The average preoperative VAS score was 8.36; it decreased to an average of 3.98 postoperatively (p = 0.001). No improvement was reported by 12% of patients, improvement of 4 and more of the VAS scale was reported by 67% of patients. The majority (58%) of patients reported postoperative pain for up to 10 days. Bothersome sensations persisted in 15% of patients. No predictive factors for the success of treatment were found. LAUP diminished snoring in 88% of patients. A major drawback was the postoperative pain. Further studies looking for predictive factors are needed.

Uvulopalatopharyngoplasty versus laser assisted uvulopalatoplasty for the treatment of snoring: an objective randomised clinical trial

This study was designed to evaluate objectively the clinical effectiveness of surgery for snoring and to compare the results of conventional uvulopalatopharyngoplasty (UPPP) and laser assisted uvulopalatoplasty (LAUP) in the treatment of snoring. Patients who had been referred for investigation and treatment of their snoring were randomly allocated to receive either UPPP or LAUP. Forty-seven patients with confirmed palatal flutter had surgery and all of them had a preoperative and postoperative objective assessment of their snoring loudness and duration in the home. The recording device (Snore Box) is simple for the patient to operate, portable with a built in microphone, and able to produce objective results, which can be automatically analysed. Of the 38 patients, who had technically valid recordings, 22 underwent LAUP and 16 UPPP. Overall the mean postoperative Snore Index (SI) was less than the preoperative SI (P < 0.0001), the average difference being 78.2 snores/h. There was no significant difference between the LAUP and UPPP regarding the fall in the SI. This study is the first objective comparative study to demonstrate the effectiveness of snoring surgery.

Psychometric performance before and after laser palatoplasty for non-apnoeic snoring

Psychometric tests are an objective way of examining cognitive functioning, and have shown impairment in patients with obstructive sleep apnoea. Non-apnoeic snoring may cause reduced concentration, but psychometric tests have been used rarely in this population. We investigate whether their use can demonstrate an improvement in cognitive performance in 20 non-apnoeic snorers following Laser Palatoplasty (LPP). The subjects completed psychometric tests, Beck Anxiety and Depression Inventories and an Epworth Sleepiness Scale on two occasions before LPP and once postoperatively. The only index to show any significant change with LPP was the Beck Depression Inventory (P < 0.005), which was reduced by a mean of 1.6 units following surgery. There was also a highly significant improvement in information processing between the preoperative tests, for which no explanation could be found. Our results suggest that commonly applied psychometric tests are unable to demonstrate significant improvements following surgery for non-apnoeic snoring. However, we have demonstrated for the first time a significant reduction in depression following surgery, which is evidence that snoring is more than a social nuisance.