Australasian Sleep Association position statement on consensus and evidence based treatment for primary snoring

Abstract

Primary snoring impacts a significant portion of the adult population and has the potential to significantly impair quality of life. The purpose of these guidelines is to provide evidence‐based recommendations to assist Australasian practitioners in the management of adult patients who present with primary snoring without significant obstructive sleep apnoea. The Timetable, Methodology and Standards by which this Position Statement has been established is outlined in the Appendix S1. The main recommendations are: Weight loss, and reduced alcohol consumption should be recommended, where appropriate If clinical judgement dictates, benzodiazepine and opioid reduction or avoidance may be advised Positional therapy should be considered in supine dominant snorers In dentate patients, Mandibular advancement devices (MAD) should be recommended as a first line treatment following assessment by both an appropriate Dentist and Sleep physician Continuous positive airway pressure (CPAP) devices may be recommended in patients with primary snoring in those already committed to their use or willing to try Surgical treatment of primary snoring by an appropriately credentialled surgeon may be advised and includes nasal (adjunctive), palatal and other interventions This position statement has been designed based on the best available current evidence and our combined expert clinical experience to facilitate the management of patients who present with primary snoring. It provides clinicians with a series of both non‐surgical and surgical options with the aim of achieving optimal symptom control and patient outcomes. This is the first such set of recommendations to be established within Australasia and has also been reviewed and endorsed by the Australasian Sleep Association.

Usual dietary intake and change in DNA methylation over years: EWAS in KORA FF4 and KORA fit

“…The longitudinal association indicates increased methylation at the time of the Fit survey which some studies show can result in gene suppression due to the CpG positioned in the first exon (34). Another CpG was associated with the DLEU7 gene, which was shown to be associated with snoring (35) and therefore this epigenetic mechanism could be related to alcohol-induced snoring (36).…”

Mandibular Advancement vs Combined Airway and Positional Therapy for Snoring

“…The median (min-max) of the pre-and posttreatment PSQI score for the MAD group was 6 (2-14) and 4 (1-12), respectively. For the CAPT group, pre-and posttreatment PSQI scores were 6 (3-18) and 6 (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17), respectively. The median (min-max) of preto posttreatment PSQI score change was 3 (−1 to 11) for the MAD group and 0 (−4 to 5) for the CAPT group for a median difference of −3 (95% CI, −6 to −1) favoring the MAD group.…”

“…However, only 1 of the 18 studies included primary snorers without OSA, and the sample size was small (N = 8) and did not provide a primary snoring definition. In 2023, the Australasian Sleep Association position statement on snoring identified MAD as first-line treatment for snoring …”

“…In 2023, the Australasian Sleep Association position statement on snoring identified MAD as first-line treatment for snoring. 13 Snoring is an unusual clinical condition, as the person snoring may experience less bother than family members or friends. Loud snoring can be disruptive for the sleeping partner and other members of the house and can prevent people who snore from engaging in overnight trips and other social activities.…”

Up‐to‐date data on NightLase laser treatment of snoring for discussion

“…To the Editors: I read with great appreciation the article entitled '"Australasian Sleep Association position statement on consensus and evidence-based treatment for primary snoring" in a recent issue of Respirology'. 1 However, it is not clear whether the authors have direct experience in the use of various laser treatments for snoring. Under the heading '"Other surgical options', the Australasian Sleep Association (ASA) position statement reads 'Office based treatments such as laser assisted uvuloplasty (LAUP) and use of the Er:YAG laser (NightLase) have limited clinical effectiveness to support implementation with potential long-term side effects'.…”