phenylephrine-hydrochloride and Snoring

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.. 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.. 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%.. 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.

Topics: Airway Obstruction; Humans; Nose; Sleep Apnea Syndromes; Sleep Apnea, Obstructive; Snoring; Sound

It is estimated that half of the adult population older than 60 years snores. This article discusses the many aspects of snoring, including impacts on bed partners, the individual who snores, and when and how to appropriately evaluate, diagnose, and treat the perpetrator. The goal is for clinicians to expand their knowledge regarding diagnosis and treatment of the phenomenon of snoring.It is estimated that half of the adult population over the age of 60 years of age snores. This chapter discusses snoring, including the impact on bed partners, the individual that snores and when and how to treat the snorer. The goal is for clinicians to expand their knowledge regarding diagnosis and treatment of patients who snores.

Topics: Airway Obstruction; Humans; Nasopharynx; Nose; Polysomnography; Sleep Apnea, Obstructive; Snoring; Sound Spectrography

To evaluate the effect of the different surgical techniques used in the treatment of obstructive sleep apnea (OSA) on the postoperative voice and nasalance, and to conduct a meta-analysis through the assessment of postoperative changes.. Systematic literature review and meta-analysis of published data using the data sources, MEDLINE, Google Scholar, Cochrane, and SAGE. All studies published in English specifying any upper airway surgery for treatment of snoring and/or OSA were included, provided they indicated the pre- and postoperative mean ± standard deviation (SD) values for voice parameters and nasality. The primary outcomes were the changes in preoperative-postoperative mean values of fundamental frequency (mF0), jitter, shimmer, and nasalance scores.. After removal of duplications, 214 studies were potentially relevant, and 25 studies ultimately met the criteria for inclusion in the present review. Of the 25 studies evaluated in this review, 12 studies with 379 patients were available for the meta-analysis calculations. In general, a fixed-effects model was used to analyze the data in the subgroups. The meta-analysis results showed no significant differences in either subgroup analysis between the preoperative and postoperative assessments of mF0, jitter, shimmer, oral nasalance, nasal nasalance, and oronasal nasalance (All had values of p > 0.05).. The results of this meta-analysis indicated no significant effect of surgical treatments for snoring or OSA on glottic functioning and nasalance parameters, regardless of surgery type. Further prospective studies are needed to assess more parameters for detailed acoustic analyses.

Topics: Humans; Nose; Prospective Studies; Sleep Apnea, Obstructive; Snoring; Treatment Outcome; Voice

This review highlights recent advances and views on the role of the nose in snoring and obstructive sleep apnoea.. Recent reviews and past randomized controlled trials generally agree that nasal surgery may improve quality of life in snoring and obstructive sleep apnoea. There have been no published randomized controlled trials regarding nasal treatments in snoring or obstructive sleep apnoea in the past year.. Snoring and obstructive sleep apnoea are upper airway disorders in which the role of the nose has been well researched. Studies support that nasal surgery improves quality of life in snoring, but it may not lead to resolution of snoring. Likewise, nasal treatments for obstructive sleep apnoea increase the quality of life and treatment compliance in some patients. Further stratification of patients who may benefit from nasal intervention may clarify the role of nasal surgery.

Topics: Humans; Nose; Quality of Life; Sleep Apnea, Obstructive; Snoring

Snoring and obstructive sleep apnoea are both due to multilevel anatomical obstruction, and the nose and nasal pathology both contribute in many cases. This paper addresses some of the issues surrounding the problem and briefly discusses the role of medication and nasal dilators and in more detail the implication of nasal surgery in various aspects of sleep related breathing disorders (SRBD). Nasal obstruction leads to mouth breathing, which destabilises the upper airway and aggravates SRBD.

Topics: Continuous Positive Airway Pressure; Humans; Nose; Quality of Life; Rhinitis, Allergic, Perennial; Sleep Apnea, Obstructive; Sleep Wake Disorders; Snoring

Data from observational studies suggest that nasal obstruction contributes to the pathogenesis of snoring and obstructive sleep apnoea (OSA). To define more accurately the relationship between snoring, OSA and nasal obstruction, the current authors have summarised the literature on epidemiological and physiological studies, and performed a systematic review of randomised controlled trials in which the effects of treating nasal obstruction on snoring and OSA were investigated. Searches of bibliographical databases revealed nine trials with randomised controlled design. External nasal dilators were used in five studies, topically applied steroids in one, nasal decongestants in two, and surgical treatment in one study. Data from studies using nasal dilators, intranasal steroids and decongestants to relieve nasal congestion showed beneficial effects on sleep architecture, but only minor improvement of OSA symptoms or severity. Snoring seemed to be reduced by nasal dilators. Nasal surgery also had minimal impact on OSA symptoms. In conclusion, chronic nasal obstruction seems to play a minor role in the pathogenesis of obstructive sleep apnoea, and seems to be of some relevance in the origin of snoring. The impact of treating nasal obstruction in patients with snoring and obstructive sleep apnoea on long-term outcome remains to be defined through randomised controlled trials of medical and surgical therapies.

Topics: Humans; Nose; Randomized Controlled Trials as Topic; Sleep Apnea, Obstructive; Snoring

During sleep there is a discrete fall in minute ventilation and an associated increase in upper airway resistance. In normal subjects, the nasal part of the upper airway contributes only little to the elevation of the total resistance, which is mainly the consequence of pharyngeal narrowing. Yet, swelling of the nasal mucosa due to congestion of the submucosal capacitance vessels may significantly affect nasal airflow. In many healthy subjects an alternating pattern of congestion and decongestion of the nasal passages is observed. Some individuals demonstrate congestion of the ipsilateral half of the nasal cavity when lying down on the side. Nasal diseases, including structural anomalies and various forms of rhinitis, tend to increase nasal resistance, which typically impairs breathing via the nasal route in recumbency and during sleep. A role of nasal obstruction in the pathogenesis of sleep-disordered breathing has been implicated by many authors. While it proves difficult to show a relationship between the degree of nasal obstruction and the number of disturbed breathing events, the presence of nasal obstruction will most likely have an impact on the severity of sleep-disordered breathing. Identification of nasal obstruction is important in the diagnostic work-up of patients suffering from snoring and sleep apnea.

Topics: Airway Resistance; Humans; Nasal Cavity; Nasal Mucosa; Nasal Obstruction; Nose; Posture; Respiratory Mechanics; Sleep; Sleep Apnea Syndromes; Snoring

We report the successful use of a Furlow palatoplasty to salvage velopharyngeal competence following iatrogenic avulsion of a pharyngeal flap that had been previously established to treat velopharyngeal insufficiency associated with a submucous cleft palate.. A tonsillectomy, conducted by a surgeon unaffiliated with a cleft palate team, was used to remove enlarged tonsils that had developed after pharyngeal flap surgery and extended into the lateral ports causing nasal obstruction and hypernasality because of mechanical interference with port closure. A posttonsillectomy evaluation revealed avulsion of the pharyngeal flap, which was successfully treated using a Furlow palatoplasty.. To our knowledge, this is the first report of iatrogenic avulsion of a pharyngeal flap caused by tonsillectomy. Based on a review of the literature and this case experience, we would conclude that tonsillectomy should not be regarded as a routine procedure in patients previously treated with a pharyngeal flap. If required, it should be performed by a skilled otolaryngologist, preferably one affiliated with a multidisciplinary cleft palate team who is familiar with pharyngoplasty surgery. Finally, our experience would suggest that the Furlow palatoplasty is sufficiently robust to be used as a secondary salvage procedure to restore velopharyngeal sufficiency following iatrogenic avulsion of a pharyngeal flap.

Topics: Airway Resistance; Child, Preschool; Female; Follow-Up Studies; Humans; Iatrogenic Disease; Nasal Obstruction; Nose; Palate; Pharynx; Snoring; Speech Disorders; Surgical Flaps; Tonsillectomy; Velopharyngeal Insufficiency

Topics: Breath Tests; Child; Child, Preschool; Choanal Atresia; Fluorometry; Humans; Infant; Infant, Newborn; Lip; Mouth Breathing; Nose; Palate; Physical Exertion; Respiration; Sleep Apnea Syndromes; Smoking; Snoring; Spirometry; Sudden Infant Death; Uvula

Both neural and anatomical factors play an important role in the maintenance of upper airway patency. An abnormality in one or both of these factors is felt to be the underlying cause of obstructive sleep apnea.

Topics: Airway Obstruction; Airway Resistance; Central Nervous System; Humans; Larynx; Mandible; Muscles; Nose; Oropharynx; Pharynx; Positive-Pressure Respiration; Pressure; Respiratory Physiological Phenomena; Respiratory System; Sleep; Sleep Apnea Syndromes; Snoring; Tomography, X-Ray Computed

To illustrate the reliability of the Pang-Rotenberg (PR) sign as a prognosticator of snoring surgery. Our hypothesis was that patients who are PR-positive have better snoring reduction scores and outcomes than PR-negative patients after nose and palate surgery.. A multicenter prospective series of 153 patients with snoring.. All patients graded the snoring intensity on a visual analog scale (VAS). All 137 patients enrolled had both the nose surgery and palate surgery. The control group consisted of 16 patients who underwent nasal surgery alone.. There were 122 men and 15 women, the mean age was 44.6 years old, and mean body mass index was 26.1. There were 15 simple snorers and 122 obstructive sleep apnea patients. Patients who were PR-positive showed significantly better postoperative snoring VAS reduction (from 9.04 to 1.02) compared to those patients who were PR-negative (from 8.91 to 3.14) (P < .001). The mean follow-up time was 7.4 months. The control group had poor snoring VAS reduction from 9.21 to 6.72. After adjusting for covariates that influence the snoring VAS change due to surgery, we found that PR-negative patients achieved an average of 5.78 improvement in snoring VAS, whereas PR-positive patients achieved an average of 8.02 improvement in snoring VAS (P < .001).. The PR sign is a reliable prognosticator of snoring reduction, after combined nose and palate surgery, for patients with troublesome snoring.

Topics: Adult; Aged; Endoscopy; Female; Humans; Male; Middle Aged; Nose; Palate; Polysomnography; Prospective Studies; Snoring; Treatment Outcome

A bench study using an artificial lung model was performed to evaluate the snoring detection sensitivity of six (commercially available) auto-nasal continuous positive airway pressure (NCPAP) devices. Snoring was simulated by a loudspeaker connected to the lung model and abruptly activated during 1 s of each inspiratory period to induce pressure oscillation. The oscillation frequencies chosen were 30, 60, 90, and 120 Hz. For each frequency, the amplitude of the pressure oscillation produced by the loudspeaker was adjusted to find the threshold at which the auto-nCPAP devices detected snoring. Differences in pressure-amplitude thresholds of up to three-fold were found across auto-nCPAP devices. A randomized clinical study to compare the effects of the least sensitive (Virtuoso LX; Respironics, Nantes, France) and one of the most sensitive, (Goodknight 418A; Malinckrodt, Nancy, France) devices, in two groups of six patients with obstructive sleep apnoea syndrome was then conducted. Goodknight 418A was more sensitive than Virtuoso LX for detecting snoring (mean +/- SD 92 +/- 11% versus 50 +/- 39% respectively, p = 0.03). To conclude, striking differences exist between auto-nasal continuous positive airway pressure devices in sensitivity for detecting snoring.

Topics: Humans; Middle Aged; Models, Theoretical; Nose; Positive-Pressure Respiration; Sleep Apnea, Obstructive; Snoring

Chronic rhinitis patients often suffer from unrefreshing sleep and snoring, related to increased nasal resistance to airflow. Previous trials based on subjective assessment of snoring have demonstrated beneficial effects of Breathe Right (BR), a noninvasive external nasal dilator. Polysomnography (PSG) was applied to objectively assess the effects of BR on snoring. Twelve nonobese chronic rhinitis patients participated in the present study, which had a randomized, placebo-controlled design. The presence of snoring and the absence of sleep apnoea was demonstrated during a baseline overnight sleep study. Patients were then randomized for placebo or true nasal dilator treatment, which was also assessed by overnight PSG. The use of BR had no effect on sleep quality, arousal-index apnoea-hypopnoea-index or snoring loudness. Snoring frequency was significantly lowered by BR (173+/-29 snores x h(-l)), compared with placebo (258+/-34 snores x h(-1); p=0.016). The results support the hypothesis that Breathe Right is effective in reducing the amount of snoring in patients with chronic rhinitis. This objective finding is in line with some other reports on subjective improvement of snoring, based upon the judgement of bedpartners.

Topics: Adult; Chronic Disease; Cross-Over Studies; Dilatation; Double-Blind Method; Female; Humans; Male; Middle Aged; Nasal Obstruction; Nose; Placebos; Polysomnography; Prospective Studies; Rhinitis; Sleep; Snoring

This clinical trial was designed to evaluate the efficacy of the external nasal dilator Breathe Right (nasal strip) on snoring. The assessment of snoring intensity and duration as well as the sleep quality without the Breathe Right nasal strip and after application was performed in 30 out-patients with primary habitual snoring. An all-night polysomnographic investigation including registration of a17-channel EEG, EMG, respiration parameters such as breathing efforts and nasal/oral air flow, snoring vibrations, ECG, oxygen saturation, etc. was conducted in the sleep laboratory of Pro Science Private Research Clinic GmbH. The drug-free strip Breathe Right was able to reduce the maximum snoring intensity (maximum snoring vibration) throughout the night (p = 0.02, sign test), especially during the superficial sleep (sleep stage 1 and 2). The snoring intensity remained almost unchanged during slow wave sleep (SWS) and REM. In comparison with the baseline the maximum snoring intensity was reduced during the second treatment night in 22 of the 30 investigated snorers. The differentiation between snorers with and without obstructive sleep apnea and between mild and heavy snorers allowed to state that especially the snorers without apnea and the time in bed, TIB) can achieve a reduction of the maximum snoring intensity using the strip. Moreover, the number of snores per hour TIB (snoring index, SI) was reduced after application of the nasal strip for the snores with an intensity greater than 20 dB (p = 0.02, sign test). The sleep architecture remained almost unchanged, although the nasal strip led subjectively (SF-A questionnaire) to an improvement of sleep quality. The overall estimation of the subjective efficacy rating revealed that 17 of 30 patients (second treatment night) needed a certain period of time to accustom to the nasal strip. After that they could breathe easily, slept well and felt recuperated in the following morning. No adverse events were observed after adhesion of the nasal strip, except for one patient, who had the sensation as if they needed to sneeze for a short time after the first application of the nasal strip. Consequently, Breathe Right is a safe and easily applied noninvasive method to reduce the maximum snoring intensity, especially in habitual mild snorers.

Topics: Adult; Dilatation; Female; Humans; Leg; Male; Movement; Nose; Polysomnography; Respiratory Mechanics; Sleep; Sleep Apnea Syndromes; Sleep Stages; Snoring; Surveys and Questionnaires; Vibration

A nasal dilator (Nozovent) has been developed to fit in the nasal cavity and external nose of Caucasians, and beneficial effects have been confirmed. However, the ability of the device to dilate nasal valve areas of Orientals, whose external nose structure differs from that of Caucasians, has not been studied. We studied the effectiveness of the Nozovent device in preventing snoring and sleep apnea in Japanese subjects according to the methods described by Petruson. When the Nozovent device was worn by the eighteen subjects who experienced snoring, nine showed significant improvement, four showed good improvement, two fair improvement, and three discontinued the trial; the rate of improvement was 72.2%. The device was also seen to be effective for three patients with sleep apnea. The Nozovent device provides a unique method for non-surgical treatment of snoring, and the effectiveness is a result of dilatation of the nasal valve area. The principle is medically sound, and is equally applicable to nasal valves of both Caucasians and Japanese who have different external nose structures.

Topics: Adult; Aged; Dilatation; Female; Humans; Japan; Male; Middle Aged; Nose; Snoring

A study was conducted to polysomnographically evaluate the effects of external nasal dilation on sleep quality in mild snorers by examining the amount of sleep fragmentation and cyclic alternating pattern sequences (CAPS) rates. A two-night, open-label, one-way crossover polysomnographic evaluation, with and without use of an external nasal dilator, was done at the Tri-State Sleep Disorders Center in Cincinnati, Ohio. Nine snorers, polysomnographically determined to be free of clinically significant levels of obstructive sleep apnea, were studied. CAPS rates with nasal dilation were 28.4% as compared to 37.9% without nasal dilation (p < 0.05). We conclude that external nasal dilation reduces arousal instability in snorers without obstructive sleep apnea.

Topics: Airway Obstruction; Chi-Square Distribution; Cross-Over Studies; Dilatation; Humans; Nose; Polysomnography; Respiration; Sleep Stages; Snoring

We evaluated an auto-nasal continuous positive airway pressure (nCPAP) prototype (MC+; SEFAM, Nancy, France) in which apnoea/hypopnoea detection was disabled and nasal mask pressure vibration detection was the only mode of pressure setting. The device was tested in 15 previously untreated obstructive sleep apnoea patients during a night with polysomnography. We observed that a single night of auto-nCPAP improved the apnoea/hypnoea index (AHI) (12 +/- 21 vs 51 +/- 31 disordered breathing events.h-1 of sleep (mean +/- SD)), the awakening-arousal index (13 +/- 20 vs 40 +/- 26 arousals.h-1 of sleep), and duration of slow wave sleep (102 +/- 49 vs 71 +/- 56 min) but not of rapid eye movement (REM) sleep (55 +/- 31 vs 64 +/- 38 min). Auto-nCPAP was effective (apnoea/hypopnoea and arousal indices < 10 events.h-1) in all but three patients. Auto-nCPAP was ineffective in one patient, whose obstructive respiratory events were not preceded by nasal mask pressure vibration detection, and in two patients who were quasi-permanent mouth breathers. Snoring detection may be effective in sleep apnoea syndrome with heavy snoring and without permanent mouth breathing, during the first night of nasal continuous positive airway pressure treatment.

Topics: Airway Obstruction; Arousal; Awareness; Evaluation Studies as Topic; Humans; Male; Masks; Middle Aged; Mouth Breathing; Nose; Polysomnography; Positive-Pressure Respiration; Pressure; Sleep Apnea Syndromes; Sleep Stages; Sleep, REM; Snoring; Vibration

The effects of nasal valve dilation on snoring and obstructed breathing were studied in 11 patients with habitual snoring and/or obstructive sleep apnea. The anterior part of the nose, the valve region, was dilated by means of a plastic device. Ten patients underwent polysomnographic investigation including pulse oximetry and measurement of snoring noise with and without the nasal dilator in a randomized manner. Snoring, nocturnal arousals, and daytime hypersomnolence were rated by the patient and partner on a questionnaire before and after a 10-day treatment period with the dilator. The nasal airflow, as assessed by rhinomanometry when awake in the sitting position, increased by 18% (range, 5.5% to 45%) when the nasal dilator was used. The frequency and severity of obstructed breathing decreased significantly with the nasal dilator. The apnea index with and without the nasal dilator was 6.4 (range, 1.3 to 15) and 18 (range, 1.8 to 60), respectively. The mean decrease of the apnea index was 47%. The overnight minimum arterial oxygen saturation (with and without the nasal dilator was 84% (range, 76% to 88%) and 78% (range, 68% to 89%), respectively. There was a substantial decrease in snoring noise (number of epochs with Leq values, equal energy level, above 55 or 60 dB) with the dilator in all patients who presented with snoring noise above these levels during the control night. No subjective effects on arousal frequency or daytime hypersomnolence were reported. Four of 11 patients were positive to continue using the nasal dilator.

Topics: Adult; Dilatation; Equipment Design; Female; Humans; Male; Middle Aged; Nose; Otolaryngology; Sleep Apnea Syndromes; Snoring; Treatment Outcome

Apnea during sleep has been associated with both increased pharyngeal resistance and nasal obstruction. Alcohol can worsen obstructive sleep apnea, but its influence on pharyngeal resistance and nasal patency has not been evaluated. Accordingly, we determined the effects of alcohol on pharyngeal and nasal resistances in 11 normal awake subjects on 2 separate days. Baseline pharyngeal resistance prior to placebo and alcohol was not significantly different. After placebo, pharyngeal resistance did not change significantly. However, after alcohol, pharyngeal resistance increased from 1.9 +/- 0.5 (SEM) to 3.3 +/- 0.8 cm H2O/L/s at 45 min (p less than 0.05) and returned to near baseline level by 90 min. Baseline nasal resistance varied considerably within subjects on the 2 days, but the mean values for baseline nasal resistance on alcohol and placebo days were not significantly different. Nasal resistance did not change after placebo, but after alcohol, nasal resistance increased from 2.4 +/- 0.9 at baseline to 3.7 +/- 0.8 at 45 min (NS) and to 4.3 +/- 1.2 cm H2O/L/s at 90 min (p less than 0.05). We conclude that a decrease in pharyngeal airway size and an increase in nasal resistance may account for alcohol's ability to worsen obstructive sleep apnea.

Topics: Adult; Airway Resistance; Ethanol; Humans; Nose; Pharynx; Sleep Apnea Syndromes; Snoring

The aim of this study was to test whether rapid palatal expansion is effective to improve nasal airway patency in a sample of pediatric patients with primary snoring.. A group of 21 subjects, 11 girls (52%) and 10 boys (48%), with a mean age of 7.1 years (SD=1.3; range 4-9 years) were treated with a rapid maxillary expansion (RME) device. Nasal airway resistance was assessed via rhinomanometric exam before (pre-) and 6 months after (post-) the rapid palatal expansion treatment.. Data analysis showed a statistically significant increase in the mean scores of the results of the rhinomanometric exam between the pre- and post-measurements with a significant reduction in total inspiratory and expiratory air resistance values after rapid palatal expansion.. Our results show that RME treatment is associated with an improvement in nasal airway resistance due to a substantial reduction in nasal resistance associated with the orthopedic action of the orthodontic device.

Topics: Airway Resistance; Child; Female; Humans; Male; Nasal Cavity; Nose; Palatal Expansion Technique; Rhinomanometry; Snoring

Sleep-disordered breathing (SDB) is a common disorder in children, characterized by snoring and/or increased breathing force due to narrowing and increased upper airway collapse while sleeping. Over the last decade, it has been recognized that SDB occurs more frequently in children with craniofacial anomalies, but data in Thailand is quite limited. This study retrospective descriptive study aims to find the prevalence of SDB among children with craniofacial anomalies in Thailand and associated risk factors by collecting data among Thai children with congenital craniofacial anomalies younger than 15 years old who visited the Princess Sirindhorn Craniofacial Center at King Chulalongkorn Memorial Hospital between 2016 and 2021. All children were defined into syndromic and nonsyndromic groups. Data collected from the electronic medical record includes baseline characteristics, diagnosis of craniofacial anomalies, associated risk factors, diagnosis of SDB, diagnostic tools, and treatment. Total of 512 children, there were 80 children (15.4%) who had SDB. The most diagnosis was 51 (10%) obstructive sleep apnea followed by 27 (5.3%) primary snoring and 2 (0.4%) obstructive hypoventilation. The prevalence of SDB in the syndromic group was 43 (46.7%) while the nonsyndromic group was 37 (8.6%), ( P <0.001). The risk factors associated with SDB were overweight, allergic rhinitis, tonsillar hypertrophy, high arch palate, micrognathia, and syndromic craniofacial anomalies. The prevalence of SDB is higher in children with syndromic craniofacial anomalies than in the nonsyndromic group. Knowledge of the prevalence and related factors can lead to better care, including early screening and monitoring of SDB in craniofacial patients.

Topics: Adolescent; Child; Humans; Nose; Retrospective Studies; Sleep Apnea Syndromes; Sleep Apnea, Obstructive; Snoring

This study aimed to evaluate subjective symptom changes in obstructive sleep apnoea hypopnea syndrome patients following nasal surgery, and to explore treatment efficacy in improving patient quality of life.. Patients with nasal blockage accompanied by habitual snoring were stratified into four groups. Their subjective symptoms were evaluated before and after nasal surgery.. There was a significant decrease in the nasal blockage symptom visual analogue scale, Epworth Sleepiness Scale, Snore Outcomes Survey, Spouse/Bed Partners Survey and Sino-Nasal Outcome Test 20 scores for all patients at six months after surgery. The visual analogue scale score for subjective olfactory function was significantly improved in the severe obstructive sleep apnoea hypopnea syndrome patient group.. Nasal surgery can effectively improve the subjective symptoms of patients with simple snoring accompanied by nasal blockage and of patients with obstructive sleep apnoea hypopnea syndrome, thus improving their quality of life.

Topics: Adolescent; Adult; Female; Humans; Male; Middle Aged; Nasal Obstruction; Nose; Polysomnography; Quality of Life; Severity of Illness Index; Sleep Apnea, Obstructive; Smell; Snoring; Treatment Outcome; Visual Analog Scale; Young Adult

The objective of this study was to compare to each other the methods currently recommended by the American Academy of Sleep Medicine (AASM) to measure snoring: an acoustic sensor, a piezoelectric sensor and a nasal pressure transducer (cannula). Ten subjects reporting habitual snoring were included in the study, performed at Landspitali-University Hospital, Iceland. Snoring was assessed by listening to the air medium microphone located on a patient's chest, compared to listening to two overhead air medium microphones (stereo) and manual scoring of a piezoelectric sensor and nasal cannula vibrations. The chest audio picked up the highest number of snore events of the different snore sensors. The sensitivity and positive predictive value of scoring snore events from the different sensors was compared to the chest audio: overhead audio (0.78, 0.98), cannula (0.55, 0.67) and piezoelectric sensor (0.78, 0.92), respectively. The chest audio was capable of detecting snore events with lower volume and higher fundamental frequency than the other sensors. The 200 Hz sampling rate of the cannula and piezoelectric sensor was one of their limitations for detecting snore events. The different snore sensors do not measure snore events in the same manner. This lack of consistency will affect future research on the clinical significance of snoring. Standardization of objective snore measurements is therefore needed. Based on this paper, snore measurements should be audio-based and the use of the cannula as a snore sensor be discontinued, but the piezoelectric sensor could possibly be modified for improvement.

Topics: Adult; Aged; Aged, 80 and over; Cannula; Female; Humans; Iceland; Male; Middle Aged; Nose; Polysomnography; Sleep; Sleep Medicine Specialty; Snoring; Sound; Vibration

Obstructive sleep apnoea syndrome (OSAS) is a sleep disorder that leads to metabolic abnormalities and increased cardiovascular risk. This study aimed to define the expression and clinical significance of biomarkers involved in oxidative stress in patients with OSAS. A prospective study was designed to compare outcomes of oxidative stress laboratory tests in three groups of subjects. The study involved the recruitment of three groups of subjects, 10 patients with obstructive sleep apnoea syndrome with AHI > 30; 10 patients suffering from snoring at night with AHI < 15; 10 patients with nasal respiratory impairment with AHI < 5. Patients were subjected to skin prick tests for common aero-allergens, nasal endoscopy, active anterior rhinomanometry, fibrolaryngoscopy and polysomnography; and extra-routine diagnostic tests and procedures; analysis of oxidative and antioxidant (plasma thiol groups) biomarkers in blood and urine samples. No statistical differences in age, sex distribution or body mass index were present between the three groups (p > 0.05). There were significant differences in AHI among the three groups of patients (p < 0.05). No statistical significance was found in the Analysis of Variance (ANOVA) test (p > 0.05) between the levels of biomarkers of oxidative stress in the three populations studied. The results of our study show that the nose can play a role in the pathogenesis of OSAS through the production of biomarkers of oxidative stress.. La sindrome delle apnee ostruttive del sonno (OSAS) è una malattia che può portare ad alterazioni metaboliche e a un’aumentata incidenza di patologie cardiovascolari. Questo studio ha lo scopo di definire l’espressione e il significato clinico di biomarkers coinvolti nello stress ossidativo nei pazienti con diagnosi di OSAS. I risultati degli esami di laboratorio dello stress ossidativo sono stati confrontai prospetticamente in tre gruppi di soggetti: 10 con sindrome delle apnee ostruttiva del sonno con Apnea Hypopnea Index (AHI) > 30; 10 con roncopatia notturna e AHI < 15 e 10 con insufficienza respiratoria nasale e AHI < 5. I pazienti sono stati sottoposti a test cutanei per aero-allergeni comuni, rinoscopia anteriore, rinomanometria anteriore attiva, fibrolaringoscopia e polisonnografia. Per la ricerca dei biomarkers dello stress ossidativo sono stati effettuati test diagnostici in campioni di sangue e urine. I gruppi sono risultati omogenei per età, sesso e distribuzione del Body Mass Index (BMI) (p > 0.05). Ci sono state differenze significative nell’AHI tra i tre gruppi di pazienti (p < 0.05). Nessuna significatività statistica è stata identificata (p > 0.05) tra i livelli di biomarkers di stress ossidativo nelle tre popolazioni studiate. I risultati del nostro studio hanno mostrato che il naso può svolgere un ruolo nella patogenesi dell’ OSAS, attraverso la produzione di biomarkers di stress ossidativo.

Topics: Adult; Female; Humans; Male; Nose; Oxidative Stress; Prospective Studies; Respiration Disorders; Sleep Apnea, Obstructive; Snoring

This guideline aims to promote high-quality care by medical specialists for subjects who snore and is designed for everyone involved in the diagnosis and treatment of snoring in an in- or outpatient setting.. To date, a satisfactory definition of snoring is lacking. Snoring is caused by a vibration of soft tissue in the upper airway induced by respiration during sleep. It is triggered by relaxation of the upper airway dilator muscles that occurs during sleep. Multiple risk factors for snoring have been described and snoring is of multifactorial origin. The true incidence of snoring is not clear to date, as the incidence differs throughout literature. Snoring is more likely to appear in middle age, predominantly in males. Diagnostic measures should include a sleep medical history, preferably involving an interview with the bed partner, and may be completed with questionnaires. Clinical examination should include examination of the nose to evaluate the relevant structures for nasal breathing and may be completed with nasal endoscopy. Evaluation of the oropharynx, larynx, and hypopharynx should also be performed. Clinical assessment of the oral cavity should include the size of the tongue, the mucosa of the oral cavity, and the dental status. Furthermore, facial skeletal morphology should be evaluated. In select cases, technical diagnostic measures may be added. Further objective measures should be performed if the medical history and/or clinical examination suggest sleep-disordered breathing, if relevant comorbidities are present, and if the subject requests treatment for snoring. According to current knowledge, snoring is not associated with medical hazard, and generally, there is no medical indication for treatment. Weight reduction should be achieved in every overweight subject who snores. In snorers who snore only in the supine position, positional treatment can be considered. In suitable cases, snoring can be treated successfully with intraoral devices. Minimally invasive surgery of the soft palate can be considered as long as the individual anatomy appears suitable. Treatment selection should be based on individual anatomic findings. After a therapeutic intervention, follow-up visits should take place after an appropriate time frame to assess treatment success and to potentially indicate further intervention.

Topics: Adult; Airway Obstruction; Algorithms; Cooperative Behavior; Endoscopy; Germany; Humans; Interdisciplinary Communication; Mandibular Advancement; Nasopharynx; Nose; Occlusal Splints; Otorhinolaryngologic Surgical Procedures; Polysomnography; Sleep Apnea, Obstructive; Snoring; Sound Spectrography; Tomography, Optical Coherence

To evaluate the effects of rapid maxillary expansion (RME) on nocturnal enuresis (NE) related to the nasal airway, nasal breathing, and plasma osmolality (as an indicator for antidiuretic hormone).. Nineteen patients with monosymptomatic primary NE, aged 6-15 years, were treated with RME for 10-15 days. To exclude a placebo effect of the RME appliance, seven patients were first treated with a passive appliance. Computed tomography of nasal cavity, rhinomanometric, and plasma osmolality measurements were made 2-3 days before and 2-3 months after the RME period. RME effects on NE were followed for three more years.. Two to three months after the expansion there were significant improvements in the breathing function and a decrease in the plasma osmolality. NE decreased significantly in all patients after the RME period, and all patients showed full dryness after 3 years.. This study demonstrates that RME causes complete dryness in all patients, with significant effects on pathophysiological mechanisms related to NE.

Topics: Adolescent; Airway Resistance; Blood Glucose; Blood Urea Nitrogen; Child; Female; Follow-Up Studies; Humans; Male; Malocclusion; Mouth Breathing; Nasal Cavity; Nocturnal Enuresis; Nose; Osmolar Concentration; Palatal Expansion Technique; Pulmonary Ventilation; Respiration; Rhinomanometry; Snoring; Sodium; Tomography, X-Ray Computed; Vasopressins

The aim of the present study was to investigate if any of the three awake procedures [fiberoptic nasopharyngoscopy with modified Müller Maneuver (FNMM), nasal snoring endoscopy (NSE), or oral snoring endoscopy (OSE)] could efficiently predict the grade or pattern of upper airway (UA) collapse found with drug-induced sleep endoscopy (DISE), which is considered by many authors as the current gold standard in optimizing obstructive sleep apnea syndrome (OSAS) patient selection for UA surgery. Twenty consecutive patients (simple snorers and OSAS patients) were studied with FNMM, NSE, OSE, and DISE. The inter-test agreement was evaluated with Cohen's kappa coefficient (κ). In the current series, we found that NSE and OSE were better than FNMM in predicting the pattern of collapse found with DISE. A significant pattern agreement between NSE and DISE was present in all sub-sites, and the agreement was measured with a scale proposed by Landis and Koch as: moderate in velo- and oropharynx (κ = 0.52, p = 0.001, and κ = 0.47, p = 0.003, respectively), and substantial in hypopharynx (κ = 0.63, p < 0.00001). Comparing OSE with DISE, the pattern agreement was almost perfect at oropharyngeal level (κ = 0.82, p < 0.00001), and moderate at hypopharyngeal level (κ = 0.55, p = 0.0002); while a trend towards significance was found at velopharyngeal level (κ = 0.20, p = 0.07). FNMM showed a fair pattern agreement with DISE only at oropharyngeal level (κ = 0.31, p = 0.009); while in the other sub-sites, no significant agreement was found. NSE and OSE are new promising diagnostic tools in OSAS patients. Further investigations are needed to see if they could predict the effectiveness of UA surgery.

Topics: Anesthetics, Intravenous; Endoscopy; Female; Fiber Optic Technology; Humans; Male; Middle Aged; Nose; Patient Selection; Pharynx; Propofol; Reproducibility of Results; Severity of Illness Index; Sleep Apnea, Obstructive; Snoring

To evaluate the lateral view photography of the face as a tool for assessing morphological properties (i.e. facial convexity) as a risk factor for sleep disordered breathing (SDB) in children and to test how reliably oral health and non-oral healthcare professionals can visually discern the lateral profile of the face from the photographs.. The present study sample consisted of 382 children 6-8 years of age who were participants in the Physical Activity and Nutrition in Children (PANIC) Study. Sleep was assessed by a sleep questionnaire administered by the parents. SDB was defined as apnoeas, frequent or loud snoring or nocturnal mouth breathing observed by the parents. The facial convexity was assessed with three different methods. First, it was clinically evaluated by the reference orthodontist (T.I.). Second, lateral view photographs were taken to visually sub-divide the facial profile into convex, normal or concave. The photos were examined by a reference orthodontist and seven different healthcare professionals who work with children and also by a dental student. The inter- and intra-examiner consistencies were calculated by Kappa statistics. Three soft tissue landmarks of the facial profile, soft tissue Glabella (G`), Subnasale (Sn) and soft tissue Pogonion (Pg`) were digitally identified to analyze convexity of the face and the intra-examiner reproducibility of the reference orthodontist was determined by calculating intra-class correlation coefficients (ICCs). The third way to express the convexity of the face was to calculate the angle of facial convexity (G`-Sn-Pg`) and to group it into quintiles. For analysis the lowest quintile (≤164.2°) was set to represent the most convex facial profile.. The prevalence of the SDB in children with the most convex profiles expressed with the lowest quintile of the angle G`-Sn-Pg` (≤164.2°) was almost 2-fold (14.5%) compared to those with normal profile (8.1%) (p = 0.084). The inter-examiner Kappa values between the reference orthodontist and the other examiners for visually assessing the facial profile with the photographs ranged from poor-to-moderate (0.000-0.579). The best Kappa values were achieved between the two orthodontists (0.579). The intra-examiner Kappa value of the reference orthodontist for assessing the profiles was 0.920, with the agreement of 93.3%. In the ICC and its 95% CI between the two digital measurements, the angles of convexity of the facial profile (G`-Sn-Pg`) of the reference orthodontist were 0.980 and 0.951-0.992.. In addition to orthodontists, it would be advantageous if also other healthcare professionals could play a key role in identifying certain risk features for SDB. However, the present results indicate that, in order to recognize the morphological risk for SDB, one would need to be trained for the purpose and, as well, needs sufficient knowledge of the growth and development of the face.

Topics: Anatomic Landmarks; Cephalometry; Child; Chin; Face; Feasibility Studies; Female; Forehead; Humans; Male; Mouth Breathing; Nose; Observer Variation; Photography; Reproducibility of Results; Risk Factors; Sleep Apnea Syndromes; Snoring

This study presents a rule-based method for automated, real-time snoring detection using nasal pressure recordings during overnight sleep. Although nasal pressure recordings provide information regarding nocturnal breathing abnormalities in a polysomnography (PSG) study or continuous positive airway pressure (CPAP) system, an objective assessment of snoring detection using these nasal pressure recordings has not yet been reported in the literature. Nasal pressure recordings were obtained from 55 patients with obstructive sleep apnea. The PSG data were also recorded simultaneously to evaluate the proposed method. This rule-based method for automatic, real-time snoring detection employed preprocessing, short-time energy and the central difference method. Using this methodology, a sensitivity of 85.4% and a positive predictive value of 92.0% were achieved in all patients. Therefore, we concluded that the proposed method is a simple, portable and cost-effective tool for real-time snoring detection in PSG and CPAP systems that does not require acoustic analysis using a microphone.

Topics: Aged; Algorithms; Female; Humans; Male; Middle Aged; Nose; Polysomnography; Pressure; Sensitivity and Specificity; Signal Processing, Computer-Assisted; Snoring

To investigate the source of snoring sound in patients with simple snoring (SS) and different degrees of obstructive sleep apnea syndrome (OSAS) in order to provide a basis for the surgical treatment of snoring.. Fifty-two patients with either SS or OSAS (with an apnea-hypopnea index ≤40) underwent drug-induced sleep nasendoscopy (DISN). Vibration sites in the pharyngeal cavity were observed.. Vibration of the soft palate, pharyngeal lateral wall, epiglottis, and tongue base appeared in 100, 53.8, 42.3, and 26.9% of the patients, respectively. The source of snoring sound was divided into two types: palatal fluttering only (type I) and multisite vibration (type II). The latter was divided into 3 subtypes: palatal fluttering with epiglottis vibration (type IIa), palatal fluttering with lateral wall vibration (type IIb), and palatal fluttering with vibration of the lateral wall, epiglottis, and tongue base together (type IIc). The distribution of type I snoring was the highest in SS patients. Type IIb was more common in patients with medium and severe OSAS. Type IIc was most common in patients with severe OSAS.. The source of snoring sound is diverse, with SS and OSAS patients showing different features. DISN is a very effective method of identifying the snoring source.

Topics: Adult; Endoscopy; Female; Follow-Up Studies; Humans; Male; Middle Aged; Nose; Palate; Polysomnography; Retrospective Studies; Sleep; Snoring; Tongue; Young Adult

Topics: Endoscopy; Female; Humans; Male; Middle Aged; Nose; Pilot Projects; Sleep Apnea, Obstructive; Snoring; Treatment Outcome

Obstructive sleep disordered breathing can cause death and significant morbidity in adults and children. We previously found that children with smaller upper airways (measured by magnetic resonance imaging while awake) generated loud high frequency inspiratory sounds (HFIS, defined as inspiratory sounds > 2 kHz) while they slept. The purpose of this study was (1) to determine what characteristics of airflow predicted HFIS intensity, and (b) to determine if we could calculate changes in hydraulic diameter (D) in both an in vitro model and in the upper airways of sleeping humans. In an in vitro model, high frequency sound intensity was an estimate of airflow turbulence as reflected by the Reynold's number (Re). D of the in vitro model was calculated using Re, the pressure gradient, Swamee-Jain formula and Darcy formula. D was proportional to but smaller than the actual diameters (r(2) = 0.94). In humans, we measured HFIS intensity and the pressure gradient across the upper airway (estimated with oesophageal pressure, Pes) during polysomnography in four adult volunteers and applied the same formulae to calculate D. At apnoea termination when the airway opens, we observed (1) an increase in HFIS intensity suggesting an increase in turbulence (higher Re), and (2) a larger calculated D. This method allows dynamic estimation of changes in relative upper airway hydraulic diameter (D) in sleeping humans with narrowed upper airways.

Topics: Adult; Humans; Inhalation; Larynx; Models, Biological; Nose; Sleep Apnea, Obstructive; Snoring

Simple snoring represents a social problem, not only because it could affect the patient's married life, but it often goes along with sleep-disordered breathing. Chronic nasal obstruction has many sequel including snoring and the inferior turbinate hypertrophy (ITH) is its most common cause. The aim of the study is to evaluate the efficacy of video-assisted endoscopic radiofrequency volumetric tissue reduction (RFVTR) to reduce snoring in patients affected by chronic nasal obstruction due to ITH.. This prospective study was conducted over 48 habitual snoring with persistent nasal obstruction due to bilateral ITH refractory to medical management received one time RFVTR of both it. Nasal symptoms were assessed both subjectively, by Visual Analog Scale (VAS) and NOSE Scale, and objectively by videorhinohygrometer. Snoring was measured by Snoring severity rated by the bed partner, in a longitudinal fashion, using VAS. All patients were evaluated pre-operatively, and after 45th day (range 35-50 days) post-operatively.. Thirty-two subjects completed study. All patients had significant symptomatic improvement in nasal breathing (5.53 ± 2.88 vs 1.87 ± 1.75; p < 0.05), confirmed by videorhinohygrometer values (p < 0.05). We had a significantly improvement of snoring in all patients (5.62 ± 2.80 vs 1.86 ± 1.43, p < 0.001) with a mean snoring Visual Analog Scale improvement of 77.4%.. Based on this study and literature review, it seems that RFVTR represents a safe, minimal invasive, easy performed, and time and cost effective surgery, which may decrease symptoms of snoring in patients with ITH, at least, in short-term follow-up.

Topics: Adult; Endoscopy; Female; Humans; Hypertrophy; Male; Middle Aged; Nasal Obstruction; Nose; Prospective Studies; Snoring; Turbinates; Young Adult

Sleep disordered breathing (SDB) might affect craniofacial growth and children with obstructive sleep apnea syndrome present an increase in total and lower anterior heights of the face and a more anterior and inferior position of the hyoid bone when compared to nasal breathers.. To investigate the correlation between rhinomanometric and cephalometric parameters in children with primary snoring (PS), without apnea or gas exchange abnormalities.. Thirty children with habitual snoring (16 females and 14 males) aged 4-8 years (mean age 6.85±1.51 years) were selected by a SDB validate questionnaire. All subjects underwent lateral cephalometric, panoramic radiographies.. In our sample 10 children (33%) had snoring 3 nights/week, 11 (37%) 4-6 nights/week and 9 (30%) every night/week. Overall 7 patients (23.3%) were affected by adenoid hypertrophy (AH), 4 (13.3%) by tonsillar hypertrophy (TH) and 13 (43.3%) by AH and TH. We found a more vertical position of the hyoid bone to the mandibular plane (H⊥VT) in patients with a higher frequency (7.3±2.7 vs 7.6±3.7 vs 10.9±2.5 in children snoring 3 nights/week, 4-6 nights/week and every night/week respectively; p = 0.032). Concerning nasal patency significant correlations were found with ANB (maxillary and jaw position with respect to the cranial base), NS∧Ar (growth predictor), sumangle, FMA (total divergence), SnaSnp∧GoMe (inferior divergence), BaN∧PtGn (facial growth pattern), Phw1_PsP (posterosuperior airway space), AHC3H (the horizontal distance between the most anterosuperior point of the hyoid bone and the third cervical vertebra).. The present study supports the relationship between nasal obstruction and specific craniofacial characteristics in children with primary snoring and lead us to hypothesize that nasal obstruction might explain the indirect link between snoring and cephalometric alterations.

Topics: Cephalometry; Child; Child, Preschool; Female; Humans; Male; Nose; Snoring

This study presents a method for automatic snoring detection from a nasal pressure data. First, a spectrogram analysis was performed in order to obtain information about the spectral characteristic of nasal pressure data. The automatic method is based on a simple signal filtering and short-time energy technique. Fifteen patients were participated in order to evaluation the performance of the proposed method. Results are compared with manually labeled snoring events by watching video records. The sensitivity and positive predictivity value were 93.73% and 93.70%, respectively. The results in this study could provide sleep experts with the method to objectively monitor sleep-disordered breathing in CPAP system or PSG study.

Topics: Adult; Female; Humans; Male; Middle Aged; Nose; Polysomnography; Predictive Value of Tests; Pressure; Signal Processing, Computer-Assisted; Snoring; Spectrum Analysis; Young Adult

To study the effect of OSAHS on adult nasal-cycle.. The nasal cycle of 20 healthy adults, 18 patients of snoring and 22 patients of OSAHS were examined with acoustic rhinometry, which was performed every 30 minutes in 7 hours.. The ratio of nasal cycle in healthy adults was (19/20, 95.0%), in snoring patients was (15/18, 83.0%), in patients of OSAHS was (15/22, 68.2%). The mean alteration amplitude of nasal cycle in healthy adults was significantly larger than that in patients with OSAHS (P < 0.05). The distribution of the healthy adults and patients with OSAHS between the typical cycle categories was significantly different (P < 0.05).. The characteristics of nasal-cycle in of OSAHS patients were different with healthy adults, which maybe owing to change of physical function of basal cavity.

Topics: Adult; Aged; Case-Control Studies; Female; Humans; Male; Middle Aged; Nasal Cavity; Nose; Rhinometry, Acoustic; Sleep Apnea, Obstructive; Snoring

Obstructive sleep apnea syndrome (OSAS) is characterized by repetitive episodes of partial or complete obstruction of the upper airway during sleep and is associated with increasing respiratory efforts, with a consequent oxyhemoglobin desaturation, sleep fragmentation, and daytime symptoms, most commonly excessive sleepiness. The effectiveness of continuous positive airway pressure (CPAP) is undoubtedly high in treating those patients who use it regularly, but for those who refuse it, the success rate is 0. It is for this subset of patients that surgical therapy can be useful. The purpose of this study was to evaluate the effects of nasal surgery on nasal resistance, sleep apnea, sleep quality, and nasal volumetric measurement in adult male patients with OSAS.. Twenty male patients with complaints of hypersomnia and snoring were included in the study. Polysomnography of patients with the prediagnosis of OSAS was planned. All patients underwent CPAP treatment before and after surgery. Patients, who had anatomic structural defects causing nasal valve shrinkage, were operated on at the Plastic Reconstructive and Aesthetic Department. Volumetric measurements of the nose were obtained before and after the operation.. In our study, it was observed that respiratory tract space of patients increased subsequent to the surgery, and thereby OSAS level decreased, and tolerating CPAP device was easier. Measurements of internal nasal valve vertex and fields and external nasal valve fields before and after operation were significant.. Surgical relief of this nasal obstruction may improve quality of life in patients with OSAS.

Topics: Adult; Airway Resistance; Anatomy, Cross-Sectional; Cephalometry; Continuous Positive Airway Pressure; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Nasal Obstruction; Nose; Oxygen; Polysomnography; Pulmonary Ventilation; Quality of Life; Sleep; Sleep Apnea Syndromes; Sleep Apnea, Obstructive; Sleep Stages; Snoring; Time Factors; Treatment Outcome

Our objective was to investigate the occurrence of sleep-related breathing disturbances in a large cohort of school-aged children in Southern Italy, and to evaluate the association with anthropometric data and clinical findings of oropharynx and nasal airways.. A two-phase cross-sectional study was conducted with children from schools in Turi, Italy.. A screening phase aimed to identify symptomatic children and clinical data from a cohort of 495 children by a self-administered questionnaire, and an instrumental phase for the definition of sleep-related disorders and clinical analysis of oral status were performed. According to the answers, children were classified into 3 groups: habitual snorers, occasional snorers, and non-snorers. All habitual snoring children underwent a polysomnographic home evaluation, and those with oxygen desaturation index (ODI) > 2 were considered for nocturnal polygraphic monitoring (NPM). Children with apnoea/ hypopnea index (AHI) > 3 received a diagnosis of obstructive sleep apnoea syndrome (OSAS). Moreover, a complete oral examination was performed.. A total of 436 questionnaires (response rate: 88.08%) were returned and scored (202 M, 234 F; Mean age ± Standard deviation: 6.2 ± 1.8); 18 children (4%) were identified as habitual snorers, 140 children (32%) were identified as occasional snorers, and 278 children (64%) were identified as non-snorers. The percentage of female children who were habitual snorers was higher than the percentage of male children (4.7% vs 3.6%). Habitual snorers had significantly more nighttime symptoms. OSAS was diagnosed in 2 children by NPM. A statistically significant association between snoring, cross-bite, open-bite and increased over-jet was found.. Habitual snoring and OSAS are significant problems for children and may be associated with diurnal symptoms. The presence of malocclusion increases the likelihood of sleep-related breathing disturbances.

Topics: Airway Obstruction; Bronchitis; Child; Child, Preschool; Female; Humans; Italy; Male; Nose; Open Bite; Oropharynx; Otitis; Overbite; Prevalence; Sinusitis; Sleep Apnea, Obstructive; Snoring; Surveys and Questionnaires; Tonsillitis

To investigate the relationship between nasal cavity dimensions and airflow based on measures of acoustic rhinometry (AR) and peak nasal inspiratory flow (PNIF) in a very large sample of mixed rhinologic and nonrhinologic patients.. Clinical survey conducted between 2001 and 2007.. Secondary referral ambulatory center and hospital.. The study population comprised 2523 consecutive adult patients, mainly white, referred to the Department of Otolaryngology-Head and Neck Surgery, Sørlandet Hospital, Kristiansand, Norway, for evaluation of sleep-related disorders (eg, snoring, sleep apnea) or chronic nasal complaints.. The subjects underwent AR and PNIF at baseline and after decongestion of the nasal mucosa with xylometazoline hydrochloride. Questionnaires and height and weight measurements were obtained prior to the nasal recordings.. Associations between measures of AR (volume and area) and PNIF.. Nearly linear relationships were found between PNIF in 4 categories and nasal cavity volumes and minimal cross-sectional areas (analysis of variance, P < .001; post hoc analysis, P < .01). Adjusted associations between 5 of 6 AR measures and PNIF both at baseline and after decongestion were significant (P < .001 in 9 cases and P = .03 in 1 case).. Our study indicates statistically significant associations between nasal cavity dimensions and PNIF. The most important structural determinant for PNIF is the minimal cross-sectional area of the nasal cavity.

Topics: Adrenergic alpha-Agonists; Adult; Airway Resistance; Comorbidity; Female; Humans; Imidazoles; Male; Nasal Cavity; Nasal Mucosa; Nose; Rhinometry, Acoustic; Sleep Apnea Syndromes; Smoking; Snoring

To investigate the long-term effects of pharyngeal flap surgery (PFS) on nasal and nasopharyngeal dimensions of patients with velopharyngeal insufficiency (VPI) and to correlate the findings with the onset of respiratory complaints after surgery.. Prospective study in 58 nonsyndromic patients with repaired cleft palate and VPI, evaluated 2 days before and 5 months (POST1) and 1 year (POST2) after PFS, on average. Patients were divided into two groups: one consisting of patients with postoperative respiratory complaints (RC group) and the other without complaints (NRC group).. Superiorly based PFS.. Respiratory complaints (self reports of mouth breathing, snoring, and other sleep obstructive events) assessed at POST1 and POST2, and minimum nasal (NCSA) and nasopharyngeal (NPA) cross-sectional areas assessed by rhinomanometry at POST2.. Respiratory complaints were reported by 55% and 36% of the patients evaluated at POST1 and POST2, respectively. Posterior rhinomanometry showed a significant postoperative reduction of mean NCSA in the RC and NRC groups (p < .05), to subnormal levels in some of them. The decrease was more pronounced in the RC group. No significant changes in NCSA were observed by anterior rhinomanometry. Similar results were obtained when NPA was assessed by modified anterior rhinomanometry.. In the long-term, PFS yielded a significant reduction in upper airways dimensions beyond what should be expected and associated with persistent respiratory complaints in some cases.

Topics: Adolescent; Adult; Child; Cleft Palate; Female; Humans; Male; Middle Aged; Mouth Breathing; Nasal Obstruction; Nasopharynx; Nose; Oral Surgical Procedures; Plastic Surgery Procedures; Prospective Studies; Rhinomanometry; Snoring; Surgical Flaps; Velopharyngeal Insufficiency

The aim of the study was to identify craniofacial and pharyngeal anatomical factors directly related to obstructive sleep apnoea (OSA). The design and setting was a hospital-based, case-controlled study. Ninety-nine subjects (78 males and 21 females) with a confirmed diagnosis of OSA, who were referred to the Dental Hospital for construction of a mandibular advancement splint were recruited. A similar number of control subjects, matched for age and sex, were recruited after completing snoring and Epworth Sleepiness Scale questionnaires to exclude habitual snoring and daytime sleepiness. An upright cephalogram was obtained and skeletal and soft tissue landmarks were traced and digitized. In OSA subjects the anteroposterior skeletal measurements, including maxillary and mandibular length were reduced (P < 0.001). The intermaxillary space was found to be 3.1 mm shorter in OSA subjects (P = 0.001). The nasopharyngeal airway in OSA subjects was narrower (P < 0.001) but pharyngeal length showed no difference. The tongue size was increased (P = 0.021), soft plate length, thickness and area were all greater (P < 0.001) and the hyoid bone was more inferiorly positioned in OSA subjects (P < 0.001). This study identifies a significant number of craniofacial and pharyngeal anatomical factors directly related to OSA.

Topics: Adult; Case-Control Studies; Cephalometry; Female; Humans; Hyoid Bone; Male; Middle Aged; Nose; Oropharynx; Palate, Soft; Pharynx; Skull Base; Sleep Apnea, Obstructive; Snoring; Tongue

Topics: Acoustics; Anesthesia; Diagnosis, Differential; Endoscopy; Humans; Loudness Perception; Nose; Sleep; Snoring

To validate the technique of sleep nasendoscopy using target controlled infusion in symptomatic patients and a control group of asymptomatic individuals.. Prospective cohort study.. Department of otolaryngology-head and neck surgery and anesthesia in a teaching hospital.. Two groups of patients were compared and matched for their body mass index. The first group consisted of 53 patients with a history suggestive of obstructive sleep apnea. The second group consisted of 54 patients with partner-confirmed history of no snoring. These patients were undergoing anesthesia for other reasons. Both groups of patients were free of associated otorhinolaryngologic symptoms.. Assessment of production of snoring or obstruction in patients with no documented history of snoring when sedation was administered as part of general anesthesia using target controlled infusion with propofol.. None of the patients in the asymptomatic group snored or obstructed at any level of propofol, and this was clearly significant on comparison with the symptomatic group (P < .001). All of the symptomatic patients were induced to become symptomatic (snoring/obstruction).

Topics: Body Mass Index; Case-Control Studies; Endoscopy; Female; Humans; Hypnotics and Sedatives; Male; Middle Aged; Nose; Propofol; Prospective Studies; Reproducibility of Results; Sleep; Sleep Apnea Syndromes; Sleep Apnea, Obstructive; Snoring

This prospective, cohort study evaluated the role of sleep nasendoscopy (SNE) with simultaneous mandibular protrusion in predicting successful mandibular advancement splint (MAS) therapy in subjects with obstructive sleep apnoea (OSA). Nineteen OSA subjects diagnosed by overnight polysomnography were referred for MAS therapy, following SNE investigation. A Herbst MAS was fabricated for each subject. Once this had been adjusted for maximal, subjective, therapeutic effect, follow-up sleep studies were undertaken with the appliance in situ. The SNE was repeated with the appliance in place to allow the effects of the original mandibular protrusion and the actual effect of the MAS to be compared. The MAS was removed and the original and current site(s) of obstruction evaluated. Pre-treatment SNE showed airway obstruction at the following levels: intermittent multi-level (16 subjects), sustained multi-level (two subjects) and tongue base (one subject). In all individuals, gentle advancement of the mandible during SNE improved airway patency and reduced snoring. When the SNE was repeated with the MAS in situ, all subjects showed improvements in snoring and airway patency. Follow-up sleep studies confirmed the efficacy of the MAS, with all patients showing a reduction in the apnoea/hypopnoea index (AHI). Median reductions in AHI (from 28.1 to 6.1, P < 0.001) and Epworth Sleepiness Scale (ESS) scores (from 9 to 6, P < 0.001) were highly statistically significant. The results suggest that SNE with concomitant mandibular advancement to mimic MAS wear, could be a valuable prognostic indicator of successful MAS treatment.

Topics: Adult; Aged; Airway Obstruction; Cohort Studies; Endoscopy; Female; Follow-Up Studies; Forecasting; Humans; Male; Mandibular Advancement; Middle Aged; Nose; Occlusal Splints; Orthodontic Appliances, Functional; Polysomnography; Prospective Studies; Pulmonary Ventilation; Sleep; Sleep Apnea, Obstructive; Sleep Stages; Snoring; Treatment Outcome

Breathing route during sleep has been studied very little, however, it has potential importance in the pathophysiology of sleep disordered breathing. Using overnight polysomnography, with separate nasal and oral thermocouple probes, data were obtained from 41 subjects (snorers and nonsnorers; 25 male and 16 female; aged 20-66 yrs). Awake, upright, inspiratory nasal resistance (Rn) was measured using posterior rhinomanometry. Each 30-s sleep epoch (not affected by apnoeas/hypopnoeas) was scored for presence of nasal and/or oral breathing. Overnight, seven subjects breathed nasally, one subject oro-nasally and the remainder switched between nasal and oro-nasal breathing. Oral-only breathing rarely occurred. Nasal breathing epochs were 55.79 (69.78) per cent of total sleep epochs (%TSE; median (interquartile range)), a value not significantly different to that for oro-nasal (TSE: 44.21 (68.66)%). Oro-nasal breathing was not related to snoring, sleep stage, posture, body mass index, height, weight, Rn (2.19 (1.77) cm H2O x L(-1) x sec(-1)) or sex, but was positively associated with age. Subjects > or = 40 yrs were approximately six times more likely than younger subjects to spend >50% of sleep epochs utilising oro-nasal breathing. Ageing is associated with an increasing occurrence of oro-nasal breathing during sleep.

Topics: Adult; Age Factors; Aged; Airway Resistance; Analysis of Variance; Body Composition; Body Mass Index; Case-Control Studies; Female; Humans; Incidence; Logistic Models; Male; Middle Aged; Mouth; Multivariate Analysis; Nose; Physiological Phenomena; Polysomnography; Reference Values; Respiration; Risk Assessment; Sensitivity and Specificity; Severity of Illness Index; Sleep; Snoring

Snoring is related to narrowing of the upper airway. Treatment options for snoring may have potential side effects or discomfort which may not be tolerated by some patients. Mandibular advancement devices may cause fewer negative side effects than other treatment modalities and have been advocated as a treatment for snoring.. The aim of the pilot study was to evaluate effects of the anterior mandibular positioner (AMP) on upper airway structures in patients with a snoring problem.. Fifteen subjects with snoring problems as identified by spouses or close relatives were selected to complete a questionnaire related to snoring, respiratory symptoms, body mass index (BMI), and smoking habits. Computerized tomography (CT) scans were obtained with and without AMP device fabricated as a monoblock of acrylic resin. Measurements of the oropharynx including length (mm), cross-sectional area (mm2), and plane angle (degrees) were made using anatomic landmarks on standardized CT images and lateral scanograms. The data were statistically evaluated using Wilcoxon signed rank test (alpha=.05).. When the AMP was inserted, the cross-sectional area of the oropharynx increased by 60 mm2 on average (P<.05). A mean increase of 2.4 mm (range 1-7 mm) was observed in the posterior airway space on lateral scanograms (P<.005). The range for mandibular advancement was between 4 and 8 mm (mean 5.73 mm).. The primary effect of the AMP was enlargement of the oropharyngeal airway. Within the limitations of this pilot study, the results suggest that CT evaluation of the upper airway structures may be helpful in determining treatment modality and monitoring the effectiveness of the positioner.

Topics: Adult; Anatomy, Cross-Sectional; Body Mass Index; Cephalometry; Humans; Hyoid Bone; Mandible; Mandibular Advancement; Maxilla; Middle Aged; Nose; Oropharynx; Pharynx; Pilot Projects; Sella Turcica; Smoking; Snoring; Statistics, Nonparametric; Tomography, X-Ray Computed; Uvula

Recent laser and radiofrequency techniques for the treatment of snoring have provided improvements, but intraoperative and postoperative risks, complications, and long-term results have not been explored in a statistically large enough sample of patients. The goal of this article is to provide practitioners with important data and guidelines to help them in decision-making and prepare them to anticipate problems and recommend a systematic approach to avoid or treat complications.. This investigation was a retrospective review of 5,600 cases, performed over a 10-year period by a single investigator, in a private practice setting. The data on complications were gathered from chart review as well as questionnaires filled out on each patient and by patient reports. The inclusion criteria for this review were: 1) patients with a history of chronic snoring or nasal congestion; 2) patients with an American Society of Anesthesiologists physical status classification (ASA) Classes I or II medical history; 3) patients provide a detailed preoperative snoring questionnaires; 4) patients provide informed consent; 5) patients were followed for a minimum of 2 years following surgery; 6) patients completed a comprehensive postoperative survey; 7) operative report stating the exact nature of any complications; 8) surgeons provided a clinical assessment; 9) sleep apnea reports if available; and 10) patient body mass index of less than 30 kg/m2.. Laser-assisted uvulopalatopharyngoplasty (LA-UPPP) was used for the treatment of snoring and mild obstructive sleep apnea in all cases; 40% of patients also had simultaneous nasal radioablation. No fatalities were recorded and fewer than 3% of patients had long-term complications. The most common intraoperative complication was bleeding, which occurred in 9.5% of patients.. Reducing the amount of tissue resected from the soft palate helped reduce or eliminate the common complications of traditional uvulopalatopharyngoplasty procedures. LA-UPPP and radioablation procedures are effective, safe, and can be carried out in an office setting equipped with anesthesia monitors and services. The complications associated with the procedure were rare and usually manageable.

Topics: Adult; Aged; Blood Loss, Surgical; Catheter Ablation; Chronic Disease; Female; Follow-Up Studies; Hiccup; Humans; Laser Therapy; Male; Middle Aged; Nose; Nose Diseases; Palate, Soft; Pharynx; Postoperative Complications; Retrospective Studies; Rhinitis; Safety; Sleep Apnea, Obstructive; Snoring; Treatment Outcome; Uvula

In this communication, we report the current status of OSAS (Obstructive Sleep Apnea Syndrome) in the southern region of Higashikatsushika around Ichikawa City, our effort to improve patient QOL as well as to establish diagnostic and therapeutic methods, and the results of a comparison of therapeutic options with the focus on improvement of compliance by using nCPAP (nasal continuous positive airway pressure). We examined 112 patients who visited the Otolaryngology Department at Tokyo Dental College, Ichikawa General Hospital, with the chief complaint of nocturnal snoring or sleep apnea from January 2001 to April 2003 and underwent all-night PSG (polysomnography). Based upon the results of these all-night PSGs, 89 and 23 patients were diagnosed as having OSAS and simple snoring, respectively. Using the AHI classification of severity, 58 and 31 patients were assessed as having severe OSAS and mild OSAS, respectively. (1) nCPAP was tried in 61 patients, and 39 patients (63%) were able to continue it. After the introduction of nCPAP, surgery was performed in 18 patients (30%). As a result, weaning from nCPAP was successfully achieved in 10 cases, compliance with nCPAP was improved in six cases, alleviation of symptoms (decreased pressure) was seen in one case, and aggravation was noted in one case. In addition, four patients (7%) unilaterally discontinued nCPAP. (2) Surgery was performed in 34 patients, and 18 of them had surgery after nCPAP was tried. (3) We asked the dental department to make OAs (oral appliances) for 31 patients but seven of them did not attend the department, so a total of 24 patients used OAs. Fourteen patients (58%) were able to tolerate an OA for 3 months or more. Based on these results, we are hoping to achieve a better control of OSAS by combining nCPAP and other modalities.

Topics: Adolescent; Adult; Aged; Child; Child, Preschool; Combined Modality Therapy; Continuous Positive Airway Pressure; Endoscopy; Female; Humans; Male; Middle Aged; Nose; Orthodontic Appliances; Patient Compliance; Polysomnography; Quality of Life; Sleep Apnea, Obstructive; Snoring; Tokyo; Treatment Outcome; Ventilator Weaning

One hundred and twenty-three patients with snoring problems and/or obstructive Sleep Apnea Syndrome (OSAS) were offered Rhinosleep Flextube-reflectometry during sleep registration to assess the upper airway. The main point of interest was patient acceptance of the procedure. 36 patients with OSAS received Rhino Flextube reflectometry. Of these, 19 (53%) completed a whole night registration with the Rhinosleep tube and 17 (47%) did not. This low success rate is multifactorial and will be discussed in detail in the text. The development of Rhinosleep is a challenge, as it improves the topical diagnostic work-up of OSAS patients. At present however various practical problems have to be solved to make it a viable alternative to sleep endoscopy.

Topics: Endoscopy; Feasibility Studies; Humans; Intubation; Nose; Polysomnography; Rhinometry, Acoustic; Sleep Apnea, Obstructive; Snoring

The goal was to compare the effect of an improved nasal airway on obstructive sleep apnea (OSA) by use of subjective and objective measures.. A prospective study of 50 consecutive patients with nasal airway obstruction and OSA was carried out.. Subjectively, nasal breathing improved in 49 (98%) patients, whereas snoring decreased or disappeared in 17 (34%); the remaining 33 (66%) patients did not notice any significant change in their snoring. Daytime energy levels increased in 39 (78%) patients and remained unchanged or worsened in 11 (22%). In review of the polysomnographic data, the group overall did not have significant changes in respiratory disturbance index (RDI) or lowest oxygen saturation levels (LSaO(2)). Continuous positive airway pressure (CPAP) levels required to correct OSA decreased after nasal surgery (P < 0.01). Patients with mild OSA showed significant worsening in RDI (P < 0.05), whereas LSaO(2) levels were improved in the group with moderate OSA (P < 0.05). In patients with severe OSA neither the RDI levels nor the LSaO(2) changed, but CPAP levels required to alleviate the obstruction after surgery were reduced (P < 0.01).. Most patients report improvement in nasal and sleep symptoms after correction of nasal airway obstruction. However, nasal surgery alone does not consistently improve OSA when measured objectively. Depending on the severity of OSA, nasal airway reconstruction may contribute to a decrease in CPAP level and improvement in oxygen saturation. Correction of the obstructed nasal airway should certainly be included in the overall treatment plan for OSA.

Topics: Adult; Aged; Female; Humans; Male; Middle Aged; Nasal Obstruction; Nose; Polysomnography; Positive-Pressure Respiration; Prospective Studies; Respiration; Sleep Apnea, Obstructive; Snoring

To determine the diagnostic utility of a nasal cannula/pressure transducer (NC), in comparison to thermistor (TH), during routine, clinical nocturnal polysomnography (NPSG).. We analyzed the respiratory arousal index (RAI) using TH (RAI-TH) or NC (RAI-NC) in patients with suspected sleep-disordered breathing (SDB).. Sleep disorders center of a university-affiliated teaching hospital.. Fifty consecutive, nonselected patients referred for evaluation of suspected SDB.. Twenty patients were found to have obstructive sleep apnea/hypopnea syndrome (OSA), 25 had upper airway resistance syndrome (UARS), and 5 had primary snoring (PS). Mean RAI-NC was greater than the mean RAI-TH by 25%, 302%, and 500% in OSA, UARS, and PS, respectively. RAI-NC was >/= 14 (mean, 25.2) in UARS and < 14 (mean, 9) in PS. Mean RAI-TH was 8.4 in UARS and 1.8 in PS, with significant overlap between the two groups.. NC is more sensitive than TH in detecting respiratory events during NPSG and may represent a simple, objective means to identify UARS among patients with a range of SDB.

Topics: Adult; Aged; Aged, 80 and over; Airway Obstruction; Airway Resistance; Catheterization; Circadian Rhythm; Female; Humans; Male; Middle Aged; Nose; Polysomnography; Retrospective Studies; Sensitivity and Specificity; Sleep Apnea Syndromes; Snoring; Syndrome; Transducers, Pressure

The increase in systemic blood pressure after an obstructive apnea is due, in part, to sympathetically mediated vasoconstriction. We questioned whether upper airway (UA) receptors could contribute reflexly to this vasoconstriction. Four unanesthetized dogs were studied during wakefulness and non-rapid-eye-movement (NREM) sleep. The dogs breathed via a fenestrated tracheostomy tube sealed around the tracheal stoma. The snout was sealed with an airtight mask, thereby isolating the UA when the fenestration was closed and exposing the UA to negative inspiratory intrathoracic pressure when it was open. The blood pressure response to three UA perturbations was studied: 1) square-wave negative pressures sufficient to cause UA collapse with the fenestration closed during a mechanical hyperventilation-induced central apnea; 2) tracheal occlusion with the fenestration open vs. closed; and 3) high-frequency pressure oscillations (HFPO) with the fenestration closed. During NREM sleep, 1) blood pressure response to tracheal occlusion was similar with the fenestration open or closed; 2) collapsing the UA with negative pressures failed to alter blood pressure during a central apnea; and 3) application of HFPO to the UA during eupnea and resistive-loaded breaths increased heart rate and blood pressure. However, these changes were likely to be secondary to the effects of HFPO-induced reflex changes on prolonging expiratory time. These findings suggest that activation of UA pressure-sensitive receptors does not contribute directly to the pressor response associated with sleep-disordered breathing events.

Topics: Airway Obstruction; Airway Resistance; Animals; Blood Pressure; Disease Models, Animal; Dogs; Electromyography; Female; Heart Rate; Hemodynamics; Larynx; Nose; Polysomnography; Pressure; Sleep; Sleep Stages; Snoring; Trachea

Topics: Dilatation; Humans; Male; Nose; Patient Compliance; Snoring

This prospective study analysed the upright lateral cephalometric radiographs of 115 dentate, Caucasian males. Forty-five subjects exhibited proven obstructive sleep apnoea (OSA), 46 were simple snorers, and the remaining 24 subjects, who had no history of respiratory disease and did not snore, acted as controls. Radiographs were traced and digitized, and comparisons were made of the dento-skeletal, soft tissue, and oropharyngeal features of the three groups. Differences were also sought between the snoring and OSA subjects. Of the hard tissue measurements, only the cranial base angle and mandibular body length showed significant inter-group differences (P < 0.001 and P < 0.05, respectively). When the airway and associated structures were examined, both snorers and OSA subjects exhibited narrower airways, reduced oropharyngeal areas, shorter and thicker soft palates, and larger tongues than their control counterparts. Comparison of the two sleep disordered breathing groups showed no differences in any of the skeletal or dental variables examined. However in OSA subjects, the soft palate was larger and thicker (P < 0.05), both lingual and oropharyngeal areas were increased (P < 0.01 and P < 0.05, respectively) and the hyoid was further from the mandibular plane (P < 0.05). Thus, whilst the dento-skeletal patterns of snorers resembled those of subjects with OSA, some differences in soft tissue and hyoid orientation were apparent. There was not, however, a recognizable gradation in size of the airway and its associated structures from control through snoring to OSA subjects. This suggests that there may be a cephalometrically recognizable predisposition towards the development of sleep disordered breathing, but that this is only one facet of the condition.

Topics: Adult; Aged; Body Mass Index; Case-Control Studies; Cephalometry; Discriminant Analysis; Humans; Hyoid Bone; Male; Middle Aged; Nasal Obstruction; Nose; Oropharynx; Palate, Soft; Prospective Studies; Reference Values; Skull Base; Sleep Apnea, Obstructive; Snoring; Tongue

This prospective open study was performed to examine the relation between pathologic findings of the upper respiratory tract and the types of noncentral sleep disorders (rhonchopathy, obstructive sleep apnea). 312 men and 274 women aged between 35-75 years attended our outpatient department for relief of their nocturnal breathing disorder. About 1/3 of the patients suffered only of habitual rhonchopathy and 2/3 were obstructive. No findings of the head and neck examination could predict the degree of oxygen desaturation, although pathologies of the nose (73.68%), the soft palate (94.1%) and narrowing of the oro- and hypopharynx (74.19%) were very common in patients with sleep disorder. At least one pathology could be found in every patients. The more pathologies were found the higher was the risk of obstructive sleep apnoea with desaturation below 70%. Unrelated tonsillectomy (51.36%) did not prevent nocturnal breathing disorders.

Topics: Adult; Aged; Airway Resistance; Body Mass Index; Data Interpretation, Statistical; Female; Hemodynamics; Humans; Hypopharynx; Male; Manometry; Middle Aged; Nose; Oropharynx; Oximetry; Oxygen; Palate; Prospective Studies; Pulmonary Ventilation; Sleep Apnea Syndromes; Snoring

To determine the relationship between upper airway muscle activity and upper airway resistance in nonsnoring and snoring young adults, 17 subjects were studied during sleep. Genioglossus and alae nasi electromyogram activity were recorded. Inspiratory and expiratory supraglottic resistance (Rinsp and Rexp, respectively) were measured at peak flow, and the coefficients of resistance (Kinsp and Kexp, respectively) were calculated. Data were recorded during control, with continuous positive airway pressure (CPAP), and on the breath immediately after termination of CPAP. Rinsp during control averaged 7 +/- 1 and 10 +/- 2 cmH2O.l-1.s and Kinsp averaged 26 +/- 5 and 80 +/- 27 cmH2O.l-1.s-2 in the nonsnorers and snorers, respectively (P = not significant). On the breath immediately after CPAP, Kinsp did not increase over control in snorers (80 +/- 27 for control vs. 46 +/- 6 cmH2O.l-1.s-2 for the breath after CPAP) or nonsnorers (26 +/- 5 vs. 29 +/- 6 cmH2O.l-1.s-2). These findings held true for Rinsp. Kexp did not increase in either group on the breath immediately after termination of CPAP. Therefore, 1) increases in upper airway resistance do not occur, despite reductions in electromyogram activity in young snorers and nonsnorers, and 2) increases in Rexp and expiratory flow limitation are not observed in young snorers.

Topics: Adult; Airway Resistance; Electromyography; Female; Humans; Inhalation; Male; Nose; Respiratory Muscles; Sleep; Snoring; Tongue

We previously showed that upper airway resistance can be inferred from the inspiratory flow contour during continuous positive airway pressure (CPAP) titration in obstructive sleep apnea syndrome (OSAS). The present study examines whether similar information can be obtained from inspiratory flow measured by a nasal cannula/pressure transducer. Ten symptomatic patients (snoring, upper airway resistance syndrome [UARS], or OSAS) and four asymptomatic subjects underwent nocturnal polysomnography (NPSG) with monitoring of flow (nasal cannula) and respiratory driving pressure (esophageal or supraglottic catheter). For each breath the inspiratory flow signal was classified as normal, flattened, or intermediate by custom software. "Resistance" was calculated from peak inspiratory flow and pressure, and normalized to the resistance during quiet wakefulness. Resistance in all stages of sleep was increased for breaths with flattened (387 +/- 188%) or intermediate (292 +/- 163%) flow contour. In combination with apnea-hypopnea index (AHI), identification of "respiratory events," consisting of consecutive breaths with a flattened contour, allowed differentiation of symptomatic from asymptomatic subjects. Our data show that development of a plateau on the inspiratory flow signal from a nasal cannula identifies increased upper airway resistance and the presence of flow limitation. In patients with symptoms of excessive daytime somnolence and low AHI this may help diagnose the UARS and separate it from nonrespiratory causes of sleep fragmentation.

Topics: Adult; Aged; Airway Resistance; Humans; Intubation; Middle Aged; Nose; Polysomnography; Respiratory Function Tests; Sleep Apnea Syndromes; Snoring; Transducers, Pressure

The purpose of our study was to introduce an ultrafast MR imaging technique of the pharynx as a diagnostic tool for viewing the mechanism of obstruction in patients with obstructive sleep apnea.. Six healthy volunteers and 16 patients with obstructive sleep apnea were examined on a 1.5-T whole-body imager using a circular polarized head coil. Ultrafast two-dimensional fast low-angle shot sequences were obtained in midsagittal and axial projections during transnasal shallow respiration at rest, during simulation of snoring, and during performance of the Müller maneuver. All patients underwent physical examination, transnasal fiberoptic endoscopy, and polysomnography.. Five to six images were obtained per second with an in-plane resolution of 2.67 x 1.8 mm and 2.68 x 2.34 mm, allowing visualization of motion of the tongue, soft palate, uvula, and posterior pharyngeal surface. MR findings correlated well with results of clinical examination. The length of obstruction in the oropharynx, which cannot be ascertained by transnasal endoscopy of the pharynx, was clearly visible MR images. Differences between patients with obstructive sleep apnea and healthy subjects in terms of the degree of obstruction in the velopharynx and oropharynx depicted on MR images during the Müller maneuver were highly significant.. We believe that ultrafast MR imaging is a reliable noninvasive method for use in the evaluation of obstructive sleep apnea.

Topics: Airway Obstruction; Endoscopy; Evaluation Studies as Topic; Fluoroscopy; Humans; Image Enhancement; Inhalation; Magnetic Resonance Imaging; Middle Aged; Nose; Oropharynx; Palate, Soft; Pharynx; Physical Examination; Polysomnography; Reproducibility of Results; Respiration; Rest; Sleep Apnea Syndromes; Snoring; Tongue; Uvula

To define the standard of airway flow limitation, pharyngeal pressure and flow rate were measured during wakefulness and sleep in seven habitual snorers with widely varying degrees of sleep-induced increases in upper airway resistance. Inspiratory pressure:flow relationships were used to group breaths into four categories of flow limitation, including linear (Level 1), mildly alinear (Level 2), constant flow rate with no pressure dependence (Level 3), and decreasing flow rate throughout significant portions of inspiration, i.e., negative pressure dependence (Level 4). These pressure:flow rate gold standards of flow limitation were used to evaluate a flow limitation index derived from the time profile (or "shape") of three noninvasive estimates of flow rate: (1) pneumotach flow rate, (2) differentiated sum respiratory inductance plethysmography (RIP), and (3) nasal pressure. A nonflow limited template for each of these noninvasive measurements was taken from awake breaths and the difference in area determined between the template breath and each of the noninvasive signals measured during nonrapid eye movement (NREM) sleep. The noninvasive flow limitation indices were found to be effective in differentiating severe types of inspiratory flow limitation, i.e., Level 1 versus Level 3 or Level 4 (sensitivity/specificity > 80%). On the other hand, these indirect indices were not able to consistently detect mild levels of flow limitation (Level 1 versus Level 2; sensitivity/specificity = 62 to 72%); nor were these noninvasive estimates of flow rate "shape" sensitive to breaths with a high but fixed resistance throughout inspiration. The area index derived from measurements of pressure at the nares (Pn) was the most sensitive, nonperturbing, noninvasive measure of flow rate and flow limitation, and we recommend its use for recognizing most of the common types of moderate to severe levels of airway flow limitation in sleeping subjects.

Topics: Adult; Airway Resistance; Female; Humans; Inhalation; Inspiratory Capacity; Male; Nose; Pharynx; Plethysmography; Pressure; Pulmonary Ventilation; Rheology; Sensitivity and Specificity; Signal Processing, Computer-Assisted; Sleep; Sleep Stages; Snoring; Tidal Volume; Time Factors; Wakefulness

Masticatory and tongue muscle activity was examined polysomnographically in 14 patients with sleep apnea syndrome and six snorers. The all-night polysomnographic recordings included electromyograms (EMG) of the genioglossal, the masseter and the inferior head of the lateral pterygoid muscles, nasal airflow and thoracoabdominal respiratory effort. The apneas were defined and classified into three types (obstructive, central and mixed). EMG amplitudes of each muscle were measured before, during and after the obstructive and central apneas. In the apnea patients the three muscles showed significantly lower EMG amplitudes during the obstructive apnea than before the apnea, and then significantly higher amplitudes after the apnea. These findings indicate that the hypotonia of the muscles during sleep can result in obstructive apnea. There was no significant difference in the pattern of muscle activity during obstructive apnea between the apnea patients and the snorers. On the other hand, a decrease in the mean EMG amplitude during the central apnea was not observed. It is suggested that central apnea occurs independently of masticatory and tongue muscle activity.

Topics: Abdomen; Adult; Aged; Electromyography; Female; Humans; Male; Masseter Muscle; Middle Aged; Muscle Hypotonia; Nose; Polysomnography; Pterygoid Muscles; Pulmonary Ventilation; Respiratory Mechanics; Sleep Apnea Syndromes; Snoring; Thorax; Tongue

Adenoidal hypertrophy is the commonest cause of nasal obstruction in the pediatric population. It may cause marked morbidity as regards respiratory physiology, facial growth and middle ear function. Determination of adenoidal presence and size is not easy. Nasal endoscopy and radiology are the most accepted modes of diagnosis and each has its disadvantages. We have used acoustic rhinometry to determine the size of adenoids. Changes in nasal volume and resistance were recorded and an easy formula was devised to determined adenoid size. This technique is easy, non-invasive and reproducible with a 93.5% predictive value.

Topics: Acoustics; Adenoidectomy; Adenoids; Airway Resistance; Cephalometry; Child; Child, Preschool; Ear, Middle; Endoscopy; Female; Humans; Hypertrophy; Male; Manometry; Maxillofacial Development; Mouth Breathing; Nasal Obstruction; Nose; Otitis Media with Effusion; Otitis Media, Suppurative; Predictive Value of Tests; Radiography; Reproducibility of Results; Respiration; Sleep Apnea Syndromes; Snoring

We present the surgical management of 51 patients with a primary diagnosis of snoring. Patients with sleep apnoea syndrome were eliminated from the study. Four procedures were used: the classical uvulopalatopharyngoplasty, a limited uvulopalatoplasty, laser palatoplasty with tonsillectomy; and laser palatoplasty alone. Fifty-one of the 67 patients (76.1%) responded to a telephone questionnaire with a mean follow-up period of 18.2 months, 78.4% of patients reported improved or absent snoring. There was almost equal patient satisfaction between the conventional technique and the laser technique. The improvement in snoring was not influenced by the type of operation performed.

Topics: Adult; Aged; Alcohol Drinking; Body Mass Index; Female; Follow-Up Studies; Humans; Laser Therapy; Male; Middle Aged; Nose; Pain, Postoperative; Palate, Soft; Patient Satisfaction; Pharynx; Smoking; Snoring; Surveys and Questionnaires; Telephone; Tonsillectomy; Treatment Outcome; Uvula

Ten subjects known to suffer from heavy snoring but not obstructive sleep apnoea were studied using the technique of sleep nasendoscopy. The mechanism of snoring was noted for each and sound recordings of the snoring noise were made. Six subjects were observed to snore using their soft palate only, three snored using only their tongue base and one snored using a combination of palate and tongue base. The sound recordings were subjected to computer analysis of waveform and frequency. Palatal flutter snoring and tongue base snoring appear to have distinct waveform and frequency patterns which allows them to be differentiated from each other.

Topics: Confounding Factors, Epidemiologic; Endoscopy; Humans; Noise; Nose; Oximetry; Palate, Soft; Pharynx; Saliva; Signal Processing, Computer-Assisted; Sleep; Sleep Apnea Syndromes; Snoring; Sound Spectrography; Tongue; Video Recording

Twenty-one patients were examined, of whom 18 suffered from obstructive sleep apnea syndrome and 3 were heavy snorers. The diagnosis was established by a combination of medical history, clinical examination and standard nocturnal polysomnography. Five pressure transducers were used in the pharynx and one in the esophagus, in addition to monitors for oxygen saturation and oro-nasal airflow. A clinically significant obstruction was defined as occurring when the pressure difference between two transducers was higher than 50% of the more caudal of the two pressures. In the 20 patients having obstructions during sleep, 7 had obstruction in only one segment of the airway, 9 in two segments and 4 in three segments. All but 2 patients had obstructions in the velopharyngeal region. Since the effect of uvulopalatopharyngoplasty (UPPP) is best during the first few months after surgery, 10 patients were re-examined after only 3 months in order to record optimal results sequentially. Of these, 6 still had obstructions involving the velopalatine segments and only 4 had none. This may explain why UPPP has a success rate of only 50-70% in most publications, depending on the definitions of success.

Topics: Airway Obstruction; Airway Resistance; Esophagus; Follow-Up Studies; Humans; Mouth; Nose; Oxygen Consumption; Palate, Soft; Pharynx; Polysomnography; Pressure; Pulmonary Ventilation; Sleep; Sleep Apnea Syndromes; Snoring; Transducers, Pressure; Uvula

Topics: Bandages; Clinical Trials as Topic; Dilatation; Humans; Nose; Snoring

The ability of a target-controlled propofol infusion system to provide sedation for patients undergoing assessment of the upper airway during snoring is presented. This technique provides the desired sedation level for induction of snoring and is short acting and readily controllable. We advocate its use in sedation nasal endoscopy.

Topics: Adolescent; Adult; Anesthesia; Endoscopy; Female; Humans; Infusion Pumps; Lidocaine; Male; Middle Aged; Nose; Palate; Propofol; Snoring

Snoring is a common disorder usually presenting to otolaryngologists. Most patients who have any nasal symptoms would normally be offered nasal surgery, but there is a significant incidence of failure to control the snoring (approximately 25%). We analysed a group of patients, all having nasal surgery for snoring, with the aim of assessing whether any pre-operative factors would predict success or failure of the surgery. We found symptoms of excessively loud snoring, witnessed apnoeic episodes and hypersomnolence, or obstructive sleep apnoea diagnosed by overnight oxygen saturation measurements to be statistically associated with failure of nasal surgery to improve snoring.

Topics: Adult; Aged; Airway Resistance; Apnea; Endoscopy; Female; Fiber Optic Technology; Humans; Male; Middle Aged; Nasal Obstruction; Nose; Polysomnography; Sleep Apnea Syndromes; Sleep Stages; Snoring; Sound; Treatment Failure; Treatment Outcome

Topics: History, 18th Century; History, 19th Century; Humans; Indians, North American; Medicine, Traditional; Nose; Paintings; Pennsylvania; Respiration; Sleep Wake Disorders; Snoring

This study was designed to test the hypothesis that nasal dilation reduces snoring. To achieve this we performed nocturnal polysomnography, including measurement of snoring, in 15 patients without nasal pathology before and after insertion of a nasal dilator (NOZOVENT). Snoring was quantified for each sleep stage by recording the number of snores per minute of sleep, number of snores per minute of snoring time and nocturnal sound intensities (maximum, average and minimum). We found that nasal dilation had no effect on the number of apneas, hypopneas or oxygen saturation. Snoring parameters were unaffected by NOZOVENT during stages I, II and REM sleep, but were all significantly reduced during slow wave sleep. We conclude that dilation of the anterior nares in patients without nasal pathology has a relatively weak effect on snoring, and routine use of nasal dilating appliances is not recommended for treatment of snoring.

Topics: Adult; Aged; Airway Obstruction; Dilatation; Equipment Design; Female; Humans; Male; Middle Aged; Nose; Respiration; Sleep Apnea Syndromes; Sleep Stages; Snoring

Although it is widely accepted that nasal obstruction leads to snoring and sleep apnea, the relationship between these variables is not clear, mainly because of the lack of studies in which nasal resistance (Rna) and snoring were measured concurrently. The authors studied eight nonapneic snoring men with healthy noses by nocturnal polysomnography that included quantitative assessment of snoring and concomitant nasal resistance. In six of these eight patients nasal resistance increased during sleep, but there was no significant change for the group as a whole between wakefulness (0.209 +/- 0.224 Pa/cm3 per second) and sleep (0.292 +/- 0.203 Pa/cm3 per second). Linear regression analysis showed no significant correlation between sleeping nasal resistance and snoring index (partial R2 = .44, P = .071). We used each subject as his own control and compared the snoring profile at a time during sleep when nasal resistance was at its highest (0.550 +/- 0.375 Pa/cm3 per second) and lowest (0.146 +/- 0.090 Pa/cm3 per second) levels. Despite the significant (P < .01) differences in nasal resistance, they were not reflected in the number of snores or their sound intensity. It is concluded that nasal obstruction during sleep is not correlated significantly to frequency or intensity of snoring during exclusively nasal breathing.

Topics: Adult; Airway Resistance; Anthropometry; Humans; Male; Middle Aged; Nose; Regression Analysis; Sleep; Snoring

Knowledge of the level of pharyngeal obstruction during sleep is an important factor in deciding whether or not a patient suffering from obstructive sleep apnoea syndrome (OSAS) will benefit from uvulopalatopharyngoplasty. The Muller manoeuvre has been advocated as a method of obtaining this information. We compared the findings from the technique of sleep nasendoscopy, which actually allows visualization of the level of obstruction in the sleeping patient, with the results of the Muller manoeuvre performed in the same patients while awake. We found the Muller manoeuvre to be less accurate than previously believed.

Topics: Airway Obstruction; Endoscopy; Humans; Hypopharynx; Nose; Oropharynx; Palate, Soft; Pharynx; Respiration; Sleep Apnea Syndromes; Snoring

Cineradiography of the pharynx during simulated snoring was done in 6 healthy volunteers, and supraglottic pressure and flow rate were recorded in 12 others. We observed, immediately before snoring, a decrease in the sagittal diameter of the oropharynx followed, during snoring, by high-frequency oscillations of soft palate and pharyngeal walls. The pattern of soft palate oscillations was different while snoring through the nose or mouth. During inspiratory snoring through the nose, the soft palate remained in close contact with the back of the tongue and only the uvula presented high-frequency oscillations. Snoring through the mouth resulted in ample high-frequency oscillations of the whole soft palate. Frequency of airflow and supraglottic pressure oscillations was less (P less than 0.05) during mouth (28.2 +/- 7.5 Hz) than during nasal snoring (77.8 +/- 36.7 Hz). This difference may be related to the smaller oscillating mass (i.e., uvula) during nasal snoring. At variance with our previous data, which showed that snoring during sleep, in both heavy (nonapneic) snorers and obstructive sleep apnea patients, was systematically preceded by flow limitation, this was not true during simulated snoring.

Topics: Adult; Airway Resistance; Female; Glottis; Humans; Male; Mouth; Nose; Oropharynx; Palate, Soft; Pressure; Respiratory Mechanics; Sleep Apnea Syndromes; Snoring; Uvula

Snoring is a common disorder, and may be associated with obstructive sleep apnoea, although there is little published information on the incidence of apnoea in snorers. This study aimed to assess the upper airway and to relate the findings to sleep study data in a population of patients referred by their general practitioners with loud snoring. Each patient had a full history, weight and height measurements, nasal examination, rhinomanometry, peroral grading of the oropharyngeal features, and fibreoptic pharyngoscopy with a modified Muller manoeuvre, followed by a sleep study. The results in our group of 35 patients demonstrate a high incidence of obstructive sleep apnoea (46%). Factors which correlated well with apnoea were excessively loud snoring, a narrow oropharynx, and marked obesity; 94% of patients with one or more of these features had evidence of sleep apnoea.

Topics: Adult; Aged; Airway Resistance; Endoscopy; Female; Humans; Male; Manometry; Middle Aged; Nose; Pharynx; Sleep Apnea Syndromes; Snoring

This report describes the polysomnographic findings and the respiratory alterations during sleep in a 20-year-old patient with the Prader-Willi syndrome. Nocturnal recordings and a variant of the multiple sleep latency test showed excessive daytime sleepiness, sleep onset rapid eye movement episodes, snoring and sleep apnea. Treatment with nasal continuous positive airway pressure normalized the respiratory pattern and the sleep structure, except for rapid eye movement sleep onset. Whereas upper airway obstruction and obesity may explain the respiratory disorders, as shown by their resolution with continuous positive airway pressure treatment, hypothalamic dysfunction could play a role in the disruption of the normal nonrapid eye movement/rapid eye movement sleep periodicity.

Topics: Adult; Airway Obstruction; Heart Rate; Humans; Hypothalamus; Male; Nose; Positive-Pressure Respiration; Prader-Willi Syndrome; Sleep Apnea Syndromes; Sleep Wake Disorders; Sleep, REM; Snoring

To examine if gender and airway resistance (nasal and pulmonary) influence the loudness and intensity of snoring, we prospectively studied 370 unselected patients referred to our sleep clinic because of heavy snoring and a possibility of sleep apnea. All patients had full nocturnal polysomnography, including measurements of snoring using a calibrated microphone-sound meter system, and determination of pulmonary (Raw) and nasal resistance (Rna). Snoring was quantified by reporting the number of snores per hour of sleep (snoring index--SI) and the maximum nocturnal sound intensity (dBmax). The patient population comprised 77 females and 293 males, ranging in age from 12 to 80 years. Based on the apnea/hypopnea index (AHI) we separated all patients into the apneic and non-apneic groups. There were 201 non-apneic snorers (AHI less than or equal to 10) and 160 apneic snorers (AHI greater than 10). There was no significant difference in snoring frequency, maximum nocturnal sound intensity, nasal and pulmonary resistance between men and women or between apneic and non-apneic snorers. Stepwise, forward, multiple linear regression analysis showed that body mass index and nasal resistance correlate significantly with the snoring index (R2 = 0.29, p less than 0.005), while age and body mass index correlate only weakly, but significantly, with the maximum nocturnal sound intensity. We conclude that (1) men snore similarly to women, and (2) obesity and nasal resistance are important determinants of the frequency of snoring. It follows that measures taken to reduce weight and decrease nasal resistance may be of benefit in reducing snoring.

Topics: Adolescent; Adult; Age Factors; Aged; Airway Resistance; Analysis of Variance; Child; Female; Humans; Linear Models; Lung; Male; Middle Aged; Nasal Obstruction; Nose; Obesity; Prospective Studies; Sex Factors; Sleep Apnea Syndromes; Snoring; Sound

The Nasal Spray Test, as herein described, is a simple, reliable, no-cost, self-administered test for assessment of the nasal component in several combined etiologies of snoring and obstructive sleep apnea. A topical decongestant is sprayed into the nose on alternate nights for one week. Spray-nights are compared to non-spray nights for the severity of snoring and apnea. Improvement on the spray-nights implies that nasal obstruction is a causative factor in snoring and that relief of that obstruction will also improve the snoring problem. The test helps the physician decide when nasal surgery should or should not be performed for the complaint of snoring.

Topics: Administration, Intranasal; Adult; Aged; Female; Humans; Male; Methods; Middle Aged; Nasal Obstruction; Nose; Oxymetazoline; Sleep Apnea Syndromes; Snoring

Snorers represent a heterogenous group that require adequate assessment before recommending surgical treatment. There are unfortunately no specific features either in the history or physical examination that might predict those chronic snorers with obstructive sleep apnoea. We have used trained observation together with pulse oximetry ('sleep screening') and fibreoptic nasendoscopy with Muller manoeuvre in our unit to assess snorers. This combination is a reliable means of distinguishing apnoeic patients from simple snorers and determining the level of the obstructing segment. We report our experience in using these methods in the management of 71 chronic snorers. We stress the value of conservative management, and emphasize that obesity, habitual alcohol ingestion and nasal obstruction should be corrected before embarking on pharyngeal surgery.

Topics: Adult; Aged; Body Weight; Chronic Disease; Female; Humans; Male; Middle Aged; Nasal Obstruction; Nose; Sleep Apnea Syndromes; Snoring

Topics: Adult; Dilatation; Female; Humans; Male; Middle Aged; Mouth Breathing; Nose; Sleep; Snoring

We studied two populations of patients who snored and had frequent nocturnal asthma attacks: ten overweight men presenting with typical obstructive sleep apnoea syndrome, and a group of five adolescents with regular snoring and an increase in negative inspiratory oesophageal pressure during stage II non-rapid eye movement (NREM) and rapid eye movement (REM) sleep. All subjects presented cranio-mandibular abnormalities at cephalometric evaluation, with a narrow space behind the base of the tongue. Both populations were treated with nasal continuous positive airway pressure (CPAP) during sleep. Snoring and partial or complete airway obstruction were eliminated, as were the nocturnal asthma attacks. Two adolescents treated with upper airway surgery after nasal CPAP showed no nocturnal asthma at short-term follow-up. Nasal CPAP had no effect on daytime asthma. One hypothesis is that a subgroup of asthmatic patients with small pharynxes may have enhanced vagal stimulation during sleep compared with other asthmatic patients. This enhancement would be related to the repetitive Müller manoeuvres noted with airway obstruction during sleep. Combined with the local effects of snoring, this extra vagal stimulation would be a precipitating factor in nocturnal asthma attacks.

Topics: Adolescent; Adult; Asthma; Humans; Male; Middle Aged; Nose; Pharynx; Positive-Pressure Respiration; Prospective Studies; Sleep Apnea Syndromes; Snoring; Time Factors

Habitual snoring in adults may be related to upper airway dysfunction, although the precise relationship has never been studied. We quantitatively measured snoring and correlated it with upper airway properties in 50 apneic and 59 nonapneic adult male patients. Both groups were similar in terms of nasal airflow resistance and pulmonary function tests. We found a significant correlation between the severity of snoring and nasal airflow resistance in both groups, and between the severity of snoring and pharyngeal and glottic areas in the apneic group. We conclude that snoring may be associated with abnormalities in upper airway properties.

Topics: Adult; Aged; Airway Resistance; Functional Residual Capacity; Humans; Male; Middle Aged; Nose; Plethysmography; Pulmonary Ventilation; Residual Volume; Snoring; Trachea

32 patients with habitual snoring and 2 patients with obstructive sleep apnea syndrome underwent nasal and/or palatopharyngeal surgery. 12 patients with combined nasal septoplasty, submucous resection of the inferior turbinate bones and palatopharyngoplasty gained total relief from snoring. The same result was achieved in 10 children with removal of extremes of tonsillar and adenoid enlargement. From 7 patients with nasal surgery alone 4 experienced total improvement in the snoring, 3 perceived no long-term relief. 3 adults with PPP alone gained some change in their snoring. Uvulectomy in 2 adults had no influence on the snoring situation.

Topics: Adenoidectomy; Adolescent; Adult; Airway Obstruction; Child; Child, Preschool; Female; Humans; Male; Middle Aged; Nose; Palate; Pharynx; Sleep Apnea Syndromes; Snoring; Suture Techniques; Tonsillectomy; Uvula

Eighteen children were treated for snoring. Surgical removal of enlarged tonsils and/or adenoids resulted in prompt and total elimination of snoring in 17 of these patients. One child required nasal and sinus surgery to gain relief from snoring. Eighty-three adults were interviewed, examined, and treated for snoring. Correction of anatomical abnormalities in the nose, soft palate, uvula, and pharynx achieved elimination of snoring in 72% of surgically treated cases. By contrast, nonsurgical remedies achieved snoring elimination in only 5% of patients (controls). Tracheostomy was required in 10% of snoring adults--those who proved to have severe obstructive sleep apnea syndrome. Snoring is due to the combined effect of several anatomic and physiologic abnormalities in the nasal and pharyngeal segments of the airway. It may be amenable to surgical therapy when the severity of the problem warrants it.

Topics: Adenoidectomy; Adolescent; Adult; Aged; Airway Obstruction; Child; Child, Preschool; Female; Humans; Male; Middle Aged; Muscle Tonus; Nasal Mucosa; Nasal Septum; Nose; Palate, Soft; Pharyngeal Muscles; Pharynx; Respiratory Sounds; Sleep Apnea Syndromes; Snoring; Tonsillectomy; Tracheotomy; Turbinates; Uvula

Topics: Child; Dust; Humans; Hypersensitivity; Mouth Breathing; Nose; Occupational Diseases; Otitis Media; Snoring

Topics: Face; Humans; Mouth; Nose; Snoring