Singing Exercises Improve Sleepiness and Frequency of Snoring among Snorers—A Randomised Controlled Trial

Objectives: To assess the effectiveness of regular singing exercises in reducing symptoms of snoring and sleep apnoea. Methods: A prospective single blinded randomised controlled trial was conducted in the otolaryngology department of a UK teaching hospital (Exeter). 127 adult patients with a history of simple snoring or sleep apnoea were recruited. 93 patients completed the study. Patients were excluded because of severe sleep apnoea (apnoea index > 40), or morbid obesity (BMI > 40). The study group completed a self-guided treatment programme of singing exercises contained on a 3CD box set, performed for 20 minutes daily. Outcome measures included the Epworth Sleepiness Scale, the SF-36 generic quality of life assessment tool, visual analogue scales (VAS range 0-10) of snoring loudness and frequency, and visual analogue scale of compliance (for intervention group). Results: The Epworth scale improved significantly in the experimental group compared to the control group (difference -2.5 units;95% CI -3.8 to -1.1;p = 0.000). Frequency of snoring reduced significantly in the experimental group (difference -1.5;95% CI -2.6 to -0.4;p = 0.01), and loudness of snoring showed a trend to improvement which was non-significant (difference -0.8;95% CI -1.7 to 0.1;p = 0.08). Compliance with exercises was good;median 6.6 (quartiles = 4.1, 8.3). Conclusions: Improving the tone and strength of pharyngeal muscles with a 3 months programme of daily singing exercises reduces the severity, frequency and loudness of snoring, and improves symptoms of mild to moderate sleep apnoea.

Mandibular advancement devices in the treatment of obstructive sleep apnea and snoring in community dental care: A pilot study on self-reported sleep quality

Background: The high efficacy of continuous positive airway pressure (CPAP) in treating obstructive sleep apnea (OSA) patients is sometimes limited because of intolerance. Mandibular advancement devices (MAD) are proven to be efficient in treating mild to moderate sleep apnea and snoring. We examined patients who had been treated in Community Dental Care with a titrable Herbst-type MAD. The aim of the study was to evaluate the quality of sleep based on self report. Methods: A questionnaire was mailed to patients (n = 184) who had received treatment for OSA or snoring between 2007 and2010 inthe Helsinki Health Centre Oral Care Unit. The patients were referred to the clinic for primary treatment, or because another treatment modality had failed. Results: Of the respondents (n = 142, 78.4%), OSA had been diagnosed in 74%, while the MAD was applied for snoring to the remaining. Among all respondents, 78.4% had worn the MAD at least three nights per week. With the MAD in situ, sleep was felt significantly less disrupted (p < 0.001) and more restorative (p < 0.001), and snoring was markedly reduced (p < 0.001). Daytime tiredness was also markedly less frequent (p < 0.001). Conclusions: Treatment with a MAD improved perceived sleep quality and awoke alertness in mild and moderate OSA patients and in snorers. This study supports such treatment to be initiated and monitored in community dental care.

Cutting-edge technologies for diagnosis and monitoring of snoring in children

Snoring is a very common problem in children and may be an indication of obstructive sleep apnea(OSA). Appropriate diagnosis is of importance due to detrimental effects of OSA. Polysomnography is considered the gold standard for the diagnosis of OSA. However, it is impractical for several reasons and this is why other tests have been developed as alternatives to formal polysomnography(PSG) for the assessment of children with snoring. In this mini-review basic features of PSG as well as alternative tests are presented and future perspectives are provided in addition to current guideline for the diagnosis and monitoring of childhood snoring. The aim of this review is to highlight briefly currently developed technologies that seem promising for the evaluation of snoring.

Snoring sounds’ statistical characteristics depend on anthropometric parameters

Snoring is common in people with obstructive sleep apnea (OSA). Although not every snorer has OSA or vice-versa, many studies attempt to use snoring sounds for classification of people into two groups of OSA and simple snorers. This paper discusses the relationship between snorers’ anthropometric parameters and statistical characteristics of snoring sound (SS) and also reports on classification accuracies of methods using SS features for screening OSA from simple snorers when anthropometric parameters are either matched or unmatched. Tracheal respiratory sounds were collected from 60 snorers simultaneously with full-night Polysomnography (PSG). Energy, formant frequency, Skewness and Kurtosis were calculated from the SS segments. We also defined and calculated two features: Median Bifrequency (MBF), and projected MBF (PMBF). The statistical relationship between the extracted features and anthropometric parameters such as height, Body Mass Index (BMI), age, gender, and Apnea-Hypopnea Index (AHI) were investigated. The results showed that the SS features were not only sensitive to AHI but also to height, BMI and gender. Next, we performed two experiments to classify patients with Obstructive Sleep Apnea (OSA) and simple snorers: Experiment A: a small group of participants (22 OSA and 6 simple snorers) with matched height, BMI, and gender were selected and classified using Na?ve Bayes classifier, and Experiment B: the same number of participants with unmatched height, BMI, and gender were chosen for classification. A sensitivity of 93.2% (87.5%) and specificity of 88.4% (86.3%) was achieved for the matched (unmatched) groups.

Characterization of Upper Air Way Tract in Snoring and Non-Snoring Patients: A CT Based Study

Snoring is part of the spectrum of sleep disordered breathing. The patients with snoring should be evaluated for nasal airway obstruction. In this study, the upper air way tract was characterized in snoring patients and compared with none snoring using a quantify method for the corresponding anatomic upper air way (UA) parameters examined by Computerized Tomography (CT). Two hundred Asian patients undergoing CT scanning for head and neck were included and were divided into two groups (snoring group [n = 127] and non-snoring group [n = 73]) (mean age: 44.8 ± 15.9 years and 26.2 ± 7.0). Total 8 parameters were measured on sagital reconstructed CT images for each subject. The differences in neck circumference (NC), linear distance between mandibular plane and hyoid bone (Mp-H), upper airway length (UAL), the maximum thickness of the soft palate (SP max), soft palate length (PNS-U), linear distance between anterior and posterior nasal spine (ANS-PNS), retroglosal width (RS), retroplatal width (RP) between the snoring and non-snoring groups were compared statistically using independent sample t-test. Results showed that the NC, UAL, and SP max were significantly higher in snoring group;however RP was found to be significantly lower. Inferior positioning of hyoid bone gives longer measurement for MP-H. In snoring group UAL was found to be significantly different at p ≤ 0.000 between the two genders. All the measured variables showed no significant differences in respect to age. UA CT quantitative features play an important role in the characterization of the anatomy and are compared between snoring patients and non-snoring subjects.

Ear Field Adaptive Noise Control for Snoring:An Real-time Experimental Approach

In this paper, an active noise control(ANC) system is developed to provide an effective and non-intrusive solution for reducing loud snoring to provide a quiet environment for a snorer's bed partner. An adaptive least mean square(LMS)algorithm optimized for different kinds of snore signals is introduced and theoretically analyzed. Also, a residual noise masking approach is proposed to further reduce the effect of the snore noise without interfering with the LMS algorithm. Computer simulations followed by real-time experiments are conducted to demonstrate the feasibility of the snore ANC systems based on a pillow setup. For the optimum effect based on the characteristics of human hearing, the performance of the proposed approach is evaluated by using the multi-channel feedforward ANC systems based on the filtered-X least mean square(FXLMS) algorithm.Compared with a traditional headboard setup for snoring noise control, the proposed snore ANC systems optimized for ear field operation yield much higher noise reduction around the ears of the snorer's bed partner.

Effectiveness of Low-Temperature Plasma Adenoidectomy Combined with Bilateral Tonsillectomy in the Treatment of Snoring in Children and Its Effect on Sleep Quality

Objective:To evaluate the therapeutic effect of low-temperature plasma adenoidectomy(abbreviation:adenoid low-temperature plasma excision)coupled with tonsillectomy(bilateral)on snoring in children.Methods:Seventy-six cases of snoring children treated in the hospital between November 2020 and November 2023 were selected.38 cases of children in Group A agreed to surgery and were admitted to the hospital for surgical treatment and were treated with adenoid cryo-plasma excision combined with tonsillectomy(bilaterally),and 38 cases of children in Group B did not agree to outpatient conservative treatment for surgery,and the results of the treatment were compared.Results:Before treatment,there was no difference between the ventilation function indexes,sleep quality scores,and quality of life scores of the two groups compared with each other(P>0.05).After treatment,the ventilation function indexes of Group A were better than Group B,and the sleep quality score and quality of life score were higher than that of Group B.The total effective rate of Group A was higher than that of Group B(P<0.05).Conclusion:Adenoid cryo-plasma excision combined with tonsillectomy(bilateral)can improve the quality of life,ventilation function,and sleep quality of children with snoring,and can enhance the efficacy.

Association between Self-reported Snoring and Prediabetes among Adults Aged 40 Years and Older without Diabetes

Background：Several previous studies have shown that snoring is associated with glucose metabolism and the development of diabetes,but rare study has shown the association between snoring frequency and prediabetes,particularly in China.We hypothesized that individuals who snore might have a higher risk of prediabetes.This study aimed to investigate the association between self-reported snoring and prediabetes in a Chinese population.Methods：A cross-sectional study was performed in three large communities of Beijing from December 2011 to August 2012 by recruiting individuals aged ≥40 years old.All participants were requested to complete a detailed questionnaire and undergo anthropometric measurements.A 75 g oral glucose tolerance test was performed in individuals without diabetes.Blood samples of all participants were collected;blood glucose and blood fat levels were measured.Multivariate logistic regression models were built to assess the association between snoring frequency and prediabetes.Results：A total of 13,592 participants （female：66.56%;mean age：56.8 ＆#177; 7.9 years;mean body mass index：25.5 ± 3.4 kg/m2） were included in the final analysis.Of these,30.9% were diagnosed with prediabetes,while 41.3% and 25.4% had occasional and habitual snoring,respectively.Habitual snoring was associated with an increased risk of prediabetes （odds ratio [OR]：1.3,95% confidence interval [CI]：1.1-1.4,P 〈 0.001）,after adjusting for diabetes and sleep-related confounders in the multivariable models.Habitual snoring was also associated with isolated impaired fasting glucose （IFG;OR：1.3,95% CI：1.0-1.6;P 〈 0.001） and isolated impaired glucose tolerance （IGT;OR：1.3,95% CI：1.2-1.5;P 〈 0.001）,but not IFG ＋ IGT （OR：1.1,95% CI：0.9-1.4;P =0.281）.When stratified by total cholesterol （TC） levels,this association between habitual snoring and prediabetes was observed only in individuals with TC 〈5.6 mmol/L （OR：1.4,95% CI：1.2-1.6;P〈 0.001）.Conclusions：Habitual snoring is associated with prediabetes,but only in individuals with TC 〈5.6 mmol/L.Further prospective studies are needed to confirm this finding.

Radiofrequency ablation of the lateral palatal space for snoring

Objective:Pilot study to examine the effect of radiofrequency ablation (RFA) of the lateral palatal fat pad in patients with socially-disruptive snoring.Method:Snoring outcomes and complications were compared between a group of patients with treated with RFA ablation of the lateral soft palate fat pad with or without inferior turbinate reduction (8 patients) and another group undergoing inferior turbinate reduction alone (12 patients).Results:Snoring loudness and bothersomeness improved in the palate but not inferior turbinate group.Pain was mild and no major complications were observed.Conclusion:The study supports RFA ablation of the lateral palatal space as a potential low morbidity procedure for snoring.

Epworth嗜睡量表联合鼾声量表在阻塞性睡眠呼吸暂停低通气综合征筛查中的应用

阻塞性睡眠呼吸暂停低通气综合征（OSAHS）是最常见的睡眠障碍形式,伴有打鼾、睡眠结构紊乱、白天嗜睡等病症,其发病率在西方国家报道约为2%～5%,可发生在任何年龄阶段,随着研究的深入,OSAHS作为许多疾病的源头已得到共识，它不仅严重影响患者的生活质量和工作效率，而且易并发心脑血管疾病，具有潜在的危险性。

Prospective study of the prevalence and co-morbidities of obstructive sleep apnea in active-duty army personnel in the three southernmost provinces of Thailand using questionnaire screening

Background: It is crucial for the army to know the prevalence of obstructive sleep apnea(OSA) syndrome in activeduty army personnel. Little information has been reported on the prevalence of OSA and clinical features in activeduty army personnel. This study was aimed to estimate the prevalence of snoring and risk of developing OSA in activeduty army personnel in Thailand and to identify the co-morbidities of OSA. In total, 1107 participants who were aged20–60 years and were deployed to the three southernmost provinces of Thailand were enrolled. All the participants completed the Phramongkutklao(PMK) Hospital OSA Questionnaire that was modified and validated from the Berlin Questionnaire and underwent physical examination. The participants were 1107 active-duty army personnel in the three southernmost provinces of Thailand, both males and females, aged 20–60 years.Methods: The PMK OSA Questionnaire was used to assess the risk of OSA together with interviewing for snoring,fatigue, falling asleep and day-time sleepiness. Physical examination of the neck, chest and hip circumference,and height was performed. Information concerning physical training, co-morbid diseases, smoking and alcoholic consumption was collected.Results: The prevalence of snoring was 58.5, and 4.8% met the PMK OSA Questionnaire criteria, thus indicating a high risk of OSA. The information obtained indicated that laryngopharyngeal reflux(LPR), current smoking and alcoholic consumption were significantly higher in the high-risk OSA group.Conclusions: Early detection and treatment of OSA in active-duty army personnel are imperative. Physical examination and polysomnography can be used to reveal the high-risk group. High body mess index(BMI), laryngopharyngeal reflux, current smoking and alcoholic consumption are modifiable factors for OSA and are avoidable. A policy to decrease the BMI and risk of LPR, as well as to stop smoking and alcoholic consumption, should be applied.

Epworth嗜睡量表在阻塞性睡眠呼吸暂停低通气综合征筛查中的应用价值

阻塞性睡眠呼吸暂停低通气综合征（OSAHS）是指各种原因导致睡眠状态下反复出现呼吸暂停和（或）低通气、高碳酸血症、睡眠中断,从而使机体发生一系列病理生理改变的临床综合征。现在人们越来越多的认识到OSAHS对健康的危害,

Relationship between obstructive sleep apnea hypopnea syndrome and cardiovascular disorders in adult snorers

Objective：To investigate the relationship between sleep apnea hypopnea syndrome（OSAHS） and some cardiovascular disorders in adult habitual snorers as well as the effectiveness of nasal continuous positive airway pressure（NCPAP） on those with OSAHS. Methods： With the use of polysomnography, 262 adult habitual snorers were examined and divided into the OSAHS group and the Non-OSAHS group （control）. Using ambulatory electrocardiogram and blood pressure measurement, daily nocturnal rhythm of blood pressure, hypertension, heart rate variability, some arrythmias and angina pectoris of coronary heart disease were monitored and compared between the two groups, before and after 14 days of treatment with NCPAP in the OSAHS group. Results.This study indicated a higher incidence （39.6%） of OSAHS in adult snorers and demonstrated that there was a significantly higher incidence of hypertension, disappearance of the daily nocturnal rhythm of blood pressure, poor effectiveness of nitrate on angina pectoris of coronary heart disease, decreased heart rate variability during sleep, increased arrythmias and lower SpO2 levels in the OSAHS group than in the Non-OSAHS group. After NCPAP treatment during sleep, snoring control, significantly higher SpO2 and lower apnea hypopnea indices were achieved in the OSAHS group; heart rate variability and daily nocturnal rhythm of blood pressure returned to normal levels. Conclusion：The results of this research suggested that there was a close relationship between the development of OSAHS and some cardiovascular disorders. Furthermore, NCPAP treatment was effective not only on OSAHS but also on coexisting cardiovascular disorders.

Sleep breathing disorders in female population of Dubai, UAE

PURPOSE: United Arab Emirates (UAE) is part of the GCC countries and ranks 18 on 2007 WHO list of the fattest countries with 68.3% of its citizens with an unhealthy weight. The WHO data in 2008 state that the prevalence of overweight in UAE is 71%, while it is 61% in the UK, 54% in Germany, and 45% in France. The increasing overweight and obesity in the UAE are closely related to high social-economic development. Accordingly, the medical authority has observed that the rates of hypertension and diabetes mellitus type 2 appear to be one of the highest rates worldwide. We presume that the increase prevalence of obesity in the UAE would be linked to the increase in prevalence of obstructive sleep apnea syndrome (OSAS). The purpose of this study is to estimate the prevalence of symptoms and risk of OSAS in women followed up in the primary health care (PHC) setting in Dubai and the relationship between obesity and sleep apnea in females in the UAE. DESIGN: Prospective observational community-based survey. SETTING: 20 primary health centers in Dubai. PARTICI-PANTS: Consecutive female patients who were older than 14 years, regardless of the reason of their visit. METHODS: In this prospective survey, trained medical nurse administered the Berlin Questionnaire (which includes questions about self-reported snoring, witnessed apneas, daytime sleepiness, hypertension, and obesity) to a consecutive random sample of female patients in the age group older than 14 years, attending the PHC center in Dubai Health Authority, Dubai, UAE, from September 2011 to March 2012. Based on the questionnaire, individuals were classified into high-risk and low-risk groups for OSAS. RESULTS: Based on the responses and measurement of the Berlin Questionnaire of 704 female subjects studied, 137 respondents met the criteria for the high-risk scoring. This gives a prevalence rate of 19.5% while the remainders of the participants were classified as low risk. The overall mean age of the high risk for OSAS female respondents was 39.95 ± 11.73 years. The highest prevalence was noticed between age group 51 to 60 years. 70% of the high risk group patients had Body Mass Index (BMI) ≥30 kg/m2 and nearly 75% of the low risk group had BMI 2 and the Mean BMI was 33.59 ± 6.44 kg/m2. CONCLUSIONS: One in five women in Dubai, UAE is at high risk of having OSAS. Awareness by the primary care medical community about this disorder in females should be increased so that the patients would benefit from proper evaluation and treatment of OSAS.

Changes in Breastfeeding and of Breasts before and after Babies’ Surgeries for Ankyloglossia with Deviation of the Epiglottis and Larynx (ADEL) —Healthy Breastfeedin

Background: Historically frenotomy was performed at newborn babies’ baptism for healthy breast-feeding over many centuries. Although it was necessary for nursing babies, its application was denied subjectively without clinical observation since the early 20th century. As a result solutions for breastfeeding and breast problems are confused now. Methods: We studied changes in breastfeeding and mothers’ breasts before and one month after the surgeries for ADEL by standards for healthy breastfeeding and breasts. Results: With regard to suckling, before the surgeries 24% of babies opened their eyes during breastfeeding, while after surgeries 76% opened eyes while nursing. 30% of the babies latched onto the mother’s breast with a wide-open mouth. After surgeries, 84% properly latched on. 73% of the babies had calluses on the upper lip before surgeries, and no calluses were observed after surgeries. 27% of babies before surgeries moved the jaws during breast-feeding, but after surgeries 88% moved the jaws while nursing. White debris was on the dorsum tongue in 70% of babies prior to surgeries. After surgeries, 22% were with debris. 67% of mothers experienced nipple pain before their babies’ surgeries while 6% had pain after the surgeries. Flattened nipples were observed in 55% of mothers before the infants’ surgeries, 7% after surgeries. 23% of mothers had breast pain before the surgeries, and 4% had breast pain after the surgeries. Mastitis was also reduced from 9% to 1% after surgeries. 73% of women had palpable breast masses, and after the surgeries 25% had palpable masses. Summary: Remarkable improvements in breastfeeding and in women’s breasts were achieved after their infants underwent operations for ADEL. These results indicate the necessity of surgical interventions in babies with ADEL for healthy breastfeeding and breasts (279).

A simplified two-piece mandibular advancement appliance for obstructive sleep apnea

Nowadays mandibular advancement appliances (MA- As) are available and distributed widely in the field of dentistry for the treatment of snoring and ob- structtive sleep apnea (OSA). However, a few stud- ies discussed temporomandibular joint (TMJ) discom- fort and masticatory muscle stiffness during wearing MAAs are found. A new appliance that we introduced in this pilot study has shown significant jaw move- ment and could diminish TMJ and masticatory side effects.

Alternating sleeping arrangements as a coping strategy for snorers and their bed partners—A prospective study

Background: Despite overwhelming evidence for gender differences in sleep quality as well as gender-specific changes of sleep parameters with respect to habitual sleeping arrangements, studies on snorers and their bed partners have ignored the influence of individual quality of sleep as a potential co-factor. Objective: The objective of this study was to record subjective and objective sleep parameters and to analyze the effects of alternating of sleeping arrangements in snorers and their bed partners. Methods: Habitual snorers and their bed partners were recruited via newspaper articles not stating the exact purpose of the study. Both filled out a 90-day sleep diary. During this time, we recorded subjective and objective sleep parameters in the snorers and their bed partners via wrist actigraphy and sleep diaries for 14 days. For statistical analysis, we used two-sided t-tests and Spearman’s Rho. Results: The dataset included 45 snorers (11 females) and 45 bed partners (34 females) with a mean age of 47 ± 13 and 43 ± 12 years. Screening for sleep apnea yielded snoring without OSAS, mild-, moderate- and severe OSAS in 27 (60%), eight (18%), three (7%) and six (15%) snorers. PSQI total scores were significantly lower in snorers than in bed partners (4 ± 2 vs. 6 ± 4, p = 0.002). We could not find a significant correlation between subjective and objective sleep latency and efficiency. Couples who changed their sleeping arrangement were significantly younger than those who habitually slept alone or together (p = 0.01). Subjective sleep parameters of snorers or bed partners were not related to the number of consecutive nights spent either together or apart. Conclusions: Our study confirmed the weak correlation of subjective and objective sleep parameters in pairs with snoring problems. Couples changing their sleeping arrangement were the youngest among the whole group, but their separation of sleeping arrangements did not improve subjective sleep parameters.

Failure Rate of Adenoidectomy and Reasons of Failure in the Short Term

Objectives: The aim of the present study was to analyze the recovery rate of symptoms in patients with adenoid hypertrophy and investigate the role of nasal pathologies, allergy and gastroesophageal reflux (GER) as the reason of failure in patients with persistent symptoms. Patients and Methods: Patients undergoing adenoidectomy were enrolled in this study. There were 58 males and 42 females, aged between 1 - 13 years (mean ± SD: 4.9 ± 2.2 years). The parents of each child were questioned about the following symptoms;apnea, nasal obstruction, mouth breathing, snoring and nasal discharge. Presence or absence of nasal obstruction due to septal deviation and/or chonchal hypertrophy was noted. All children were evaluated for GER by upper gastrointestinal endoscopy or pH monitorization and for allergy by specific IgE analysis or skin prick test. Three months after the operation the children were re-examined and their parents were interviewed about persistent symptoms. Patients with persistent symptoms were re-evaluated with rigid endoscopy for residual adenoid vegetation. Results: Apnea was cleared in the entire group postoperatively. However, 9 patients complained of nasal obstruction, 16 patients had mouth breathing, 9 patients had snoring and 17 patients continued to have nasal discharge two months after the operation. Statistical assessment showed a significant difference for each symptom between the pre- and postoperative level (p Conclusions: Adenoidectomy alone is an effective treatment for nasal obstruction and obstructive sleep symptoms in children. Persistent obstructive symptoms are usually due to nasal pathology and allergy.

鼾声声学特征研究现状

鼾声是睡眠时上气道发出的特殊声音,也是单纯打鼾和阻塞性睡眠呼吸暂停低通气综合征患者最突出的症状之一.近十余年来,对于鼾声声学特征的研究越来越多,本文从鼾声产生机制的理论及模型、影响因素、鼾声来源的观察、鼾声采集方法、目前的研究结果等方面进行综述.

鼻用糖皮质激素对小儿鼾症的疗效

鼻用糖皮质激素因具有强大的抑制变态反应、抗炎及抗水肿作用,临床上作为治疗变应性鼻炎（AR）、鼻窦炎和鼻息肉的一线用药,其疗效已经得到了普遍认同和证实。鼻用糖皮质激素喷鼻的给药方式不仅作用于鼻腔,亦使得整个上气道受益。腺样体肥大是小儿鼾症最主要的病因之一,