Snoring Patterns During Hypoglossal Nerve Stimulation Therapy Up-Titration

Longitudinal snoring changes can be captured using a mobile phone application. During hypoglossal nerve stimulator (HNS) therapy up-titration, increasing stimulation voltage was associated with reduced snoring frequency and intensity in this case series of six patients. Laryngoscope, 134:987-992, 2024.

Effects of demographic and sleep-related factors on snoring sound parameters

OBJECTIVE

To investigate the effect of frequently reported between-individual (viz., age, gender, body mass index [BMI], and apnea-hypopnea index [AHI]) and within-individual (viz., sleep stage and sleep position) snoring sound-related factors on snoring sound parameters in temporal, intensity, and frequency domains.

METHODS

This study included 83 adult snorers (mean ± SD age: 42.2 ± 11.3 yrs; male gender: 59%) who underwent an overnight polysomnography (PSG) and simultaneous sound recording, from which a total of 131,745 snoring events were extracted and analyzed. Data on both between-individual and within-individual factors were extracted from the participants' PSG reports.

RESULTS

Gender did not have any significant effect on snoring sound parameters. The fundamental frequency (FF; coefficient = -0.31; P = 0.02) and dominant frequency (DF; coefficient = -12.43; P < 0.01) of snoring sounds decreased with the increase of age, and the second formant increased (coefficient = 22.91; P = 0.02) with the increase of BMI. Severe obstructive sleep apnea (OSA; AHI ≥30 events/hour), non-rapid eye movement sleep stage 3 (N3), and supine position were all associated with more, longer, and louder snoring events (P < 0.05). Supine position was associated with higher FF and DF, and lateral decubitus positions were associated with higher formants.

CONCLUSIONS

Within the limitations of the current patient profile and included factors, AHI was found to have greater effects on snoring sound parameters than the other between-individual factors. The included within-individual factors were found to have greater effects on snoring sound parameters than the between-individual factors under study.

Correlation between snoring sounds and obstructive sleep apnea in adults: a meta-regression analysis

OBJECTIVE

Snoring is a dominant clinical symptom in patients with obstructive sleep apnea (OSA), and analyzing snoring sounds might be a potential alternative to polysomnography (PSG) for the assessment of OSA. This study aimed to systematically examine the correlation between the snoring sounds and the apnea-hypopnea index (AHI) as the measures of OSA severity.

MATERIAL AND METHODS

A comprehensive literature review using the MEDLINE, Embase, Cochrane Library, Scopus, and PubMed databases identified the published studies reporting the correlations between and severity of snoring and the AHI values by meta-regression analysis.

RESULTS

In total, 13 studies involving 3,153 adult patients were included in this study. The pooled correlation coefficient for snoring sounds and AHI values was 0.71 (95%CI: 0.49, 0.85) from the random-effects meta-analysis with the Knapp and Hartung adjustment. The I 2 and chi-square Q test demonstrated significant heterogeneity (97.6% and p<0.001). After adjusting for the effects of the other covariates, the mean value of the Fisher's r-to-z transformed correlation coefficient would have 0.80 less by the snoring rate (95%CI = -1.02, -0.57), 1.46 less by the snoring index (95%CI = -1.85, -1.07), and 0.21 less in the mean body mass index (95%CI = -0.31, -0.11), but 0.15 more in the mean age (95%CI = 0.10, 0.20). It fitted the data very well (R 2=0.9641).

CONCLUSION

A high correlation between the severity of snoring and the AHI was found in the studies with PSG. As compared to the snoring rate and the snoring index, the snoring intensity, the snoring frequency, and the snoring time interval index were more sensitive measures for the severity of snoring.

Snoring time versus snoring intensity: Which parameter correlates better with severity of obstructive sleep apnea syndrome?

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.