[Smoking and sleep disorders]

Snoring and sleep apnea-hypopnea syndrome (SAHS) are two disorders of considerable relevance due to their high prevalence in the general population and their notable morbidity and mortality, particularly in association with their harmful effects on the cardiovascular system. As well as sex, age, weight, craniofacial malformations, alcohol consumption, and use of hypnotic drugs, it has been suggested that smoking may be a risk factor for developing sleep-disordered breathing. While there is solid evidence for the independent association between snoring and smoking in both children and adults, it is still unclear whether smoking constitutes an independent risk factor for developing SAHS, despite the many studies carried out to assess this link. This is probably because the association, if it exists, is very weak.

Snoring: referral, investigation and treatment

Snoring is a common problem and the incidence increases with age. The significance of snoring as a symptom of sleep disordered breathing must not be overlooked in assessing this complaint. This article aims to highlight some of the important aspects in the investigation and management of a snoring patient.

Palatal surgery for snoring: objective long-term evaluation

Snoring surgery has mainly been assessed in the literature using subjective outcome measures with some evidence to indicate that the benefits of surgery are short lived. There is remarkably little published on the objective outcome of snoring surgery. We reported previously short-term (2-11 months) objective results on 38 patients who had palatal surgery. All the patients had preoperative and postoperative objective assessment of their snoring loudness and duration in the home. The current study presents the long-term objective results of 24 patients from the same cohort. All patients who were included in our study had palatal snoring confirmed on sleep nasendoscopy. and none of them had significant obstructive sleep apnoea. The median follow-up period was 45 months (range 29-56 months). Overall, the mean snore index (SI) at long-term follow-up was significantly less than the preoperative SI (P < 0.0001). There was no significant difference between the short-term and the long-term results regarding the fall in the SI. This study is the first to use postoperative objective assessment in the home and to demonstrate that snoring reduction is maintained for several years after snoring surgery.

Somnoplastia: tratamiento del ronquido crónico mediante radiofrecuencia sobre el paladar

The goal of this study is to evaluate the efficacy and the safety of tissue reduction of the palate by means of radiofrequency for the treatment of snoring. Fifty-three patients were evaluated. Eight of them (15%) met criteria for mild OSAS. All of them underwent RF energy treatment with several ablation sites and the mean total energy administered was about 2500 J per treatment session. 40 patients (75%) underwent an additional RF treatment and the energy administered in the second session was the same as in the first one. We evaluated postoperative pain, snoring and the satisfaction of the patient and his enviroment. After a mean follow-up of 20 months no adverse effect was reported. The success diminishes with time as happens other surgical procedures (UPPP or LAUP) but the absence of serious adverse side-effects and the minimal postoperative pain support the use of RF as an effective procedure for reducing snoring.

Injection snoreplasty: how to treat snoring without all the pain and expense

OBJECTIVE

We introduce Injection Snoreplasty: an innovative, safe, and effective palatal snoring procedure with minimal cost and discomfort to the patient. A well-described sclerotherapy agent, Sotradecol, is injected into the soft palate to reduce/eliminate palatal flutter snoring.

STUDY DESIGN AND SETTING

Twenty-seven patients with a diagnosis of palatal flutter snoring (respiratory disturbance index less than 10) by sleep study were enrolled in the protocol. Office treatment sessions were performed 6 to 8 weeks apart. Success was judged by subjective improvement in snoring and objective evidence of palatal stiffening/scarring.

RESULTS

Twenty-five (92%) of 27 patients reported significant decrease in snoring. There were no significant postinjection complications. Visual analog pain scale confirmed minimal discomfort. Most patients received more than 1 treatment (average, 1.8) in order to receive optimal palatal stiffening.

CONCLUSION/SIGNIFICANCE

Injection Snoreplasty is a simple, safe, and effective office treatment for primary snoring. Advantages over current snoring procedures include simplicity, low cost, decreased posttreatment pain levels, and minimal/no convalescence.

Uvulopalatopharyngoplasty versus laser assisted uvulopalatoplasty for the treatment of snoring: an objective randomised clinical trial

This study was designed to evaluate objectively the clinical effectiveness of surgery for snoring and to compare the results of conventional uvulopalatopharyngoplasty (UPPP) and laser assisted uvulopalatoplasty (LAUP) in the treatment of snoring. Patients who had been referred for investigation and treatment of their snoring were randomly allocated to receive either UPPP or LAUP. Forty-seven patients with confirmed palatal flutter had surgery and all of them had a preoperative and postoperative objective assessment of their snoring loudness and duration in the home. The recording device (Snore Box) is simple for the patient to operate, portable with a built in microphone, and able to produce objective results, which can be automatically analysed. Of the 38 patients, who had technically valid recordings, 22 underwent LAUP and 16 UPPP. Overall the mean postoperative Snore Index (SI) was less than the preoperative SI (P < 0.0001), the average difference being 78.2 snores/h. There was no significant difference between the LAUP and UPPP regarding the fall in the SI. This study is the first objective comparative study to demonstrate the effectiveness of snoring surgery.