Subjective and objective assessment of uvulopalatopharyngoplasty for treatment of snoring and obstructive sleep apnea.

Miljeteig, Harald; Mateika, Susan; Haight, James S. J.; Cole, Philip; Hoffstein, V.

doi:10.1164/ajrccm.150.5.7952554

Cited by 95 publications

(62 citation statements)

References 13 publications

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“…Other studies have found differences between subjective and objective measurements of snoring, for example post uvulopalatopharyngoplasty where subjective improvement without objective alteration in snoring index was noted [11]. Furthermore, where objective improvements are noted, the correlation with subjective measures may be weak [12].…”

Section: Discussionmentioning

confidence: 97%

Long-term use of mandibular advancement splints for snoring and obstructive sleep apnoea: a questionnaire survey

et al. 2001

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A mandibular advancement splint (MAS) may be an alternative treatment for snoring and obstructive sleep apnoea (OSA). However, there is little subjective or objective information concerning long-term effectiveness, compliance and side effects.A retrospective questionnaire was used to survey these issues plus patient satisfaction and maintenance requirements in 166 patients who could have worn a mandibular advancement splint for over a year.One-hundred and twenty-six (76%) subjects returned the questionnaire, (84 with OSA, 42 snorers), of whom 69 (55%) reported still using the splint regularly, 47 (37%) every night. The most common reported reasons for stopping use were discomfort (29/ 57; 52% of nonusers), and poor perceived efficacy (12 subjects). Users reported more daytime symptoms, and they and their partners were more likely to observe improvements with splint use. Side effects were reported by 49 subjects, more commonly in nonusers. Sixty-five of 67 current users and 23 of 41 nonusers reported less snoring with splint use (p~v0.001).Long-term mandibular advancement splint usage appeared less satisfactory than previously reported, however, splints were considered effective by 97% of current users and even by over half of those who had stopped use. Reasons for stopping use included side effects, social circumstances, dental treatment, as well as lack of perceived efficacy. Snoring and obstructive sleep apnoea (OSA) may result from collapse of the upper airway during sleep because of loss of muscle tone and anatomical factors. Bringing the mandible forward advances the tongue and thus enlarges the retroglossal airway, reducing the tendency to collapse [1]. Mandibular advancement devices are therefore being increasingly used as a treatment for snoring and as a possible alternative to nasal continuous positive airway pressure (CPAP) devices in OSA. Several randomized controlled trials of mandibular advancement splints (MAS) or nasal CPAP have shown splints to be effective in some patients and although they do not always lower the apnoea-hypopnoea index (AHI) as satisfactorily as CPAP, they are preferred by most patients in shortterm trials of 4 -12 weeks treatment [2 -4]. One study of long-term use of CPAP over a median follow up of 22 months, showed that 20% of 1,103 people stopped treatment after taking a machine home [5]. However, follow up with MAS has been limited to much smaller numbers and for a shorter time, with few data on longterm usage [6]. As splints are usually fitted because a patient is symptomatic or their partner complains about their snoring, continued use of the device will depend on the patient and their partner9s perceptions of symptomatic benefit and side effects. A retrospective questionnaire based study of factors affecting continued usage of mandibular advancement splints in 166 consecutive patients who had had a splint for at least one year was carried out. MethodsOne-hundred and sixty-six patients (140 males, 26 females) with sleep disordered breathing (111 OSA, 55 snorers)...

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Section: Discussionmentioning

confidence: 97%

Long-term use of mandibular advancement splints for snoring and obstructive sleep apnoea: a questionnaire survey

et al. 2001

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“…Although snoring is a hallmark symptom of OSA, it is rarely measured objectively, and there is no standard method to do so. In this study, snoring intensity was objectively measured with an audiometer placed 1 m from the mouth, a technique similar to that used by previous groups [28,29]. Analysis was performed using the maximum for NREM and REM stages of sleep, with the area under the curve and the % sleep time >50 dB; therefore, the recordings are believed to be accurate.…”

Section: Discussionmentioning

confidence: 99%

Effect of moderate alcohol upon obstructive sleep apnoea

Scanlan

Roebuck²,

Little

et al. 2000

European Respiratory Journal

134

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Moderate-to-large quantities of alcohol are known to aggravate severe obstructive sleep apnoea (OSA), however, the reported effects of moderate alcohol consumption upon mild-to-moderate OSA are inconsistent. Given the reported benefits of moderate alcohol consumption on cardiovascular mortality, recommendations regarding the management of patients with OSA are difficult to formulate. The aim of this study was to evaluate the effects of moderate alcohol on sleep and breathing in subjects with mild-to-moderate OSA.Twenty-one male volunteers, who snored habitually, underwent polysomnography with and without 0.5 g alcohol . kg body weight (BW) -1 consumed 90 min prior to sleep time, in random order. The mean blood alcohol concentration (BAC) following alcohol at the time of lights out was 0.07 g . dL -1 . The distribution amongst the various sleep stages was not significantly altered by alcohol. The mean apnoea/hypopnoea index rose from 7.11.9 to 9.72.1 events . h -1 (meanSEM, p=0.017); however, there was no significant change in the minimum arterial oxygen saturation measured by pulse oximetry Sp,O 2 , apnoea length or snoring intensity. Mean sleep cardiac frequency rose significantly from 53.91.4 to 59.91.9 beats . min -1 (p<0.001) and overnight urinary noradrenalin increased from 14.92.3 to 18.82.3 nmol . mmol creatinine -1 (p=0.061) on the alcohol night compared to the nonalcohol night.To conclude, modest alcohol consumption, giving a mean blood alcohol concentration of 0.07 g . dL

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“…Because they were restudied after a period with the device, and acted as their own controls, we are confident that this is a real effect. Although in surgical series the subjective improvement in snoring is hard to verify objectively [11,21], this has not proved to be the case with these devices. It must be acknowledged that this group of patients was largely self-selected by their continued use of the device, compared to those who had abandoned such a device and were not therefore eligible for the trial.…”

Section: Discussionmentioning

confidence: 99%

“…Most of the above studies have looked at the occurrence of apnoeas and have not objectively measured the effect on snoring. Recent studies on the control of snoring by surgical techniques have suggested that the subjective reporting of improvement in snoring following interventions is unreliable and not confirmed by objective recordings [11]. In addition the reporting of snoring is unreliable in epidemiological studies [12].…”

mentioning

confidence: 99%

Mandibular advancement devices for the control of snoring

Stradling

Negus²,

Smith³

et al. 1998

Eur Respir J

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Patients presenting with the complaint of antisocial snoring have very few options available to them of proven efficiency. Mandibular advancement devices worn intra-orally at night, have recently been shown in controlled trials to help mild to moderate obstructive sleep apnoea. However, there are no properly controlled studies with objective measurements on the use of such appliances for the management of antisocial snoring. Fifteen patients, already established on mandibular advancement devices for the control of snoring, were asked to participate in this study. They were studied over two nights, using a portable sleep monitoring device at home, both with and without their mandibular advancement devices in place (in randomized order). Snoring was measured using a surface throat microphone. In addition oxygen saturation and indirect beat to beat blood pressure were measured. The latter (using pulse transit time) provided an index of autonomic "arousals" and a measure of inspiratory effort. In nearly all of these highly selected patients the mandibular advancement devices reduced significantly the amount of snoring from a median of 193 to 20 snores x h(-1) (p<0.0001). In addition there was a reduction in respiratory effort, implying enlargement of the upper airway whilst wearing the appliance. These patients only represent those who were able to tolerate the appliance. With such clear evidence of their potential efficacy, and no suggestion from other studies of any harm, it would seem reasonable to introduce this approach into the management of antisocial snoring.

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Subjective and objective assessment of uvulopalatopharyngoplasty for treatment of snoring and obstructive sleep apnea.

Cited by 95 publications

References 13 publications

Long-term use of mandibular advancement splints for snoring and obstructive sleep apnoea: a questionnaire survey

Long-term use of mandibular advancement splints for snoring and obstructive sleep apnoea: a questionnaire survey

Effect of moderate alcohol upon obstructive sleep apnoea

Mandibular advancement devices for the control of snoring

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