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Kim SG, Cho SW, Rhee CS, Kim JW. How to objectively measure snoring: a systematic review. Sleep Breath 2024; 28:1-9. [PMID: 37421520 DOI: 10.1007/s11325-023-02865-6] [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: 02/12/2023] [Revised: 05/18/2023] [Accepted: 05/31/2023] [Indexed: 07/10/2023]
Abstract
PURPOSE Snoring is the most common symptom of obstructive sleep apnea. Various objective methods of measuring snoring are available, and even if the measurement is performed the same way, communication is difficult because there are no common reference values between the researcher and clinician with regard to intensity and frequency, among other variables. In other words, no consensus regarding objective measurement has been reached. This study aimed to review the literature related to the objective measurement of snoring, such as measurement devices, definitions, and device locations. METHODS A literature search based on the PubMed, Cochrane, and Embase databases was conducted from the date of inception to April 5, 2023. Twenty-nine articles were included in this study. Articles that mentioned only the equipment used for measurement and did not include individual details were excluded from the study. RESULTS Three representative methods for measuring snoring emerged. These include (1) a microphone, which measures snoring sound; (2) piezoelectric sensor, which measures snoring vibration; and (3) nasal transducer, which measures airflow. In addition, recent attempts have been made to measure snoring using smartphones and applications. CONCLUSION Numerous studies have investigated both obstructive sleep apnea and snoring. However, the objective methods of measuring snoring and snoring-related concepts vary across studies. Consensus in the academic and clinical communities on how to measure and define snoring is required.
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Affiliation(s)
- Su Geun Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Sung-Woo Cho
- Department of Otorhinolaryngology‑Head and Neck Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 173‑82 Gumi‑ro, Bundang‑gu, Seongnam, Gyeonggi‑do, 13620, South Korea
| | - Chae-Seo Rhee
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
- Sensory Organ Research Institute, Seoul National University Medical Research Center, Seoul, Korea
| | - Jeong-Whun Kim
- Department of Otorhinolaryngology‑Head and Neck Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 173‑82 Gumi‑ro, Bundang‑gu, Seongnam, Gyeonggi‑do, 13620, South Korea.
- Sensory Organ Research Institute, Seoul National University Medical Research Center, Seoul, Korea.
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Bahr-Hamm K, Abriani A, Anwar AR, Ding H, Muthuraman M, Gouveris H. Using entropy of snoring, respiratory effort and electrocardiography signals during sleep for OSA detection and severity classification. Sleep Med 2023; 111:21-27. [PMID: 37714032 DOI: 10.1016/j.sleep.2023.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 08/21/2023] [Accepted: 09/05/2023] [Indexed: 09/17/2023]
Abstract
STUDY OBJECTIVES Obstructive sleep apnea (OSA) is a very prevalent disease and its diagnosis is based on polysomnography (PSG). We investigated whether snoring-sound-, very low frequency electrocardiogram (ECG-VLF)- and thoraco-abdominal effort- PSG signal entropy values could be used as surrogate markers for detection of OSA and OSA severity classification. METHODS The raw data of the snoring-, ECG- and abdominal and thoracic excursion signal recordings of two consecutive full-night PSGs of 86 consecutive patients (22 female, 53.74 ± 12.4 years) were analyzed retrospectively. Four epochs (30 s each, manually scored according to the American Academy of Sleep Medicine standard) of each sleep stage (N1, N2, N3, REM, awake) were used as the ground truth. Sampling entropy (SampEn) of all the above signals was calculated and group comparisons between the OSA severity groups were performed. In total, (86x4x5 = )1720 epochs/group/night were included in the training set as an input for a support vector machine (SVM) algorithm to classify the OSA severity classes. Analyses were performed for first- and second-night PSG recordings separately. RESULTS Twenty-seven patients had mild (RDI = ≥ 5/h but <15/h), 21 patients moderate (RDI ≥15/h but <30/h) and 23 patients severe OSA (RDI ≥30/h). Fifteen patients had an RDI <5/h and were therefore considered non-OSA. Using SE on the above three PSG signal data and using a SVM pipeline, it was possible to distinguish between the four OSA severity classes. The best metric was snoring signal-SE. The area-under-the-curve (AUC) calculations showed reproducible significant results for both nights of PSG. The second night data were even more significant, with non-OSA (R) vs. light OSA (L) 0.61, R vs. moderate (M) 0.68, R vs. heavy OSA (H) 0.84, L vs. M 0.63, M vs. H 0.65 and L vs. H 0.82. The results were not confounded by age or gender. CONCLUSIONS SampEn of either snoring-, very low ECG-frequencies- or thoraco-abdominal effort signals alone may be used as a surrogate marker to diagnose OSA and even predict OSA severity. More specifically, in this exploratory study snoring signal SampEn showed the greatest predictive accuracy for OSA among the three signals. Second night data showed even more accurate results for all three parameters than first-night recordings. Therefore, technologies using only parts of the PSG signal, e.g. sound-recording devices, may be used for OSA screening and OSA severity group classification.
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Affiliation(s)
- K Bahr-Hamm
- Sleep Medicine Center, Department of Otorhinolaryngology, University Medical Center Mainz, Germany.
| | - A Abriani
- Sleep Medicine Center, Department of Otorhinolaryngology, University Medical Center Mainz, Germany
| | - A R Anwar
- Institut du Cerveau - Paris Brain Institute - ICM, Hôpital de la Pitié Salpêtrière, Centre MEG-EEG, CENIR, Paris, France
| | - H Ding
- Institut du Cerveau - Paris Brain Institute - ICM, Hôpital de la Pitié Salpêtrière, Centre MEG-EEG, CENIR, Paris, France
| | - M Muthuraman
- Neural Engineering with Signal Analytics and Artificial Intelligence (NESA-AI), Universitätsklinikum Würzburg, Department of Neurology, Würzburg, Germany.
| | - H Gouveris
- Sleep Medicine Center, Department of Otorhinolaryngology, University Medical Center Mainz, Germany
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Huang Z, Lobbezoo F, Vanhommerig JW, Volgenant CMC, de Vries N, Aarab G, Hilgevoord AAJ. Effects of demographic and sleep-related factors on snoring sound parameters. Sleep Med 2023; 104:3-10. [PMID: 36857868 DOI: 10.1016/j.sleep.2023.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 02/13/2023] [Accepted: 02/15/2023] [Indexed: 02/25/2023]
Abstract
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.
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Affiliation(s)
- Zhengfei Huang
- Department of Orofacial Pain and Dysfunction, Academic Center for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Department of Clinical Neurophysiology, OLVG, Amsterdam, the Netherlands.
| | - Frank Lobbezoo
- Department of Orofacial Pain and Dysfunction, Academic Center for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Joost W Vanhommerig
- Department of Research and Epidemiology, OLVG Hospital, Amsterdam, the Netherlands
| | - Catherine M C Volgenant
- Department of Preventive Dentistry, Academic Center for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Nico de Vries
- Department of Orofacial Pain and Dysfunction, Academic Center for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Department of Otorhinolaryngology - Head and Neck Surgery, OLVG, Amsterdam, the Netherlands; Department of Otorhinolaryngology - Head and Neck Surgery, Antwerp University Hospital (UZA), Antwerp, Belgium
| | - Ghizlane Aarab
- Department of Orofacial Pain and Dysfunction, Academic Center for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
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Peng H, Xu H, Xu Z, Jia R, Yu H. Long-term average spectrum measures of consecutive snore sounds from different sources determined by drug-induced sleep endoscopy. J Clin Sleep Med 2023; 19:145-150. [PMID: 36073836 PMCID: PMC9806785 DOI: 10.5664/jcsm.10280] [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: 04/21/2022] [Revised: 08/28/2022] [Accepted: 09/02/2022] [Indexed: 01/07/2023]
Abstract
STUDY OBJECTIVES The goal of this study was to investigate the value of the long-term average spectrum in the acoustic analysis of snore sounds arising from different sources in the upper airway. METHODS Long-term average spectrum was used to analyze sequences of 10 consecutive snore sounds that had been divided into 2 groups, soft-palate type and lateral-wall type, according to the vibration site generating the snore sounds and the patterns of soft tissue collapse in the upper airway as identified by drug-induced sleep endoscopy. We calculated the first spectral peak, mean spectral energy, high-frequency energy, 0-1 kHz spectral energy, 1-5 kHz spectral energy, and 0-1 kHz/1-5 kHz difference from each group and compared the differences between them. RESULTS All parameters except mean spectral energy showed significant differences between the 2 groups. The first spectral peak of less than 265.53 Hz, and the 0-1k/1-5 kHz difference of less than -11.6 dB strongly suggests soft-palate-type snore sounds. CONCLUSIONS Long-term average spectrum has potential application for snore sound source identification. We recommend using first spectral peak and a 0-1 kHz/1-5 Hz difference to identify soft-palate-type snore sounds. CITATION Peng H, Xu H, Xu Z, Jia R, Yu H. Long-term average spectrum measures of consecutive snore sounds from different sources determined by drug-induced sleep endoscopy. J Clin Sleep Med. 2023;19(1):145-150.
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Affiliation(s)
- Hao Peng
- Department of Otolaryngology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, China Academy of Medicine Sciences, Beijing, P.R. China
| | - Huijie Xu
- Department of Otolaryngology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, China Academy of Medicine Sciences, Beijing, P.R. China
| | - Zhiyong Xu
- School of Electronic and Optical Engineering, Nanjing University of Science and Technology, Nanjing, People’s Republic of China
| | - Ruifang Jia
- Department of Anesthesia, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, China Academy of Medicine Sciences, P.R. China
| | - Hui Yu
- Department of Anesthesia, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, China Academy of Medicine Sciences, P.R. China
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Chiang JK, Lin YC, Lu CM, Kao YH. Correlation between snoring sounds and obstructive sleep apnea in adults: a meta-regression analysis. Sleep Sci 2022; 15:463-470. [PMID: 36419807 PMCID: PMC9670768 DOI: 10.5935/1984-0063.20220068] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 02/07/2022] [Indexed: 09/17/2023] Open
Abstract
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.
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Affiliation(s)
- Jui-Kun Chiang
- Dalin Tzu Chi Hospital, Family Medicine - Chiayi - Taiwan
| | - Yen-Chang Lin
- Nature Dental Clinic, Dental department - Puli - Taiwan
| | - Chih-Ming Lu
- Dalin Tzu Chi Hospital, Department of Urology - Chiayi - Taiwan
| | - Yee-Hsin Kao
- Tainan Municipal Hospital (Managed by Show Chwan Medical Care
Corporation), Family Medicine - Tainan - Taiwan
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6
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Huang Z, Aarab G, Ravesloot MJL, Zhou N, Bosschieter PFN, van Selms MKA, den Haan C, de Vries N, Lobbezoo F, Hilgevoord AAJ. Prediction of the obstruction sites in the upper airway in sleep-disordered breathing based on snoring sound parameters: a systematic review. Sleep Med 2021; 88:116-133. [PMID: 34749271 DOI: 10.1016/j.sleep.2021.10.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 09/16/2021] [Accepted: 10/12/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Identification of the obstruction site in the upper airway may help in treatment selection for patients with sleep-disordered breathing. Because of limitations of existing techniques, there is a continuous search for more feasible methods. Snoring sound parameters were hypothesized to be potential predictors of the obstruction site. Therefore, this review aims to i) investigate the association between snoring sound parameters and the obstruction sites; and ii) analyze the methodology of reported prediction models of the obstruction sites. METHODS The literature search was conducted in PubMed, Embase.com, CENTRAL, Web of Science, and Scopus in collaboration with a medical librarian. Studies were eligible if they investigated the associations between snoring sound parameters and the obstruction sites, and/or reported prediction models of the obstruction sites based on snoring sound. RESULTS Of the 1016 retrieved references, 28 eligible studies were included. It was found that the characteristic frequency components generated from lower-level obstructions of the upper airway were higher than those generated from upper-level obstructions. Prediction models were built mainly based on snoring sound parameters in frequency domain. The reported accuracies ranged from 60.4% to 92.2%. CONCLUSIONS Available evidence points toward associations between the snoring sound parameters in the frequency domain and the obstruction sites in the upper airway. It is promising to build a prediction model of the obstruction sites based on snoring sound parameters and participant characteristics, but so far snoring sound analysis does not seem to be a viable diagnostic modality for treatment selection.
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Affiliation(s)
- Zhengfei Huang
- Department of Orofacial Pain and Dysfunction, Academic Center for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Department of Clinical Neurophysiology, OLVG, Amsterdam, the Netherlands.
| | - Ghizlane Aarab
- Department of Orofacial Pain and Dysfunction, Academic Center for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Madeline J L Ravesloot
- Department of Otorhinolaryngology - Head and Neck Surgery, OLVG, Amsterdam, the Netherlands
| | - Ning Zhou
- Department of Orofacial Pain and Dysfunction, Academic Center for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Department of Oral and Maxillofacial Surgery, Amsterdam UMC Location AMC and Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam, Amsterdam, the Netherlands
| | - Pien F N Bosschieter
- Department of Otorhinolaryngology - Head and Neck Surgery, OLVG, Amsterdam, the Netherlands
| | - Maurits K A van Selms
- Department of Orofacial Pain and Dysfunction, Academic Center for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Chantal den Haan
- Medical Library, Department of Research and Education, OLVG, Amsterdam, the Netherlands
| | - Nico de Vries
- Department of Orofacial Pain and Dysfunction, Academic Center for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Department of Otorhinolaryngology - Head and Neck Surgery, OLVG, Amsterdam, the Netherlands; Department of Otorhinolaryngology - Head and Neck Surgery, Antwerp University Hospital (UZA), Antwerp, Belgium
| | - Frank Lobbezoo
- Department of Orofacial Pain and Dysfunction, Academic Center for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
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7
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De Meyer MMD, Jacquet W, Vanderveken OM, Marks LAM. Systematic review of the different aspects of primary snoring. Sleep Med Rev 2019; 45:88-94. [PMID: 30978609 DOI: 10.1016/j.smrv.2019.03.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 02/04/2019] [Accepted: 03/07/2019] [Indexed: 10/27/2022]
Abstract
Primary snoring, also known as simple or non-apnoeic snoring, is regarded as the first stage of sleep disordered breathing without severe medical consequences for the snorer and co-sleeper. Although it is a highly prevalent phenomenon in the general population, our knowledge is limited because of the lack of a consensus on terminology. This systematic review of the aspects used in the definitions of simple/primary snoring was conducted to obtain an inventory of current practices and compare these definitions with the conceptual definition of the American Academy of Sleep Medicine. PubMed and Web of Science were searched from July 2016 onwards without any language limitations, and 362 references were obtained. After selection based on titles, 39 remained, among which 29 contained a definition or reference to a definition. In 69% of the studies, a cut-off <5 apnoea/Hypopnoea events per hour of sleep on the Apnoea-Hypopnoea Index was used. Despite this tendency, the cut-offs ranged from 0 to <15/h. Unfortunately, the cut-off and occasional requirements did not match the conceptual definition of the American Academy of Sleep Medicine. A consensus must be reached on an operational and clinically relevant definition based on the clear conceptual definition.
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Affiliation(s)
- Micheline M D De Meyer
- Special Needs in Oral Health, Sleep Breathing Disorders, Oral Health Sciences, Ghent University Hospital, Gent, Belgium.
| | - Wolfgang Jacquet
- Department of Oral Health Sciences ORHE, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium; Department of Educational Science EDWE-LOCI, Faculty of Psychology and Educational Sciences, Vrije Universiteit Brussel, Brussels, Belgium
| | - Olivier M Vanderveken
- Department of Ear, Nose, and Throat, Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium; Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Luc A M Marks
- Special Needs in Oral Health, Sleep Breathing Disorders, Oral Health Sciences, Ghent University Hospital, Gent, Belgium
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8
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Peng H, Xu H, Xu Z, Huang W, Jia R, Yu H, Zhao Z, Wang J, Gao Z, Zhang Q, Huang W. Acoustic analysis of snoring sounds originating from different sources determined by drug-induced sleep endoscopy. Acta Otolaryngol 2017; 137:872-876. [PMID: 28301265 DOI: 10.1080/00016489.2017.1293291] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To discuss the possibility of fundamental frequency (F0) and formant frequency (FF) to generally differentiate the sources of snoring sounds determined by drug-induced sleep endoscopy (DISE). METHODS A total of 74 snoring subjects underwent DISE and snoring sounds were recorded simultaneously. The noise-suppressed snoring sounds were analyzed and classified into different groups based on the sources of vibration identified by DISE. F0 and FFs were calculated. RESULTS Totally, 516 snoring sounds from three vibrating sources (the palate, combined the palate and the lateral wall, the lateral wall) of 47 patients were divided into three groups then analyzed. The levels of F0 and FFs for each group follow the order: Group 1 < Group 2 < Group 3. There was statistical difference between Group 1 and other groups in F0 and F2 (p < .05). The area under the receiver-operator curves (AUC) was F0, at 0.727, and the cut-off value was 134.2 Hz; and F2, at 0.654, and the cut-off value was 2028.0 Hz. CONCLUSIONS F0 and the second formant frequency (F2) are found to be significantly lower in palatal snoring sound. F0 might be a significant in distinguishing palatal snoring sound from non-palatal snoring sound. F2 is more significant than F1 and F3 in identifying the sources of the snoring sounds but is less sensitive than F0.
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Affiliation(s)
- Hao Peng
- Department of Otolaryngology, Beijing Hospital, National Center of Gerontology, Beijing, People’s Republic of China
| | - Huijie Xu
- Department of Otolaryngology, Beijing Hospital, National Center of Gerontology, Beijing, People’s Republic of China
| | - Zhiyong Xu
- School of Electronic and Optical Engineering, Nanjing University of Science and Technology, Nanjing, People’s Republic of China
| | - Weining Huang
- Department of Otolaryngology, Beijing Hospital, National Center of Gerontology, Beijing, People’s Republic of China
| | - Ruifang Jia
- Department of Anesthesia, Beijing Hospital, National Center of Gerontology, Beijing, People’s Republic of China
| | - Hui Yu
- Department of Anesthesia, Beijing Hospital, National Center of Gerontology, Beijing, People’s Republic of China
| | - Zhao Zhao
- School of Electronic and Optical Engineering, Nanjing University of Science and Technology, Nanjing, People’s Republic of China
| | - Jiajun Wang
- School of Electronic and Optical Engineering, Nanjing University of Science and Technology, Nanjing, People’s Republic of China
| | - Zhan Gao
- Department of Otolaryngology, Beijing Hospital, National Center of Gerontology, Beijing, People’s Republic of China
| | - Qiuying Zhang
- Department of Otolaryngology, Beijing Hospital, National Center of Gerontology, Beijing, People’s Republic of China
| | - Weihong Huang
- Department of Otolaryngology, Beijing Hospital, National Center of Gerontology, Beijing, People’s Republic of China
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9
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Levartovsky A, Dafna E, Zigel Y, Tarasiuk A. Breathing and Snoring Sound Characteristics during Sleep in Adults. J Clin Sleep Med 2017; 12:375-84. [PMID: 26518701 DOI: 10.5664/jcsm.5588] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Accepted: 09/23/2015] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Sound level meter is the gold standard approach for snoring evaluation. Using this approach, it was established that snoring intensity (in dB) is higher for men and is associated with increased apnea-hypopnea index (AHI). In this study, we performed a systematic analysis of breathing and snoring sound characteristics using an algorithm designed to detect and analyze breathing and snoring sounds. The effect of sex, sleep stages, and AHI on snoring characteristics was explored. METHODS We consecutively recruited 121 subjects referred for diagnosis of obstructive sleep apnea. A whole night audio signal was recorded using noncontact ambient microphone during polysomnography. A large number (> 290,000) of breathing and snoring (> 50 dB) events were analyzed. Breathing sound events were detected using a signal-processing algorithm that discriminates between breathing and nonbreathing (noise events) sounds. RESULTS Snoring index (events/h, SI) was 23% higher for men (p = 0.04), and in both sexes SI gradually declined by 50% across sleep time (p < 0.01) independent of AHI. SI was higher in slow wave sleep (p < 0.03) compared to S2 and rapid eye movement sleep; men have higher SI in all sleep stages than women (p < 0.05). Snoring intensity was similar in both genders in all sleep stages and independent of AHI. For both sexes, no correlation was found between AHI and snoring intensity (r = 0.1, p = 0.291). CONCLUSIONS This audio analysis approach enables systematic detection and analysis of breathing and snoring sounds from a full night recording. Snoring intensity is similar in both sexes and was not affected by AHI.
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Affiliation(s)
- Asaf Levartovsky
- Sleep-Wake Disorders Unit, Soroka University Medical Center and Department of Physiology and Cell Biology, Faculty of Health Sciences, Ben-Gurion University of the Negev, Israel
| | - Eliran Dafna
- Department of Biomedical Engineering, Faculty of Engineering Sciences, Ben-Gurion University of the Negev, Israel
| | - Yaniv Zigel
- Department of Biomedical Engineering, Faculty of Engineering Sciences, Ben-Gurion University of the Negev, Israel
| | - Ariel Tarasiuk
- Sleep-Wake Disorders Unit, Soroka University Medical Center and Department of Physiology and Cell Biology, Faculty of Health Sciences, Ben-Gurion University of the Negev, Israel
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10
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Alakuijala A, Salmi T. Predicting Obstructive Sleep Apnea with Periodic Snoring Sound Recorded at Home. J Clin Sleep Med 2016; 12:953-8. [PMID: 27092701 DOI: 10.5664/jcsm.5922] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Accepted: 03/07/2016] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES The cost-effectiveness of diagnosing obstructive sleep apnea (OSA) could be improved by using a preliminary screening method among subjects with no suspicion of other sleep disorders. We aimed to evaluate the diagnostic value of periodic snoring sound recorded at home. METHODS We included 211 subjects, aged 18-83 (130 men), who were referred to our laboratory for suspicion of OSA, and had a technically successful overnight polygraphy, measured with the Nox T3 Sleep Monitor (Nox Medical, Iceland) with a built-in microphone. We analyzed the percentage of periodic snoring during the home sleep apnea study. RESULTS Apnea-hypopnea index (AHI) ranged from 0.1 to 116 events/h and the percentage of periodic snoring from 1% to 97%. We found a strong positive correlation (r = 0.727, p < 0.001) between periodic snoring and AHI. The correlation was slightly stronger among female, younger, and obese subjects. The best threshold value of the periodic snoring for predicting an AHI > 15 events/h with as high sensitivity as possible was found to be 15%. There, sensitivity was 93.3%, specificity 35.1%, and negative predictive value 75.0%. CONCLUSIONS According to our results, it is possible to set a periodic snoring threshold (15% or more) for the subject to advance to further sleep studies. Together with medical history and prior to more expensive studies, measuring periodic snoring at home is a simple and useful method for predicting the probability of OSA, in particular among women who are often unaware of their apnea-related snoring.
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Affiliation(s)
- Anniina Alakuijala
- Department of Clinical Neurophysiology, HUS Medical Imaging Center, Helsinki University Hospital, Finland.,Department of Neurological Sciences, University of Helsinki, Helsinki, Finland
| | - Tapani Salmi
- Department of Clinical Neurophysiology, HUS Medical Imaging Center, Helsinki University Hospital, Finland.,Department of Neurological Sciences, University of Helsinki, Helsinki, Finland
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