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Changsiripun C, Chirakalwasan N, Dias S, McDaid C. Management of primary snoring in adults: A scoping review examining interventions, outcomes and instruments used to assess clinical effects. Sleep Med Rev 2024; 77:101963. [PMID: 38889620 DOI: 10.1016/j.smrv.2024.101963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 04/30/2024] [Accepted: 05/25/2024] [Indexed: 06/20/2024]
Abstract
While various treatment options for primary snoring are available, evidence-based recommendations to determine the optimal intervention remain unestablished. To inform future directions of research to guide clinical decision-making, this scoping review was conducted to map the existing evidence on interventions for primary snoring, the outcomes and instruments used to assess their clinical effects in adults. The feasibility of conducting further systematic reviews and comparing outcomes across these therapies using network meta-analysis was also assessed. Of the 1673 records identified, 38 interventional studies met the inclusion criteria with three-fifths of them being before-after studies. The most common reason for study exclusion was results being reported for patients with primary snoring and obstructive sleep apnoea (OSA) combined. Interventions were surgical (73 %), behavioural and the use of devices/medications. Twenty-six common outcomes were identified and categorised into six domains. Fifty-nine instruments were used to assess the outcomes and based mainly on non-validated questionnaires. Our findings indicated (1) the need for randomised controlled trials with strict discrimination between patients with primary snoring and OSA, (2) further network meta-analyses using some outcomes is feasible, and (3) a core outcome set to inform standardised reporting for future research should be developed.
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Affiliation(s)
- Chidsanu Changsiripun
- Department of Orthodontics, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand; Department of Health Sciences, University of York, York, UK.
| | - Naricha Chirakalwasan
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand; Excellence Center for Sleep Disorders, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Sofia Dias
- Centre for Reviews and Dissemination, University of York, York, UK
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2
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Bokov P, Dudoignon B, Spruyt K, Delclaux C. Reliability of parental reporting of child snoring in children referred for obstructive sleep apnea. J Sleep Res 2023:e13882. [PMID: 36918364 DOI: 10.1111/jsr.13882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 02/15/2023] [Accepted: 03/01/2023] [Indexed: 03/16/2023]
Abstract
Despite the high number of studies based on subjective reports of snoring, self-reported snoring has hardly been validated at all. As there is no "gold-standard" for objective snoring measurements, studies must evaluate whether the presence of snoring based on parental judgement is linked to objective measurements of nasal and/or pharyngeal obstruction in children referred for obstructive sleep apnea. A total of 146 children (median age 11 years) underwent polysomnography (with snoring recording using nasal cannula signal), acoustic rhinometry and pharyngometry, while their parents filled out the Spruyt-Gozal questionnaire assessing both frequency and loudness of subjective snoring. Three categories were further differentiated (null, low and high) for both frequency and loudness. The apnea-hypopnea index was significantly different in the three groups for both frequency (p = 0.04) and loudness (p = 0.01) of subjective snoring. Children in the low or high groups (frequency or loudness), compared with those in the null group, experienced a decline in both pharyngeal (sitting and supine positions) and nasopharyngeal (supine position) volumes (frequency, pharynx sitting: p = 0.03; supine: 0.005 and nasopharynx: p = 0.002; loudness, p = 0.03; p = 0.007 and p = 0.03; three group comparisons). Objective snoring frequency during the night obtained with cannula was weakly related to loudness of subjective snoring but not to subjective snoring frequency during the week, and was biased by nasal obstruction. In conclusion, our study showed that parental assessment of snoring is related to a reduction in both pharyngeal and nasopharyngeal volumes in snorers, arguing for the adequacy of their evaluation of both snoring frequency and loudness.
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Affiliation(s)
- Plamen Bokov
- AP-HP, Hôpital Robert Debré, Service de Physiologie Pédiatrique -Centre du Sommeil - CRMR Hypoventilations alvéolaires rares, INSERM NeuroDiderot, Université de Paris, Paris, France
| | - Benjamin Dudoignon
- AP-HP, Hôpital Robert Debré, Service de Physiologie Pédiatrique -Centre du Sommeil - CRMR Hypoventilations alvéolaires rares, INSERM NeuroDiderot, Université de Paris, Paris, France
| | - Karen Spruyt
- INSERM NeuroDiderot, Université de Paris, Paris, France
| | - Christophe Delclaux
- AP-HP, Hôpital Robert Debré, Service de Physiologie Pédiatrique -Centre du Sommeil - CRMR Hypoventilations alvéolaires rares, INSERM NeuroDiderot, Université de Paris, Paris, France
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3
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Kao HH, Lin YC, Chiang JK, Yu HC, Wang CL, Kao YH. Dependable algorithm for visualizing snoring duration through acoustic analysis: A pilot study. Medicine (Baltimore) 2022; 101:e32538. [PMID: 36595844 PMCID: PMC9794359 DOI: 10.1097/md.0000000000032538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Snoring is a nuisance for the bed partners of people who snore and is also associated with chronic diseases. Estimating the snoring duration from a whole-night sleep period is challenging. The authors present a dependable algorithm for visualizing snoring durations through acoustic analysis. Both instruments (Sony digital recorder and smartphone's SnoreClock app) were placed within 30 cm from the examinee's head during the sleep period. Subsequently, spectrograms were plotted based on audio files recorded from Sony recorders. The authors thereby developed an algorithm to validate snoring durations through visualization of typical snoring segments. In total, 37 snoring recordings obtained from 6 individuals were analyzed. The mean age of the participants was 44.6 ± 9.9 years. Every recorded file was tailored to a regular 600-second segment and plotted. Visualization revealed that the typical features of the clustered snores in the amplitude domains were near-isometric spikes (most had an ascending-descending trend). The recorded snores exhibited 1 or more visibly fixed frequency bands. Intervals were noted between the snoring clusters and were incorporated into the whole-night snoring calculation. The correlative coefficients of snoring rates from digitally recorded files examined between Examiners A and B were higher (0.865, P < .001) than those with SnoreClock app and Examiners (0.757, P < .001; 0.787, P < .001, respectively). A dependable algorithm with high reproducibility was developed for visualizing snoring durations.
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Affiliation(s)
- Hsueh-Hsin Kao
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Laboratory Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | | | - Jui-Kun Chiang
- Department of Family Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan
| | | | - Chun-Lung Wang
- School of Medicine, Tzu Chi University, Hualien, Taiwan
- Division of Pediatrics, Dalin Tzu Chi Hospital, Buddhish Tzu Chi Medical Foundation, Dalin Chiayi, Taiwan
| | - Yee-Hsin Kao
- Department of Family Medicine, Tainan Municipal Hospital (Managed by Show Chwan Medical Care Corporation), Tainan, Taiwan
- *Correspondence: Yee-Hsin Kao, 670 Chung Te Road, Tainan, 70173 Taiwan (e-mail: )
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Nokes B, Schmickl CN, Brena R, Bosompra NN, Gilbertson D, Sands SA, Bhattacharjee R, Mann DL, Owens RL, Malhotra A, Orr JE. The impact of daytime transoral neuromuscular stimulation on upper airway physiology - A mechanistic clinical investigation. Physiol Rep 2022; 10:e15360. [PMID: 35748091 PMCID: PMC9226850 DOI: 10.14814/phy2.15360] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 06/02/2022] [Accepted: 06/05/2022] [Indexed: 06/15/2023] Open
Abstract
There is a need for alternatives to positive airway pressure for the treatment of obstructive sleep apnea and snoring. Improving upper airway dilator function might alleviate upper airway obstruction. We hypothesized that transoral neuromuscular stimulation would reduce upper airway collapse in concert with improvement in genioglossal muscle function. Subjects with simple snoring and mild OSA (AHI < 15/h on screening) underwent in-laboratory polysomnography with concurrent genioglossal electromyography (EMGgg) before and after 4-6 weeks of twice-daily transoral neuromuscular stimulation. Twenty patients completed the study: Sixteen males, mean ± SD age 40 ± 13 years, and BMI 26.3 ± 3.8 kg/m2 . Although there was no change in non-rapid eye movement EMGgg phasic (p = 0.66) or tonic activity (p = 0.83), and no decrease in snoring or flow limitation, treatment was associated with improvements in tongue endurance, sleep quality, and sleep efficiency. In this protocol, transoral neurostimulation did not result in changes in genioglossal activity or upper airway collapse, but other beneficial effects were noted suggesting a need for additional mechanistic investigation.
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Affiliation(s)
- Brandon Nokes
- University of CaliforniaDivision of Pulmonary, Critical Care, Sleep Medicine, and PhysiologyLa JollaCaliforniaUSA
- VA San DiegoDivision of Sleep MedicineSan DiegoCaliforniaUSA
| | - Christopher N. Schmickl
- University of CaliforniaDivision of Pulmonary, Critical Care, Sleep Medicine, and PhysiologyLa JollaCaliforniaUSA
| | - Rebbecca Brena
- University of CaliforniaDivision of Pulmonary, Critical Care, Sleep Medicine, and PhysiologyLa JollaCaliforniaUSA
| | - Nana Naa‐Oye Bosompra
- University of CaliforniaDivision of Pulmonary, Critical Care, Sleep Medicine, and PhysiologyLa JollaCaliforniaUSA
| | - Dillon Gilbertson
- University of CaliforniaDivision of Pulmonary, Critical Care, Sleep Medicine, and PhysiologyLa JollaCaliforniaUSA
| | - Scott A. Sands
- Division of Sleep and Circadian DisordersBrigham and Women's Hospital and Harvard Medical SchoolBostonMassachusettsUSA
| | | | - Dwayne L. Mann
- Institute for Social Science ResearchUniversity of QueenslandBrisbaneAustralia
| | - Robert L. Owens
- University of CaliforniaDivision of Pulmonary, Critical Care, Sleep Medicine, and PhysiologyLa JollaCaliforniaUSA
| | - Atul Malhotra
- University of CaliforniaDivision of Pulmonary, Critical Care, Sleep Medicine, and PhysiologyLa JollaCaliforniaUSA
| | - Jeremy E. Orr
- University of CaliforniaDivision of Pulmonary, Critical Care, Sleep Medicine, and PhysiologyLa JollaCaliforniaUSA
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Norman MB, Harrison HC, Sullivan CE, Milross MA. Measurement of snoring and stertor using the Sonomat to assess effectiveness of upper airway surgery in children. J Clin Sleep Med 2022; 18:1649-1656. [PMID: 35216652 PMCID: PMC9163608 DOI: 10.5664/jcsm.9946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 02/14/2022] [Accepted: 02/15/2022] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES The success of surgical treatment for pediatric sleep-disordered breathing is typically assessed using the mixed and obstructive apnea-hypopnea index (MOAHI). Although an important metric, previous work has shown that snoring and stertor are also associated with sleep disruption. Our aim was to assess the efficacy of surgery using the Sonomat (Sonomedical Pty Ltd), a noncontact sleep assessment system, that accurately records complete and partial upper airway obstruction. METHODS Forty children (< 18 years) had a Sonomat study, in their own beds, before and after surgery. As an MOAHI ≥ 1 event/h is considered abnormal, the same threshold was applied to snore/stertor runs. Median (interquartile range) values are reported. RESULTS Respiratory event-induced movements decreased from 12.0 (8.7-19.0) to 0.5 (0.1-3.2) events/h (P < .01), with no significant change in spontaneous movements: 12.8 (9.8-17.9) to 16.5 (13.7-26.1) events/h (P = .07). The MOAHI decreased from 4.5 (1.9-8.6) to 0.0 (0.0-0.4) events/h (P < .01). Snoring and/or stertor runs decreased from 32.8 (23.4-44.4) to 3.0 (0.2-14.6) events/h (P < .01). Thirty-four children had an MOAHI < 1 event/h following surgery; however, 20 had snore and/or stertor runs ≥ 1 event/h and 11 had snore and/or stertor runs ≥ 5 events/h. Only 14 (35%) children had a postsurgery MOAHI < 1 event/h combined with snoring and/or stertor < 1 runs/h. CONCLUSIONS Although surgery is effective in improving breathing, success rates are overestimated using the MOAHI. Our results indicate that snoring and/or stertor are still present at levels that may disrupt sleep despite a normalization of the MOAHI and that when obstructed breathing was objectively measured, there was a large variation in its response to surgery. CITATION Norman MB, Harrison HC, Sullivan CE, Milross MA. Measurement of snoring and stertor using the Sonomat to assess effectiveness of upper airway surgery in children. J Clin Sleep Med. 2022;18(6):1649-1656.
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Affiliation(s)
| | | | - Colin E. Sullivan
- Sonomedical, Balmain, Australia
- Faculty of Medicine and Health, University of Sydney, Camperdown, Australia
| | - Maree A. Milross
- Faculty of Medicine and Health, University of Sydney, Camperdown, Australia
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Borsky M, Serwatko M, Arnardottir ES, Mallett J. Towards Sleep Study Automation: Detection Evaluation of Respiratory-Related Events. IEEE J Biomed Health Inform 2022; 26:3418-3426. [PMID: 35294367 DOI: 10.1109/jbhi.2022.3159727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
The diagnosis of sleep disordered breathing depends on the detection of several respiratory-related events: apneas, hypopneas, snores, or respiratory event-related arousals from sleep studies. While a number of automatic detection methods have been proposed, reproducibility of these methods has been an issue, in part due to the absence of a generally accepted protocol for evaluating their results. With sleep measurements this is usually treated as a classification problem and the accompanying issue of localization is not treated as similarly critical. To address these problems we present a detection evaluation protocol that is able to qualitatively assess the match between two annotations of respiratory-related events. This protocol relies on measuring the relative temporal overlap between two annotations in order to find an alignment that maximizes their F1-score at the sequence level. This protocol can be used in applications which require a precise estimate of the number of events, total event duration, and a joint estimate of event number and duration. We assess its application using a data set that contains over 10,000 manually annotated snore events from 9 subjects, and show that when using the American Academy of Sleep Medicine Manual standard, two sleep technologists can achieve an F1-score of 0.88 when identifying the presence of snore events. In addition, we drafted rules for marking snore boundaries and showed that one sleep technologist can achieve F1-score of 0.94 at the same tasks. Finally, we compared our protocol against the protocol that is used to evaluate sleep spindle detection and highlighted the differences.
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Hsu YC, Wang JD, Huang PH, Chien YW, Chiu CJ, Lin CY. Integrating domain knowledge with machine learning to detect obstructive sleep apnea: Snore as a significant bio-feature. J Sleep Res 2021; 31:e13487. [PMID: 34549473 DOI: 10.1111/jsr.13487] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 08/21/2021] [Accepted: 09/07/2021] [Indexed: 11/30/2022]
Abstract
Our study's main purpose is to emphasise the significance of medical knowledge of pathophysiology before machine learning. We investigated whether combining domain knowledge with machine learning results might increase accuracy and minimise the number of bio-features used to detect obstructive sleep apnea (OSA). The present study analysed data on 36 self-reported symptoms and 24 clinical features obtained from 3,495 patients receiving polysomnography at a regional hospital and a medical centre. The area under the receiver operating characteristic (AUC) curve was used to evaluate patients with and without moderate or severe OSA using three prediction models on the basis of various estimation methods: the multiple logistic regression (MLR), support vector machine (SVM), and neural network (NN) methods. Odds ratios stratified by gender and age were also measured to account for clinicians' common sense. We discovered that adding the self-reported snoring item improved the AUC by 0.01-0.10 and helped us to rapidly achieve the optimum level. The performance of four items (gender, age, body mass index [BMI], and snoring) was comparable with that of adding two or more items (neck and waist circumference) for predicting moderate to severe OSA (Apnea-Hypopnea Index ≥15 events/hr) in all three prediction models, demonstrating the medical knowledge value of pathophysiology. The four-item test sample AUCs were 0.83, 0.84, and 0.83 for MLR, SVM, and NN, respectively. Participants with regular snoring and a BMI of ≥25 kg/m2 had a greater chance of moderate to severe OSA according to the stratified adjusted odds ratios. Combining domain knowledge into machine learning could increase efficiency and enable primary care physicians to refer for an OSA diagnosis earlier.
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Affiliation(s)
- Yu-Ching Hsu
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Sleep Medicine Center, Tainan Hospital, Ministry of Health and Welfare, Tainan, Taiwan.,Department of Chinese medicine, Tainan Hospital, Ministry of Health and Welfare, Tainan, Taiwan
| | - Jung-Der Wang
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Department of Occupational and Environmental Medicine, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Po-Hsien Huang
- Department of Psychology, National Chengchi University, Taiwan
| | - Yu-Wen Chien
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Department of Occupational and Environmental Medicine, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Ching-Ju Chiu
- Institute of Gerontology, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Cheng-Yu Lin
- Department of Otolaryngology, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, Tainan, Taiwan.,Sleep Medicine Center, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, Tainan, Taiwan
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Topriceanu C, Tillin T, Chaturvedi N, Joshi R, Garfield V. The association between plasma metabolites and sleep quality in the Southall and Brent Revisited (SABRE) Study: A cross-sectional analysis. J Sleep Res 2021; 30:e13245. [PMID: 33283399 PMCID: PMC8365718 DOI: 10.1111/jsr.13245] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 11/10/2020] [Accepted: 11/10/2020] [Indexed: 01/17/2023]
Abstract
We examined the association between plasma metabolites and abnormal sleep patterns using data from the Southall and Brent REvisited (SABRE) cohort. Nuclear magnetic resonance spectroscopy provided 146 circulating plasma metabolites. Sleep questionnaires identified the presence or absence of: difficulty falling asleep, early morning waking, waking up tired, and snoring. Metabolites were compared between the sleep quality categories using the t test, and then filtered using a false discovery rate of 0.05. Generalised linear models with logit-link assessed the associations between filtered metabolites and sleep phenotypes. Adjustment was made for important demographic and health-related covariates. In all, 2,718 participants were included in the analysis. After correcting for multiple testing, three metabolites remained for difficulty falling asleep, 59 for snoring, and none for early morning waking and waking up tired. After adjusting for sex, age, ethnicity and years of education, 1 standard deviation increase in serum histidine and valine associated with lower odds of difficulty falling asleep by 0.89-0.90 (95% confidence intervals [CIs] 0.80-0.99). Branched-chain and aromatic amino acids (odds ratios [ORs] 1.19-1.25, 95% CIs 1.09-1.36) were positively associated with snoring. Total cholesterol in low-density lipoprotein (OR 0.90, 95% CI 0.83-0.97) and high-density lipoprotein (OR 0.88, 95% CI 0.81-0.95) associated with lower odds of snoring. In the fully adjusted model, most associations persisted. To conclude, histidine and valine associated with lower odds of difficulty falling asleep, while docosahexaenoic acid and cholesterol in low-density lipoprotein and high-density lipoprotein subfractions associated with lower odds of snoring. Identified metabolites could provide guidance on the metabolic pathways associated with adverse sleep quality.
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Affiliation(s)
| | - Therese Tillin
- Department of Population Science and Experimental MedicineInstitute of Cardiovascular ScienceUniversity College LondonLondonUK
- MRC Unit for Lifelong Health and AgeingUniversity College LondonLondonUK
| | - Nishi Chaturvedi
- Department of Population Science and Experimental MedicineInstitute of Cardiovascular ScienceUniversity College LondonLondonUK
- MRC Unit for Lifelong Health and AgeingUniversity College LondonLondonUK
| | - Roshni Joshi
- Department of Population Science and Experimental MedicineInstitute of Cardiovascular ScienceUniversity College LondonLondonUK
| | - Victoria Garfield
- Department of Population Science and Experimental MedicineInstitute of Cardiovascular ScienceUniversity College LondonLondonUK
- MRC Unit for Lifelong Health and AgeingUniversity College LondonLondonUK
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Yu M, Wen Y, Xu L, Han F, Gao X. Polysomnographic characteristics and acoustic analysis of catathrenia (nocturnal groaning). Physiol Meas 2020; 41:125012. [PMID: 33296889 DOI: 10.1088/1361-6579/abd235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Catathrenia is a sleep disorder characterized by nocturnal groaning sounds emitted during prolonged expiration. As a rare condition, its polysomnographic findings were inconsistent. We aimed to present polysomnographic characteristics of catathrenia patients and perform acoustic analysis of groaning sounds. APPROACH Twenty-three patients (eight males and 15 females) diagnosed with catathrenia by video-polysomnography were included. They underwent clinical evaluation and physical examination, and answered a questionnaire. Acoustic analyses (oscillograms and spectrograms) of catathrenia and snoring signals were performed by Praat 6.1.09. Sounds were classified according to Yanagihara criteria. MAIN RESULTS The average age of catathrenia patients was 29.6 ± 10.0 years, with a body mass index of 22.3 ± 5.1 kg m-2. A total of 3728 groaning episodes were documented. Catathrenia events of 16 patients (70%) were rapid eye movement (REM)-predominant. The average duration of groaning was 11.4 ± 4.6 s, ranging from 1.3 to 74.9 s. All signals of groaning were rhythmic or semi-rhythmic, classified as type I and type II, respectively, with formants and harmonics. Snoring events were observed in nine patients. Snoring mainly occurred in the non-REM stage, with a duration of less than 1.5 s. Signals of snoring were chaotic, classified as type III, without harmonics. SIGNIFICANCE Catathrenia occurred in all sleep stages but mainly in REM. Durations of groaning varied greatly across patients. Acoustic characteristics of catathrenia were typical. Groaning had rhythmic or semi-rhythmic waveform, formants and harmonics, indicating vocal origin, while snoring had chaotic waveform.
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Affiliation(s)
- Min Yu
- Department of Orthodontics, Peking University School and Hospital of Stomatology, 22 Zhongguancun South Avenue, Haidian District, Beijing, 100081, People's Republic of China
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Wilhelm E, Crivelli F, Gerig N, Kohler M, Riener R. The anti-snoring bed - a pilot study. SLEEP SCIENCE AND PRACTICE 2020. [DOI: 10.1186/s41606-020-00050-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Purpose
Avoiding supine position can reduce snoring in most habitual snorers. However, devices that restrict the sleeping position cause discomfort or disrupt sleep resulting in low compliance. Therefore, mechanisms, which lift the trunk of the user without disturbing sleep, have been proposed. We present the first study, which investigates whether individual interventions provided by beds with lifting mechanisms are able to stop snoring (success rate) and whether they reduce the snoring index (number of total snores divided by total time in bed) using a repeated measures design. In addition, we investigated whether the intervention is interfering with the subjective sleep quality.
Methods
Twenty-two subjects were observed for four nights (adaptation, baseline, and two intervention nights). During intervention nights, the bed lifted the trunk of the user in closed-loop manner. Subjects were divided in three groups (non-snorer, snorer one, and snorer two). Non-snorers were lifted by the bed at random time points during the night. In group snorer one, a stepwise increase of the bed inclination was compared with going directly to a randomly selected angle. In group snorer two, the influence of a small inclination angle (10 ∘) and a big inclination angle (20 ∘) was compared.
Results
Snoring was stopped successfully in 22% (small angle) and 67% (big angle) of the interventions. This did not lead to a significant reduction in the snoring index. The subjective sleep quality was not reduced by the intervention.
Conclusion
The anti-snoring bed is able to stop individual episodes of habitual snoring without reducing the subjective sleep quality.
Trial Registration
https://clinicaltrials.gov, no. NCT04053738, registered 12 August 2019 - Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT04053738.
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Snoring patterns during home polysomnography. A proposal for a new classification. Am J Otolaryngol 2020; 41:102589. [PMID: 32563786 DOI: 10.1016/j.amjoto.2020.102589] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 05/16/2020] [Accepted: 05/25/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE Snoring is a very common disorder, but, at present, there is no universally accepted classification for the condition. The main aim of this paper is to introduce a home sleep monitoring-based classification of common snoring patterns in simple snorers and in patients with obstructive sleep apnea-hypopnea syndrome (OSAHS). MATERIALS AND METHODS In total, 561 consecutive patients with a history of snoring, either simple or associated with apnea, were enrolled in this home sleep monitoring study. Analysis of the polysomnographic traces and the snoring sensor allowed the main patterns of snoring and their characteristics to be determined. RESULTS Four patterns of snoring were identified. In a spectrum of increasing severity (mild, moderate or severe), snoring can be episodic, positional, continuous, or alternating, whereas in obstructive sleep apnea syndrome, the snoring events only occur between successive respiratory obstructive events. In mild snoring, the episodic pattern is the most frequent, whereas in moderate and severe snoring, the continuous snoring pattern occurs in most cases. CONCLUSIONS The proposed classification of snoring patterns would be beneficial for providing a realistic disturbance index, for the selection and evaluation of the outcomes of surgical techniques.
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Li J, McEvoy RD, Zheng D, Loffler KA, Wang X, Redline S, Woodman RJ, Anderson CS. Self-reported Snoring Patterns Predict Stroke Events in High-Risk Patients With OSA: Post Hoc Analyses of the SAVE Study. Chest 2020; 158:2146-2154. [PMID: 32679238 DOI: 10.1016/j.chest.2020.05.615] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Revised: 05/25/2020] [Accepted: 05/28/2020] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND The relation of snoring to risks of stroke and other major cardiovascular (CV) events is uncertain. RESEARCH QUESTION We aimed to determine associations of snoring patterns and major CV events in relation to OSA among participants of the international Sleep Apnea cardiovascular Endpoints (SAVE) trial. STUDY DESIGN AND METHODS Post hoc analyses of the SAVE trial, which involved 2,687 patients with coexisting moderate-to-severe OSA and established coronary or cerebral CV disease, who were randomly allocated to CPAP treatment plus usual care or usual care alone, and followed-up for a median 3.5 years. Associations of self-reported snoring patterns (frequency and loudness) and breathing pauses collected on the Berlin questionnaire at baseline and multiple times during follow-up, and adjudicated composites of CV outcomes (primary, CV death, nonfatal myocardial infarction, nonfatal stroke, and hospitalization for unstable angina, heart failure, or transient ischemic attack; and separately of cardiac and cerebral events), were evaluated in time-dependent Cox proportional hazards models adjusted for various confounders including the apnea-hypopnea index. RESULTS Increase (per category) of snoring frequency (adjusted hazard ratio [HR], 1.10; 95% CI, 1.02-1.20; P = .015), loudness (HR, 1.16; 95% CI, 1.06-1.27; P = .001), and breathing pauses (HR, 1.16; 95% CI, 1.08-1.25; P < .001) at any time point during follow-up were each associated with the primary composite CV outcome. These associations were driven by significant associations for cerebral rather than cardiac events, and positive interactions between the three snoring patterns for cerebral events. There was no significant interaction between CPAP treatment and snoring variables for cerebral events. INTERPRETATION Snoring in patients with OSA with established CV disease is associated with greater risks of cerebral but not cardiac events, independent of CPAP treatment and frequency of apnea and hypopnea events. TRIAL REGISTRY ClinicalTrials.gov; No.: NCT00738179; URL: www.clinicaltrials.gov.
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Affiliation(s)
- Jingwei Li
- Department of Cardiology, Xinqiao Hospital, Third Military Medical University, Chongqing, China; Department of Cardiology, People's Liberation Army General Hospital, Beijing, China; The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - R Doug McEvoy
- The Adelaide Institute for Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Danni Zheng
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia; Pharmacology Discipline, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Kelly A Loffler
- The Adelaide Institute for Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Xia Wang
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Susan Redline
- The Division of Sleep and Circadian Disorders, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Richard J Woodman
- Centre for Biostatistics & Epidemiology, Flinders University, Adelaide, SA, Australia
| | - Craig S Anderson
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia; The George Institute China at Peking University Health Science Center, Beijing, China; Neurology Department, Royal Prince Alfred Hospital, Sydney Health Partners, Sydney, NSW, Australia; Heart Health Research Center, Beijing, China; Universidad del Desarrollo, School of Medicine-Clínica Alemana, ICIM, Center for Clinical Studies, Santiago, Chile.
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13
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Kallel S, Kchaou K, Jameleddine A, Sellami M, Mnejja M, Charfeddine I. Snoring time versus snoring intensity: Which parameter correlates better with severity of obstructive sleep apnea syndrome? Lung India 2020; 37:300-303. [PMID: 32643637 PMCID: PMC7507915 DOI: 10.4103/lungindia.lungindia_394_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Objective: The relationship between the severity of obstructive sleep apnea syndrome (OSAS) and both snoring intensity and rate measured objectively has not been sufficiently investigated. The aim of this study was to evaluate the relationship between severity of OSAS and snoring parameters including snoring intensity and rate. Patients and Methods: A total of 150 records of individuals who complained of snoring were analyzed. Patients were classified into four groups according to apnea–hypopnea index (AHI). Polygraphy recordings including the snoring intensity and the snoring rate (defined as the percentage of snoring time during the total sleep time) and the clinical data were compared and analyzed. Results: AHI was significantly correlated, respectively, with snoring rate (r = 0.341; P < 0.0001) and maximal intensity of snoring (r = 0.362; P < 0.0001). However, no correlation was found between the average intensity of snoring and AHI (P = 0.33). When assessing each respiratory event individually, snoring rate was more correlated with hypopnea index (r = 0.424; P < 0.0001) than with AI (r = 0.233; P = 0.004). The snoring rate (%) in the severe OSAS group (31.79 ± 19.3) was significantly higher than that in the mild OSAS group (18.02 ± 17; P = 0.001) and the control group (17 ± 16.57; P = 0.011). Similarly, the maximal intensity of snoring (db) in the severe OSAS group (90.45 ± 13.79) was higher than that in the mild OSAS group (86.46 ± 15.07; P = 0.006) and the control group (84.75 ± 6.65; P < 0.001). Conclusion: The snoring rate and maximal intensity of snoring correlate better with the severity of OSAS than average snoring intensity.
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Affiliation(s)
- Souha Kallel
- Department of ENT and Cervicofacial Surgery, Habib Bourguiba's Teaching Hospital, 3029 Sfax, Tunisia
| | - Khouloud Kchaou
- Department of ENT and Cervicofacial Surgery, Habib Bourguiba's Teaching Hospital, 3029 Sfax, Tunisia
| | - Asma Jameleddine
- Department of ENT and Cervicofacial Surgery, Habib Bourguiba's Teaching Hospital, 3029 Sfax, Tunisia
| | - Moncef Sellami
- Department of ENT and Cervicofacial Surgery, Habib Bourguiba's Teaching Hospital, 3029 Sfax, Tunisia
| | - Malek Mnejja
- Department of ENT and Cervicofacial Surgery, Habib Bourguiba's Teaching Hospital, 3029 Sfax, Tunisia
| | - Ilhem Charfeddine
- Department of ENT and Cervicofacial Surgery, Habib Bourguiba's Teaching Hospital, 3029 Sfax, Tunisia
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14
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Norman MB, Harrison HC, Waters KA, Sullivan CE. Snoring and stertor are associated with more sleep disturbance than apneas and hypopneas in pediatric SDB. Sleep Breath 2019; 23:1245-1254. [PMID: 30825066 PMCID: PMC6868107 DOI: 10.1007/s11325-019-01809-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 01/26/2019] [Accepted: 02/19/2019] [Indexed: 11/30/2022]
Abstract
PURPOSE Polysomnography is not recommended for children at home and does not adequately capture partial upper airway obstruction (snoring and stertor), the dominant pathology in pediatric sleep-disordered breathing. New methods are required for assessment. Aims were to assess sleep disruption linked to partial upper airway obstruction and to evaluate unattended Sonomat use in a large group of children at home. METHODS Children with suspected obstructive sleep apnea (OSA) had a single home-based Sonomat recording (n = 231). Quantification of breath sound recordings allowed identification of snoring, stertor, and apneas/hypopneas. Movement signals were used to measure quiescent (sleep) time and sleep disruption. RESULTS Successful recordings occurred in 213 (92%) and 113 (53%) had no OSA whereas only 11 (5%) had no partial obstruction. Snore/stertor occurred more frequently (15.3 [5.4, 30.1] events/h) and for a longer total duration (69.9 min [15.7, 140.9]) than obstructive/mixed apneas and hypopneas (0.8 [0.0, 4.7] events/h, 1.2 min [0.0, 8.5]); both p < 0.0001. Many non-OSA children had more partial obstruction than those with OSA. Most intervals between snore and stertor runs were < 60 s (79% and 61% respectively), indicating that they occur in clusters. Of 14,145 respiratory-induced movement arousals, 70% were preceded by runs of snore/stertor with the remainder associated with apneas/hypopneas. CONCLUSIONS Runs of snoring and stertor occur much more frequently than obstructive apneas/hypopneas and are associated with a greater degree of sleep disruption. Children with and without OSA are frequently indistinguishable regarding the amount, frequency, and the degree of sleep disturbance caused by snoring and stertor.
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Affiliation(s)
- Mark B Norman
- Discipline of Sleep Medicine, University of Sydney, Level 4, Chris O'Brien Lifehouse, 119-142 Missenden Road, Camperdown, NSW, 2050, Australia.
| | - Henley C Harrison
- Ear, Nose and Throat Department, Sydney Children's Hospital, Sydney, Australia
| | - Karen A Waters
- Discipline of Sleep Medicine, University of Sydney, Level 4, Chris O'Brien Lifehouse, 119-142 Missenden Road, Camperdown, NSW, 2050, Australia
- David Read Sleep Laboratory, The Children's Hospital at Westmead, Westmead, NSW, Australia
| | - Colin E Sullivan
- Discipline of Sleep Medicine, University of Sydney, Level 4, Chris O'Brien Lifehouse, 119-142 Missenden Road, Camperdown, NSW, 2050, Australia
- David Read Sleep Laboratory, The Children's Hospital at Westmead, Westmead, NSW, Australia
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15
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Westreich R, Gozlan-Talmor A, Geva-Robinson S, Schlaeffer-Yosef T, Slutsky T, Chen-Hendel E, Braiman D, Sherf Y, Arotsker N, Abu-Fraiha Y, Waldman-Radinsky L, Maimon N. The Presence of Snoring as Well as its Intensity Is Underreported by Women. J Clin Sleep Med 2019; 15:471-476. [PMID: 30853036 DOI: 10.5664/jcsm.7678] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2018] [Accepted: 11/21/2018] [Indexed: 12/21/2022]
Abstract
STUDY OBJECTIVES Women are underrepresented and thus sleep conditions are underdiagnosed at sleep clinics that evaluate sleep-disordered breathing. The most common sign of obstructive sleep apnea (OSA) is snoring; therefore, it is one of the main red flags for suspected OSA. The aim of this study is to determine whether self-reported snoring and snoring intensity by women and men correlates with snoring volume measured objectively during sleep laboratory study. METHODS Consecutive patients who were referred to a polysomnography (PSG) study in a university hospital over a 2-year period had their snoring volume quantified by means of a calibrated digital sound survey meter. Participants were given a questionnaire in which they were asked to rate the severity of their snoring. The correlation between objective snoring intensity as measured during PSG and the self-reported snoring intensity was evaluated. RESULTS A total of 1,913 patients were enrolled in the study. A positive correlation was found between objectively measured snoring intensity and the intensity listed by each participant in the questionnaire. Measurement of the volume of snoring revealed that women snored as loudly as men; however, 28% of the females (189/675) considered themselves to be nonsnorers compared to only 6.9% of men (P < .05). Furthermore, 36.5% of women (69/189) who reported themselves as nonsnorers turned out to have severe or very severe snoring intensity, whereas, in contrast, only 11.7% of men (10/85) of men had this discrepancy. These findings are in concordance with the finding that fewer women quantified their snoring as very severe or severe (38.4%), significantly less than men of whom 61.5% reported their snoring to be severe or very severe. CONCLUSIONS In a population of individuals referred to a PSG study, although no difference in snoring intensity was found between sexes, women tend to underreport the fact that they snore and to underestimate the loudness of their snoring. Improved awareness of this discrepancy may increase women's access to sleep laboratories, and improve diagnostic rates of sleep apnea in females.
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Affiliation(s)
- Roi Westreich
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Pulmonology Institute, Soroka University Medical Center, Beer-Sheva, Israel.,Department of Internal Medicine B, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Aya Gozlan-Talmor
- Department of Internal Medicine B, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Shahar Geva-Robinson
- Department of Internal Medicine B, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Tal Schlaeffer-Yosef
- Department of Internal Medicine B, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Tzachi Slutsky
- Department of Internal Medicine B, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Efrat Chen-Hendel
- Department of Internal Medicine B, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Dana Braiman
- Department of Internal Medicine B, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Yehonatan Sherf
- Department of Internal Medicine B, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Natan Arotsker
- Department of Internal Medicine B, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Yasmeen Abu-Fraiha
- Department of Internal Medicine B, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Liat Waldman-Radinsky
- Department of Internal Medicine B, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Nimrod Maimon
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Pulmonology Institute, Soroka University Medical Center, Beer-Sheva, Israel.,Department of Internal Medicine B, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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16
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Podnar S, Dolenc Grošelj L. Neuropathic changes in the tongue protruder muscles in patients with snoring or obstructive sleep apnea. Neurophysiol Clin 2018; 48:269-275. [PMID: 29910146 DOI: 10.1016/j.neucli.2018.05.040] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 05/28/2018] [Accepted: 05/28/2018] [Indexed: 10/28/2022] Open
Abstract
OBJECTIVE Both myopathic and neuropathic tongue protruder muscle changes have been demonstrated to occur in obstructive sleep apnea (OSA) patients using different methods. We tried to elucidate this dilemma using quantitative electromyographic (EMG) methods. METHODS In a group of consecutive patients with suspected OSA a full overnight polysomnography (PSG) and quantitative needle EMG of the tongue protruder, biceps brachii and vastus lateralis muscles were performed. EMG findings were compared to control subjects. RESULTS Of 23 patients, 8 were classified as simple snorers and the remaining 15 as OSA patients by PSG. Motor unit potential (MUP) parameters obtained in tongue protruder muscles, but not biceps brachii or vastus lateralis muscles, were significantly larger in patients compared to controls. However, no correlation was found between tongue protruder muscle MUP parameters and patient characteristics. DISCUSSION Our study confirmed previous findings of neuropathic changes in the tongue protruder muscles of OSA patients, and extended these to simple snorers. Changes were limited to the upper airway muscle, and could not been explained by the severity or duration of the sleep breathing disorder. The possible role of denervation injury caused by the upper airway vibrations should be tested in the future by appropriately designed studies.
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Affiliation(s)
- Simon Podnar
- Institute of Clinical Neurophysiology, Division of Neurology, University Medical Center Ljubljana, 1525 Ljubljana, Slovenia.
| | - Leja Dolenc Grošelj
- Institute of Clinical Neurophysiology, Division of Neurology, University Medical Center Ljubljana, 1525 Ljubljana, Slovenia
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17
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Hong SN, Yoo J, Song IS, Joo JW, Yoo JH, Kim TH, Lee HM, Lee SH, Lee SH. Does Snoring Time Always Reflect the Severity of Obstructive Sleep Apnea? Ann Otol Rhinol Laryngol 2017; 126:693-696. [DOI: 10.1177/0003489417727014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Seung-No Hong
- Department of Otorhinolaryngology-Head and Neck Surgery, Korea University College of Medicine, Korea University Ansan Hospital, Ansan, Korea
| | - Jun Yoo
- Department of Otorhinolaryngology-Head and Neck Surgery, Korea University College of Medicine, Korea University Ansan Hospital, Ansan, Korea
| | - In Sik Song
- Department of Otorhinolaryngology-Head and Neck Surgery, Korea University College of Medicine, Korea University Ansan Hospital, Ansan, Korea
| | - Jae Woo Joo
- Department of Otorhinolaryngology-Head and Neck Surgery, Korea University College of Medicine, Korea University Ansan Hospital, Ansan, Korea
| | - June Hyuk Yoo
- Department of Otorhinolaryngology-Head and Neck Surgery, Korea University College of Medicine, Korea University Ansan Hospital, Ansan, Korea
| | - Tae Hoon Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Korea University College of Medicine, Korea University Anam Hospital, Seoul, Korea
| | - Heung Man Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Korea University College of Medicine, Korea University Guro Hospital, Seoul, Korea
| | - Sang Hag Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Korea University College of Medicine, Korea University Anam Hospital, Seoul, Korea
| | - Seung Hoon Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Korea University College of Medicine, Korea University Ansan Hospital, Ansan, Korea
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18
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Pérez-Warnisher MT, Gómez-García T, Giraldo-Cadavid LF, Troncoso Acevedo MF, Rodríguez Rodríguez P, Carballosa de Miguel P, González Mangado N. Diagnostic accuracy of nasal cannula versus microphone for detection of snoring. Laryngoscope 2017; 127:2886-2890. [PMID: 28731530 DOI: 10.1002/lary.26710] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Accepted: 05/02/2017] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Snoring is a common reason for referral to a sleep unit. Although there are several instruments to measure snoring, there is no gold standard for this purpose. In this study, we determine the diagnostic accuracy of the cannula as compared with the microphone, which are the two most commonly used tools. STUDY DESIGN We performed a cross-sectional study of 75 patients who underwent baseline home sleep apnea testing for any reason. METHODS Snore intensity and percentage were assessed during Home sleep-apnea testing via nasal cannula and microphone in all patients. We performed a complete diagnostic accuracy analysis, assuming the microphone to be the reference instrument use in order to compare it with the cannula. RESULTS The intra-class correlation coefficient between the cannula and microphone for the percentage of snoring was 0.25. The Bland Bland-Altman analysis to determine the agreement regarding the percentage of snoring showed a lower limit of -57.73 and an upper limit of 20.30. A linear regression analysis of the differences produced a negative slope of -0.86. The receiver operating characteristic curve for severe snoring using the cannula produced an area under the curve of 0.67 (P = 0.019). The cannula showed a sensitivity of 57.89 and a specificity of 73.21. CONCLUSION The nasal cannula showed poor reliability and accuracy for measuring snoring. LEVEL OF EVIDENCE 2b. Laryngoscope, 127:2886-2890, 2017.
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Affiliation(s)
| | - Teresa Gómez-García
- Department of Pulmonary Medicine, Hospital Universitario Fundaciœn Jiménez Díaz, Madrid, Spain.,Multidisciplinary Sleep Unit, Department of Pulmonary Medicine Hospital General de Villalba, Instituto de Investigación Sanitaria Fundación Jiménez Díaz: IIS-FJD, Spain.,Centro de Investigaciœn Biomédica en Red de Enfermedades Respiratorias (CIBERES), Spain.,Spanish Sleep Network, Bogotá, Colombia
| | - Luis Fernando Giraldo-Cadavid
- Department of Pulmonary Medicine, Fundación Neumológica Colombiana, Bogotá, Colombia.,Research Department, University of La Sabana, School of Medicine, Bogotá, Colombia
| | - Maria Fernanda Troncoso Acevedo
- Department of Pulmonary Medicine, Hospital Universitario Fundaciœn Jiménez Díaz, Madrid, Spain.,Multidisciplinary Sleep Unit, Department of Pulmonary Medicine Hospital General de Villalba, Instituto de Investigación Sanitaria Fundación Jiménez Díaz: IIS-FJD, Spain.,Centro de Investigaciœn Biomédica en Red de Enfermedades Respiratorias (CIBERES), Spain.,Spanish Sleep Network, Bogotá, Colombia
| | - Paula Rodríguez Rodríguez
- Department of Pulmonary Medicine, Hospital Universitario Fundaciœn Jiménez Díaz, Madrid, Spain.,Multidisciplinary Sleep Unit, Department of Pulmonary Medicine Hospital General de Villalba, Instituto de Investigación Sanitaria Fundación Jiménez Díaz: IIS-FJD, Spain
| | | | - Nicolás González Mangado
- Department of Pulmonary Medicine, Hospital Universitario Fundaciœn Jiménez Díaz, Madrid, Spain.,Multidisciplinary Sleep Unit, Department of Pulmonary Medicine Hospital General de Villalba, Instituto de Investigación Sanitaria Fundación Jiménez Díaz: IIS-FJD, Spain.,Centro de Investigaciœn Biomédica en Red de Enfermedades Respiratorias (CIBERES), Spain.,Spanish Sleep Network, Bogotá, Colombia
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19
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Kim J, Pack AI, Riegel BJ, Chirinos JA, Hanlon A, Lee SK, Shin C. Objective snoring time and carotid intima-media thickness in non-apneic female snorers. J Sleep Res 2017; 26:147-150. [PMID: 27921347 PMCID: PMC5332278 DOI: 10.1111/jsr.12471] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 10/05/2016] [Indexed: 11/28/2022]
Abstract
Controversy persists about whether snoring can affect atherosclerotic changes in adjacent vessels, independently of obstructive sleep apnea and other cardiovascular risk factors. This study examined the independent association between snoring and carotid artery intima-media thickness (IMT) in non-apneic snorers and non-snorers. We studied 180 non-apneic snorers and non-snorers participating in a full-night home-based sleep study. Snoring sound was measured objectively by a microphone. Based on snoring time across the night, participants were classified as non-snorers (snoring time: 0%), mild snorers (1-25%) and moderate to heavy snorers (≥25%). We measured IMT on both common carotid arteries. The three groups were matched by age, body mass index, cholesterol, blood pressure and glucose levels, using weights from generalized boosted-propensity score models. Mean carotid IMT increased with increased snoring time across the night in women: non-snorers (0.707 mm), mild (0.718 mm) and moderate to heavy snorers (0.774 mm), but not in men. Snoring during at least one-fourth of a night's sleep is associated independently with subclinical changes in carotid IMT in women only.
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Affiliation(s)
| | - Allan I. Pack
- Center for Sleep and Circadian Neurobiology, Perelman School of Medicine, University of Pennsylvania
- Division of Sleep Medicine, Department of Medicine, University of Pennsylvania
| | | | | | | | - Seung Ku Lee
- Institute of Human Genomic Study, College of Medicine, Korean University Ansan Hospital
| | - Chol Shin
- Institute of Human Genomic Study, College of Medicine, Korean University Ansan Hospital
- Division of Pulmonary and Critical Care Medicine, Department of InternalMedicine, Korea University, South Korea
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20
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Norman MB, Pithers SM, Teng AY, Waters KA, Sullivan CE. Validation of the Sonomat Against PSG and Quantitative Measurement of Partial Upper Airway Obstruction in Children With Sleep-Disordered Breathing. Sleep 2017; 40:2979192. [DOI: 10.1093/sleep/zsx017] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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21
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Khayat RN, Jafari B. Snoring in the Morning Light. J Clin Sleep Med 2016; 12:1581-1582. [PMID: 27855747 DOI: 10.5664/jcsm.6332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 11/07/2016] [Indexed: 11/13/2022]
Affiliation(s)
- Rami N Khayat
- The Sleep Heart Program, The Ohio State University, Columbus, OH
| | - Behrouz Jafari
- Long Beach VA and the University of California-Irvine, Irvine, CA
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22
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Mlynczak M, Migacz E, Migacz M, Kukwa W. Detecting Breathing and Snoring Episodes Using a Wireless Tracheal Sensor-A Feasibility Study. IEEE J Biomed Health Inform 2016; 21:1504-1510. [PMID: 27913363 DOI: 10.1109/jbhi.2016.2632976] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Sleep-disordered breathing is both a clinical and a social problem. This implies the need for convenient solutions to simplify screening and diagnosis. The aim of the study was to investigate the sensitivity and specificity of a novel wireless system in detecting breathing and snoring episodes during sleep. METHODS A wireless acoustic sensor was elaborated and implemented. Segmentation (based on spectral thresholding and heuristics) and classification of all breathing episodes during recording were implemented through a mobile application. The system was evaluated on 1520 manually labeled episodes registered from 40 real-world, whole-night recordings of 16 generally healthy subjects. RESULTS The differentiation between normal breathing and snoring had 88.8% accuracy. As the system is intended for screening, high specificity of 95% is reported. CONCLUSION The system is a compromise between nonmedical phone applications and medical sleep studies. The presented approach enables the study to be repetitive, personal, and inexpensive. It has additional value in the form of well-recorded data which are reliable and comparable. SIGNIFICANCE The system opens unexplored possibilities in sleep monitoring and study enabling a multinight recording strategy involving the collection and analysis of abundant data from thousands of people.
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23
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Arnardottir ES, Gislason T. Quantifying Airflow Limitation and Snoring During Sleep. Sleep Med Clin 2016; 11:421-434. [DOI: 10.1016/j.jsmc.2016.07.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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24
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Perez-Macias JM, Viik J, Varri A, Himanen SL, Tenhunen M. Spectral analysis of snoring events from an Emfit mattress. Physiol Meas 2016; 37:2130-2143. [PMID: 27811388 DOI: 10.1088/0967-3334/37/12/2130] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The aim of this study is to explore the capability of an Emfit (electromechanical film transducer) mattress to detect snoring (SN) by analyzing the spectral differences between normal breathing (NB) and SN. Episodes of representative NB and SN of a maximum of 10 min were visually selected for analysis from 33 subjects. To define the bands of interest, we studied the statistical differences in the power spectral density (PSD) between both breathing types. Three bands were selected for further analysis: 6-16 Hz (BW1), 16-30 Hz (BW2) and 60-100 Hz (BW3). We characterized the differences between NB and SN periods in these bands using a set of spectral features estimated from the PSD. We found that 15 out of the 29 features reached statistical significance with the Mann-Whitney U-test. Diagnostic properties for each feature were assessed using receiver operating characteristic analysis. According to our results, the highest diagnostic performance was achieved using the power ratio between BW2 and BW3 (0.85 area under the receiver operating curve, 80% sensitivity, 80% specificity and 80% accuracy). We found that there are significant differences in the defined bands between the NB and SN periods. A peak was found in BW3 for SN epochs, which was best detected using power ratios. Our work suggests that it is possible to detect snoring with an Emfit mattress. The mattress-type movement sensors are inexpensive and unobtrusive, and thus provide an interesting tool for sleep research.
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Affiliation(s)
- Jose Maria Perez-Macias
- BioMediTech and Department of Electronics and Communications Engineering, Tampere University of Technology, Tampere, Finland
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Abstract
This article highlights the potential uses that smartphone applications may have for helping those with sleep problems. Applications in smartphones offer the promised possibility of detection of sleep. From the author's own experience, one can also conclude that sleep applications are approximately as good as polysomnography in detection of sleep time, similar to the conventional wearable actimeters. In the future, sleep applications will help to further enhance awareness of sleep health and to distinguish those who actually poorly and only briefly sleep from those who suffer more likely from paradox insomnia.
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Affiliation(s)
- Ingo Fietze
- Center of Sleep Medicine, Charité - Universitätsmedizin Berlin, Luisenstr 13, Berlin 10117, Germany.
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Emilsson ÖI, Benediktsdóttir B, Ólafsson Í, Cook E, Júlíusson S, Björnsson ES, Guðlaugsdóttir S, Guðmundsdóttir AS, Mirgorodskaya E, Ljungström E, Arnardóttir ES, Gíslason Þ, Janson C, Olin AC. Respiratory symptoms, sleep-disordered breathing and biomarkers in nocturnal gastroesophageal reflux. Respir Res 2016; 17:115. [PMID: 27646537 PMCID: PMC5029098 DOI: 10.1186/s12931-016-0431-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Accepted: 09/12/2016] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Nocturnal gastroesophageal reflux (nGER) is associated with respiratory symptoms and sleep-disordered breathing (SDB), but the pathogenesis is unclear. We aimed to investigate the association between nGER and respiratory symptoms, exacerbations of respiratory symptoms, SDB and airway inflammation. METHODS Participants in the European Community Respiratory Health Survey III in Iceland with nGER symptoms (n = 48) and age and gender matched controls (n = 42) were studied by questionnaires, exhaled breath condensate (EBC), particles in exhaled air (PEx) measurements, and a home polygraphic study. An exacerbation of respiratory symptoms was defined as an episode of markedly worse respiratory symptoms in the previous 12 months. RESULTS Asthma and bronchitis symptoms were more common among nGER subjects than controls (54 % vs 29 %, p = 0.01; and 60 % vs 26 %, p < 0.01, respectively), as were exacerbations of respiratory symptoms (19 % vs 5 %, p = 0.04). Objectively measured snoring was more common among subjects with nGER than controls (snores per hour of sleep, median (IQR): 177 (79-281) vs 67 (32-182), p = 0.004). Pepsin (2.5 ng/ml (0.8-5.8) vs 0.8 ng/ml (0.8-3.6), p = 0.03), substance P (741 pg/ml (626-821) vs 623 pg/ml (562-676), p < 0.001) and 8-isoprostane (3.0 pg/ml (2.7-3.9) vs 2.6 pg/ml (2.2-2.9), p = 0.002) in EBC were higher among nGER subjects than controls. Albumin and surfactant protein A in PEx were lower among nGER subjects. These findings were independent of BMI. CONCLUSION In a general population sample, nGER is associated with symptoms of asthma and bronchitis, as well as exacerbations of respiratory symptoms. Also, nGER is associated with increased respiratory effort during sleep. Biomarker measurements in EBC, PEx and serum indicate that micro-aspiration and neurogenic inflammation are plausible mechanisms.
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Affiliation(s)
- Össur Ingi Emilsson
- Faculty of Medicine, University of Iceland, Vatnsmyrarvegur 16, 101, Reykjavik, Iceland
- Department of Respiratory Medicine and Sleep, Landspitali University Hospital, Reykjavik, Iceland
- Department of Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
| | - Bryndís Benediktsdóttir
- Faculty of Medicine, University of Iceland, Vatnsmyrarvegur 16, 101, Reykjavik, Iceland
- Department of Respiratory Medicine and Sleep, Landspitali University Hospital, Reykjavik, Iceland
| | - Ísleifur Ólafsson
- Department of Clinical Biochemistry, Landspitali University Hospital, Reykjavik, Iceland
| | - Elizabeth Cook
- Department of Clinical Biochemistry, Landspitali University Hospital, Reykjavik, Iceland
| | - Sigurður Júlíusson
- Faculty of Medicine, University of Iceland, Vatnsmyrarvegur 16, 101, Reykjavik, Iceland
- Department of Otolaryngology, Landspitali University Hospital, Reykjavik, Iceland
| | - Einar Stefán Björnsson
- Faculty of Medicine, University of Iceland, Vatnsmyrarvegur 16, 101, Reykjavik, Iceland
- Department of Gastroenterology, Landspitali University Hospital, Reykjavik, Iceland
| | - Sunna Guðlaugsdóttir
- Department of Gastroenterology, Landspitali University Hospital, Reykjavik, Iceland
| | | | - Ekaterina Mirgorodskaya
- Department of Occupational and Environmental Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Evert Ljungström
- Department of Chemistry and Molecular Biology, University of Gothenburg, Gothenburg, Sweden
| | - Erna Sif Arnardóttir
- Faculty of Medicine, University of Iceland, Vatnsmyrarvegur 16, 101, Reykjavik, Iceland
- Department of Respiratory Medicine and Sleep, Landspitali University Hospital, Reykjavik, Iceland
| | - Þórarinn Gíslason
- Faculty of Medicine, University of Iceland, Vatnsmyrarvegur 16, 101, Reykjavik, Iceland
- Department of Respiratory Medicine and Sleep, Landspitali University Hospital, Reykjavik, Iceland
| | - Christer Janson
- Department of Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
| | - Anna-Carin Olin
- Department of Occupational and Environmental Medicine, University of Gothenburg, Gothenburg, Sweden
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Dijk DJ. Models and standards in sleep research and sleep medicine. J Sleep Res 2016; 25:129-30. [PMID: 27086561 DOI: 10.1111/jsr.12409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Sarberg M, Bladh M, Josefsson A, Svanborg E. Sleepiness and sleep-disordered breathing during pregnancy. Sleep Breath 2016; 20:1231-1237. [DOI: 10.1007/s11325-016-1345-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2015] [Revised: 03/15/2016] [Accepted: 04/07/2016] [Indexed: 12/17/2022]
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