Smartphone-based delivery of oropharyngeal exercises for treatment of snoring: a randomized controlled trial.

PURPOSE: Upper airway exercises for snoring treatment can be effective but difficult to administer and monitor. We hypothesized that a brief, relatively simple daily upper airway exercise regimen, administered by a smartphone application, would reduce snoring and encourage compliance. METHODS: Targeted vowel sounds causing tongue base movements were incorporated into a voice-controlled smartphone game application. Participants with habitual snoring, apnea hypopnea index (AHI) ≤ 14 events/h, and BMI ≤ 32 kg/m2 were randomly assigned to perform 15 min of daily gameplay (intervention group) or 5 s of daily voice recording (control group) and to audio record their snoring for 2 nights/week for up to 12 weeks. Sounds above 60 dB were extracted from recordings for snore classification with machine learning support vector machine classifiers. RESULTS: Sixteen patients (eight in each group) completed the protocol. Groups were similar at baseline in gender distribution (five males, three females), mean BMI (27.5 ± 3.8 vs 27.4 ± 3.8 kg/m2), neck circumference (15.1 ± 1.6 vs 14.7 ± 1.7 in.), Epworth Sleepiness Score (8 ± 3.5 vs 7 ± 4.0), and AHI (9.2 ± 4.0 vs 8.2 ± 3.2 events/h). At 8 weeks, the absolute change in snoring rate (> 60 dB/h) was greater for the intervention group than the control group (- 49.3 ± 55.3 vs - 6.23 ± 23.2; p = 0.037), a 22 and 5.6% reduction, respectively. All bed partners of participants in the intervention group reported reduced snoring volume and frequency, whereas no change was reported for the control group. CONCLUSIONS: Smartphone application-administered upper airway training reduces objective and subjective snoring measures and improves sleep quality. TRIAL REGISTRATION: ClinicalTrials.gov ; no.: NCT03264963; URL: www.clinicaltrials.gov.

Subjective effects of the sleep position trainer on snoring outcomes in position-dependent non-apneic snorers.

PURPOSE: To evaluate the effect of a new-generation positional device, the sleep position trainer (SPT), in non-apneic position-dependent snorers. METHODS: Non-apneic position-dependent snorers with an apnea-hypopnea index (AHI) < 5 events/h were included between February 2015 and September 2016. After inclusion, study subjects used the SPT at home for 6 weeks. The Snore Outcome Survey (SOS) was filled out by the subjects at baseline and after 6 weeks, and at the same time, the Spouse/Bed Partner Survey (SBPS) was filled out by their bed partners. RESULTS: A total of 36 participants were included and 30 completed the study. SOS score improved significantly after 6 weeks from 35.0 ± 13.5 to 55.3 ± 18.6, p < 0.001. SBPS score also improved significantly after 6 weeks from 24.7 ± 16.0 versus 54.5 ± 25.2, p < 0.001. The severity of snoring assessed with a numeric visual analogue scale (VAS) by the bed partner decreased significantly from a median of 8.0 with an interquartile range (IQR) of [7.0-8.5] to 7.0 [3.8-8.0] after 6 weeks (p = 0.004). CONCLUSIONS: Results of this study indicate that positional therapy with the SPT improved several snoring-related outcome measures in non-apneic position-dependent snorers. The results of this non-controlled study demonstrate that this SPT could be considered as an alternative therapeutic option to improve sleep-related health status of snorers and their bed partners.

The effect of sitting and calf activity on leg fluid and snoring.

Prolonged sitting may promote leg fluid retention that redistributes to the neck during sleep and contributes to snoring. This could be attenuated by calf activity while sitting. In 16 healthy non-obese subjects we measured leg fluid volume (LFV) below the knees using bioelectrical impedance while sitting for 4h, snoring using a portable BresoDx™ device, and Mallampati grade. Using a double cross-over study design, subjects were randomized to one of two arms and crossed-over one week later: control arm - no calf exercise while sitting; intervention arm - calf contraction against a pedal resistance while sitting. The effects of sitting±calf activity on LFV and snoring were compared. We found that LFV increased by 216±101.0ml (p<0.0001) after sitting. Calf activity while sitting attenuated LFV by 53.8ml (p<0.0001) and, in all five subjects with severe upper airway narrowing (Mallampati grade IV), reduced snoring duration (from 357±132.9 to 116.2±72.1s/h, p=0.02) suggesting reduced overnight rostral fluid shift to the neck.

Orofacial motor functions in pediatric obstructive sleep apnea and implications for myofunctional therapy.

OBJECTIVES: The purposes of this study were (1) to identify possible differences in muscular and orofacial functions between children with obstructive sleep apnea (OSA) and with primary snoring (PS); (2) to examine the standardized difference between normal values of myofunctional scores and those of subjects with OSA or PS; and (3) to identify the features associated with OSA. METHODS: Participants were 39 children (mean age 8 ± 1.2 years) of which, 27 had a diagnosis of OSA and 12 had PS. All participants were examined by an otorhinolaryngologist and underwent overnight polysomnography. Orofacial characteristics were determined through a validated protocol of orofacial myofunctional evaluation with scores (OMES), surface electromyography of masticatory muscles, and measurements of maximal lip and tongue strength. Reference values in the OMES were included to quantify the standardized difference (effect size = ES) relative to the groups studied and in the regression analysis. RESULTS: The OSA group had lower scores in breathing and deglutition, more unbalanced masticatory muscle activities than PS group (P < 0.05), but both groups had similar reductions in orofacial strength. OSA had a large ES (Cohen's d > 0.8) in all analysed OMES scores, while PS group showed small and medium differences in breathing and mastication scores, respectively. The mobility of the stomatognathic components score was the most important to contribute for group status (57%, P < 0.0001) in the regression analysis. CONCLUSION: Children with tonsillar hypertrophy and OSA had relevant impairments in orofacial functions and lesser muscular coordination than children with PS.

The effects of oropharyngeal-lingual exercises in patients with primary snoring.

Primary snoring (PS) is one of the sleep breathing disorders with suboptimal results of treatment. It is recommended that Oropharyngeal exercises can be a therapeutic choice for the patients with mild to moderate degrees of PS. We assessed the effects of oropharyngeal-lingual (OPL) exercises on patients with primary snoring (PS) referred to Amiralmomenin University Hospital, Rasht, Iran in 2012. Fifty-three patients with PS underwent the sets of OPL exercises for 3 months, 5 days a week, and 30 min a day under the supervision of a speech therapist. Severity of the snoring was assessed by use of Visual Analogue Scale (VAS) and Snoring Scale Score (SSS) criteria before and after the exercises, and data were analyzed using SPSS version 17. Mean SSS before the study was 7.01 ± 1.72, while it was 3.09 ± 2.7 after the study; and the mean VAS scores were 8.54 ± 1.89 and 4.69 ± 2.94 before and after the study, respectively (P = 0.0001). There was a significant relationship between having conflicts with roommates (P = 0.0001), duration of snoring occurrence (P = 0.0001), severity of snoring (P = 0.0001) before and after the intervention. In conclusion, doing the OPL exercises significantly decreases the severity of PS.

Long-term follow-up of patients operated with Uvulopalatopharyngoplasty from 1985 to 1991.

OBJECTIVES: Short-term outcome and side effects after Uvulopalatopharyngoplasty (UPPP) are well recognized. However, there is a lack of knowledge of the long-term outcome and side effects after this surgery. This study was completed to investigate the outcome and side effects 20 years after UPPP for snoring and obstructive sleep apnoea. METHODS: Medical records of patients who underwent UPPP surgery for sleep apnoea and snoring between 1985 and 1991 were investigated retrospectively. A specific questionnaire focusing on the present health profile, side effects of previous UPPP surgery and present sleeping patterns of patients was mailed out. RESULTS: UPPP patients, 186 (including 11 females) were identified. Of these, 35 (19%) had passed away and 7 (4%) were not located. 129 patients (mean: age 68 years, range 43-83) of the possible 144 patients answered the questionnaire (response rate 90%). At follow-up, 41 patients (32%) used continuous positive airway pressure (CPAP). 66 of the patients (52%) were satisfied with the result of the operation, but 61 (47%) were not satisfied. 49 patients (38%) reported persistent side effects (problems with nasal regurgitation 18 (14%), swallowing 26 (20%), changed voice 15 (12%), and pain in the oral cavity 15 (12%). CONCLUSION: Almost 50% of patients operated with UPPP were not satisfied with the result of the operation after about 20 years, and one third used CPAP at follow-up. A large proportion of patients still experienced side effects, which, after this time, are likely to be permanent.

Indicadores de laser en el ronquido / Laser indicators in the snore

El conocimiento de la tecnología del laser y sus características al entrar en interacción con los tejidos, ha hecho posible que sea utilizado como herramienta médica. Es importante saber que los efectos producidos en los tejidos están basados en la absorción de esta luz por diferentes compuestos sean agua, pigmentos, proteínas; estos procesos generan calor, lo que incide en la evaporación o ablación de los tejidos

[Efficiency of intraoral applicator UPLH-01 in snore and obstructive sleep apnea]. / Otsenka éffektivnosti primeneniia vnutrirotovogo applikatora UPLKH-01 pri khrape i sindrome obstruktivnogo apnoé sna.

Tolerance, subjective and objective effectiveness of domestic intraoral applicator UPLH-01 were studied in the treatment of snoring and obstructive sleep apnea (OSA). In 44 patients with uncomplicated snoring the above parameters were assessed using questionnaire, in 20 patients with uncomplicated snoring and OSA paired polysomnographic investigations were made. Tolerance of the treatment was 50%. Subjective positive effect was registered in 65% of the patients. The applicator was found effective in the majority of patients with uncomplicated snoring. In mild and moderate OSA the applicator was effective only in a few cases. In severe OSA no effect was found. Patients with chronic disorders of nasal breathing exhibited deterioration of respiration and blood saturation with oxygen. Thus nasal obstruction is a contraindication to applicator use.

Better quality of life when nasal breathing of snoring men is improved at night.

OBJECTIVE: To evaluate whether improved nasal breathing changes the quality of life in snoring men and improves the female sleeping partners' well-being in the morning. DESIGN: During 1 month, 42 heavily snoring men slept with a nostril dilator. Before and after 1 month, the snorers rated their daytime tiredness and completed the Nottingham Health Profile questionnaire. Female sleeping partners rated the snoring, the quality of their sleep, and their sense of well-being in the morning. A population sample was used for comparison. SETTING: The Central Hospital, Skövde, Sweden. RESULTS: The snorers' quality of life before the study was significantly worse (P<.001) than that of the comparison population and improved significantly (P = .001). The men were significantly (P<.001) less tired during the day when their nasal airflow was increased. Female sleeping partners had significantly (P = .005) better sleep and an improved sense of well-being in the morning during the test period. Both were correlated with a significant reduction in the snoring (P<.001). CONCLUSIONS: When nasal breathing of snoring men was improved at night, their quality of life was significantly improved. The female sleeping partners had a reduction in sleep disturbance that correlated well with an improvement in their own sleep and feelings of well-being in the morning.

Oral appliances in the treatment of snoring and sleep apnea.

Oral appliances have been developed that are effective in snoring patients and in patients with mild to moderate sleep apnea. This article reviews the types of appliances that are available, their possible modes of action, and their efficacy. In addition, the clinician is provided with guidelines on how to choose the appropriate patient for this therapy.

Management of simple snoring, upper airway resistance syndrome, and moderate sleep apnea syndrome.

The spectrum of respiratory sleep disorders has been extended in the last years to include conditions that are less well defined than severe obstructive sleep apnea (OSA). Moderate OSA, snoring, and upper airway resistance syndrome (UARS) represent three conditions in which there are still unresolved pathophysiological, epidemiological, and clinical questions. Therefore, the therapeutic approach remains unclear. We have tried to define these entities and to review the respective indications and efficacy of pharmacological treatment, weight loss, sleep posture, oral appliances, upper airway surgery, and finally, continuous positive airway pressure (CPAP). From these data, we also aim to define strategies of treatment for moderate OSA, snoring, and UARS. However, these conditions are likely to be particularly appropriate for randomized trials comparing different modalities of treatment that may be the only way to validate these treatment strategies.

The experimental modification of sonorous breathing.

Loud snoring is a noxious habit and potential personal health risk. We are reporting the first experimental study of simple behavioral techniques for the modification of chronic snoring. Twenty-four volunteers participated in a repeated measures, randomized group design over 2 weeks of intervention and one-month follow-up. Treatment groups included a contingent-awakening and breathing retraining (self-control) condition. Both treatment groups were compared to a no-treatment control. Despite considerable intra-subject variability and the lack of an adequate attention-placebo control group, objective assessment indicated a substantial reduction in snoring amplitude and frequency in both treatment groups. Follow-up assessments further demonstrated maintenance of change. This study has implications for modification of sleep habit disorders and learning without awareness.