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Published in: Sleep and Breathing 2/2021

Open Access 01-06-2021 | Polysomnography | ENT • Review

Diagnosis and treatment of isolated snoring—open questions and areas for future research

Authors: B. Hofauer, B. Braumann, C. Heiser, M. Herzog, J. T. Maurer, S. Plößl, J. U. Sommer, A. Steffen, T. Verse, B. A. Stuck

Published in: Sleep and Breathing | Issue 2/2021

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Abstract

Study objectives

Snoring is a common phenomenon which is generated by vibration of soft tissue of the upper airway during sleep. Due to the high incidence of isolated snoring and the substantial burden for the patient and the bed partner, a thorough examination and appropriate therapy are required. Many recommendations for the treatment of isolated snoring are either not evidence-based or are derived from recommendations for the management of obstructive sleep apnea. Therefore, the aim of this study is the identification and description of open questions in the diagnosis and treatment of isolated snoring and the illustration of areas for further research.

Methods

In the context of the development of the new version of the German guideline “Diagnosis and treatment of isolated snoring in adults,” a multidisciplinary team of experts performed a systematic literature search on the relevant medical data and rated the current evidence regarding the key diagnostic and therapeutic measures for snoring.

Results

The systematic literature review identified 2293 articles. As a major inclusion criterion, only studies on primary snoring based on objective sleep medical assessment were selected. After screening and evaluation, 33 full-text articles remained for further analysis. Based on these articles, open questions and areas for future research were identified for this review.

Conclusion

Several major gaps in the literature on the diagnosis and treatment of isolated snoring were identified. For the majority of diagnostic and therapeutic measures for snoring, high-level scientific evidence is still lacking.
Literature
1.
go back to reference Medicine AAOS (2014) International classification of sleep disorders, 3rd edn. American Academy of Sleep Medicine, Darien Medicine AAOS (2014) International classification of sleep disorders, 3rd edn. American Academy of Sleep Medicine, Darien
2.
go back to reference Stuck BA, Weeß HG (2015) Die neue “international classification of sleep disorders”. Eine kritische Würdigung der diagnostischen Kriterien für schlafbezogene Atmungsstörungen. Somnologie (Berl) 19:126–132CrossRef Stuck BA, Weeß HG (2015) Die neue “international classification of sleep disorders”. Eine kritische Würdigung der diagnostischen Kriterien für schlafbezogene Atmungsstörungen. Somnologie (Berl) 19:126–132CrossRef
3.
go back to reference Rosen DM, Kundel V, Rueschman M, Kaplan R, Guo N et al (2019) Self-reported snoring and incident cardiovascular disease events: results from the Jackson Heart Study. Sleep Breath Rosen DM, Kundel V, Rueschman M, Kaplan R, Guo N et al (2019) Self-reported snoring and incident cardiovascular disease events: results from the Jackson Heart Study. Sleep Breath
4.
go back to reference Hoffstein V (2005) Snoring and upper airway resistance. In: Kryger M, Roth T, Dement WC (eds) Principles and practice of sleep medicine. Elsevier Saunders, Philadelphia, pp 1001–1012CrossRef Hoffstein V (2005) Snoring and upper airway resistance. In: Kryger M, Roth T, Dement WC (eds) Principles and practice of sleep medicine. Elsevier Saunders, Philadelphia, pp 1001–1012CrossRef
5.
go back to reference De Meyer MMD, Jacquet W, Vanderveken OM, Marks LAM (2019) Systematic review of the different aspects of primary snoring. Sleep Med Rev 45:88–94CrossRef De Meyer MMD, Jacquet W, Vanderveken OM, Marks LAM (2019) Systematic review of the different aspects of primary snoring. Sleep Med Rev 45:88–94CrossRef
6.
go back to reference Ohayon MM, Guilleminault C, Priest RG, Caulet M (1997) Snoring and breathing pauses during sleep: telephone interview survey of a United Kingdom population sample. BMJ 314:860–863CrossRef Ohayon MM, Guilleminault C, Priest RG, Caulet M (1997) Snoring and breathing pauses during sleep: telephone interview survey of a United Kingdom population sample. BMJ 314:860–863CrossRef
7.
go back to reference Chan CH, Wong BM, Tang JL, Ng DK (2012) Gender difference in snoring and how it changes with age: systematic review and meta-regression. Sleep Breath 16:977–986CrossRef Chan CH, Wong BM, Tang JL, Ng DK (2012) Gender difference in snoring and how it changes with age: systematic review and meta-regression. Sleep Breath 16:977–986CrossRef
8.
go back to reference Marin JM, Carrizo SJ, Vicente E, Agusti AG (2005) Long-term cardiovascular outcomes in men with obstructive sleep apnoea-hypopnoea with or without treatment with continuous positive airway pressure: an observational study. Lancet 365:1046–1053CrossRef Marin JM, Carrizo SJ, Vicente E, Agusti AG (2005) Long-term cardiovascular outcomes in men with obstructive sleep apnoea-hypopnoea with or without treatment with continuous positive airway pressure: an observational study. Lancet 365:1046–1053CrossRef
9.
go back to reference Lee SA, Amis TC, Byth K, Larcos G, Kairaitis K et al (2008) Heavy snoring as a cause of carotid artery atherosclerosis. Sleep 31:1207–1213PubMedPubMedCentral Lee SA, Amis TC, Byth K, Larcos G, Kairaitis K et al (2008) Heavy snoring as a cause of carotid artery atherosclerosis. Sleep 31:1207–1213PubMedPubMedCentral
10.
go back to reference Stuck BA, Braumann B, Heiser C, Herzog M, Maurer JT et al. (2019) [S3 guideline „diagnosis and therapy of snoring in adults“]. Somnologie (Berl) [accepted for publication] Stuck BA, Braumann B, Heiser C, Herzog M, Maurer JT et al. (2019) [S3 guideline „diagnosis and therapy of snoring in adults“]. Somnologie (Berl) [accepted for publication]
11.
go back to reference Stuck BA, Hofauer B (2018) The diagnosis and treatment of snoring in adults. Dtsch Arztebl Int 116:817–824 Stuck BA, Hofauer B (2018) The diagnosis and treatment of snoring in adults. Dtsch Arztebl Int 116:817–824
12.
go back to reference Moher D, Liberati A, Tetzlaff J, Altman DG, PRISMA G (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 6:e1000097CrossRef Moher D, Liberati A, Tetzlaff J, Altman DG, PRISMA G (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 6:e1000097CrossRef
13.
go back to reference Ramar K, Dort LC, Katz SG, Lettieri CJ, Harrod CG et al (2015) Clinical practice guideline for the treatment of obstructive sleep apnea and snoring with oral appliance therapy: an update for 2015. J Clin Sleep Med 11:773–827CrossRef Ramar K, Dort LC, Katz SG, Lettieri CJ, Harrod CG et al (2015) Clinical practice guideline for the treatment of obstructive sleep apnea and snoring with oral appliance therapy: an update for 2015. J Clin Sleep Med 11:773–827CrossRef
14.
go back to reference Shea BJ, Bouter LM, Peterson J, Boers M, Andersson N et al (2007) External validation of a measurement tool to assess systematic reviews (AMSTAR). PLoS One 2:e1350CrossRef Shea BJ, Bouter LM, Peterson J, Boers M, Andersson N et al (2007) External validation of a measurement tool to assess systematic reviews (AMSTAR). PLoS One 2:e1350CrossRef
15.
go back to reference Bäck LJ, Hytönen ML, Roine RP, Malmivaara AO (2009) Radiofrequency ablation treatment of soft palate for patients with snoring: a systematic review of effectiveness and adverse effects. Laryngoscope 119:1241–1250CrossRef Bäck LJ, Hytönen ML, Roine RP, Malmivaara AO (2009) Radiofrequency ablation treatment of soft palate for patients with snoring: a systematic review of effectiveness and adverse effects. Laryngoscope 119:1241–1250CrossRef
16.
go back to reference Franklin KA, Anttila H, Axelsson S, Gislason T, Maasilta P et al (2009) Effects and side-effects of surgery for snoring and obstructive sleep apnea--a systematic review. Sleep 32:27–36PubMedPubMedCentral Franklin KA, Anttila H, Axelsson S, Gislason T, Maasilta P et al (2009) Effects and side-effects of surgery for snoring and obstructive sleep apnea--a systematic review. Sleep 32:27–36PubMedPubMedCentral
17.
go back to reference den Herder C, van Tinteren H, de Vries N (2005) Sleep endoscopy versus modified Mallampati score in sleep apnea and snoring. Laryngoscope 115:735–739CrossRef den Herder C, van Tinteren H, de Vries N (2005) Sleep endoscopy versus modified Mallampati score in sleep apnea and snoring. Laryngoscope 115:735–739CrossRef
18.
go back to reference Cazan D, Mehrmann U, Wenzel A, Maurer JT (2017) The effect on snoring of using a pillow to change the head position. Sleep Breath 21:615–621CrossRef Cazan D, Mehrmann U, Wenzel A, Maurer JT (2017) The effect on snoring of using a pillow to change the head position. Sleep Breath 21:615–621CrossRef
19.
go back to reference Ravesloot MJ, van Maanen JP, Dun L, de Vries N (2013) The undervalued potential of positional therapy in position-dependent snoring and obstructive sleep apnea-a review of the literature. Sleep Breath 17:39–49CrossRef Ravesloot MJ, van Maanen JP, Dun L, de Vries N (2013) The undervalued potential of positional therapy in position-dependent snoring and obstructive sleep apnea-a review of the literature. Sleep Breath 17:39–49CrossRef
20.
go back to reference Stradling JR, Negus TW, Smith D, Langford B (1998) Mandibular advancement devices for the control of snoring. Eur Respir J 11:447–450CrossRef Stradling JR, Negus TW, Smith D, Langford B (1998) Mandibular advancement devices for the control of snoring. Eur Respir J 11:447–450CrossRef
21.
go back to reference Robertson S, Murray M, Young D, Pilley R, Dempster J (2008) A randomized crossover trial of conservative snoring treatments: mandibular repositioning splint and nasal CPAP. Otolaryngol Head Neck Surg 138:283–288CrossRef Robertson S, Murray M, Young D, Pilley R, Dempster J (2008) A randomized crossover trial of conservative snoring treatments: mandibular repositioning splint and nasal CPAP. Otolaryngol Head Neck Surg 138:283–288CrossRef
22.
go back to reference Johnston CD, Gleadhill IC, Cinnamond MJ, Peden WM (2001) Oral appliances for the management of severe snoring: a randomized controlled trial. Eur J Orthod 23:127–134CrossRef Johnston CD, Gleadhill IC, Cinnamond MJ, Peden WM (2001) Oral appliances for the management of severe snoring: a randomized controlled trial. Eur J Orthod 23:127–134CrossRef
23.
go back to reference Maguire J, Steele JG, Gibson GJ, Wilson JA, Steen N, McCracken GI (2010) Randomised cross-over study of oral appliances for snoring. Clin Otolaryngol 35:204–209CrossRef Maguire J, Steele JG, Gibson GJ, Wilson JA, Steen N, McCracken GI (2010) Randomised cross-over study of oral appliances for snoring. Clin Otolaryngol 35:204–209CrossRef
24.
go back to reference Cooke ME, Battagel JM (2006) A thermoplastic mandibular advancement device for the management of non-apnoeic snoring: a randomized controlled trial. Eur J Orthod 28:327–338CrossRef Cooke ME, Battagel JM (2006) A thermoplastic mandibular advancement device for the management of non-apnoeic snoring: a randomized controlled trial. Eur J Orthod 28:327–338CrossRef
25.
go back to reference Sabbe AV, De Medts J, Delsupehe K (2017) Surgical treatments for snoring. B-ENT 13:1–7PubMed Sabbe AV, De Medts J, Delsupehe K (2017) Surgical treatments for snoring. B-ENT 13:1–7PubMed
26.
go back to reference Virkkula P, Maasilta P, Hytönen M, Salmi T, Malmberg H (2003) Nasal obstruction and sleep-disordered breathing: the effect of supine body position on nasal measurements in snorers. Acta Otolaryngol 123:648–654CrossRef Virkkula P, Maasilta P, Hytönen M, Salmi T, Malmberg H (2003) Nasal obstruction and sleep-disordered breathing: the effect of supine body position on nasal measurements in snorers. Acta Otolaryngol 123:648–654CrossRef
27.
go back to reference Virkkula P, Bachour A, Hytönen M, Salmi T, Malmberg H et al (2006) Snoring is not relieved by nasal surgery despite improvement in nasal resistance. Chest 129:81–87CrossRef Virkkula P, Bachour A, Hytönen M, Salmi T, Malmberg H et al (2006) Snoring is not relieved by nasal surgery despite improvement in nasal resistance. Chest 129:81–87CrossRef
28.
go back to reference Wu J, Zang HR, Wang T, Zhou B, Ye JY et al (2017) Evaluation of the subjective efficacy of nasal surgery. J Laryngol Otol 131:37–43CrossRef Wu J, Zang HR, Wang T, Zhou B, Ye JY et al (2017) Evaluation of the subjective efficacy of nasal surgery. J Laryngol Otol 131:37–43CrossRef
29.
go back to reference Stuck BA, Sauter A, Hörmann K, Verse T, Maurer JT (2005) Radiofrequency surgery of the soft palate in the treatment of snoring. A placebo-controlled trial. Sleep 28:847–850CrossRef Stuck BA, Sauter A, Hörmann K, Verse T, Maurer JT (2005) Radiofrequency surgery of the soft palate in the treatment of snoring. A placebo-controlled trial. Sleep 28:847–850CrossRef
30.
go back to reference Baisch A, Maurer JT, Hörmann K, Stuck BA (2009) Combined radiofrequency assisted uvulopalatoplasty in the treatment of snoring. Eur Arch Otorhinolaryngol 266:125–130CrossRef Baisch A, Maurer JT, Hörmann K, Stuck BA (2009) Combined radiofrequency assisted uvulopalatoplasty in the treatment of snoring. Eur Arch Otorhinolaryngol 266:125–130CrossRef
31.
go back to reference Stuck BA (2009) Radiofrequency-assisted uvulopalatoplasty for snoring: long-term follow-up. Laryngoscope 119:1617–1620CrossRef Stuck BA (2009) Radiofrequency-assisted uvulopalatoplasty for snoring: long-term follow-up. Laryngoscope 119:1617–1620CrossRef
32.
go back to reference Kühnel TS, Hein G, Hohenhorst W, Maurer JT (2005) Soft palate implants: a new option for treating habitual snoring. Eur Arch Otorhinolaryngol 262:277–280CrossRef Kühnel TS, Hein G, Hohenhorst W, Maurer JT (2005) Soft palate implants: a new option for treating habitual snoring. Eur Arch Otorhinolaryngol 262:277–280CrossRef
33.
go back to reference Buysse DJ, Reynolds CF, Monk TH, Berman SR, Kupfer DJ (1989) The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res 28:193–213CrossRef Buysse DJ, Reynolds CF, Monk TH, Berman SR, Kupfer DJ (1989) The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res 28:193–213CrossRef
34.
go back to reference Johns MW (1991) A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep 14:540–545CrossRef Johns MW (1991) A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep 14:540–545CrossRef
35.
go back to reference Gliklich RE, Wang PC (2002) Validation of the snore outcomes survey for patients with sleep-disordered breathing. Arch Otolaryngol Head Neck Surg 128:819–824CrossRef Gliklich RE, Wang PC (2002) Validation of the snore outcomes survey for patients with sleep-disordered breathing. Arch Otolaryngol Head Neck Surg 128:819–824CrossRef
36.
go back to reference Lim PV, Curry AR (1999) A new method for evaluating and reporting the severity of snoring. J Laryngol Otol 113:336–340CrossRef Lim PV, Curry AR (1999) A new method for evaluating and reporting the severity of snoring. J Laryngol Otol 113:336–340CrossRef
37.
go back to reference Douglas SA, Webster S, El Badawey MR, Drinnan M, Matthews JN et al (2006) The development of a snoring symptoms inventory. Otolaryngol Head Neck Surg 134:56–62CrossRef Douglas SA, Webster S, El Badawey MR, Drinnan M, Matthews JN et al (2006) The development of a snoring symptoms inventory. Otolaryngol Head Neck Surg 134:56–62CrossRef
38.
go back to reference Herzog M, Kühnel T, Bremert T, Herzog B, Hosemann W, Kaftan H (2009) The impact of the microphone position on the frequency analysis of snoring sounds. Eur Arch Otorhinolaryngol 266:1315–1322CrossRef Herzog M, Kühnel T, Bremert T, Herzog B, Hosemann W, Kaftan H (2009) The impact of the microphone position on the frequency analysis of snoring sounds. Eur Arch Otorhinolaryngol 266:1315–1322CrossRef
39.
go back to reference Pevernagie D, Aarts RM, De Meyer M (2010) The acoustics of snoring. Sleep Med Rev 14:131–144CrossRef Pevernagie D, Aarts RM, De Meyer M (2010) The acoustics of snoring. Sleep Med Rev 14:131–144CrossRef
Metadata
Title
Diagnosis and treatment of isolated snoring—open questions and areas for future research
Authors
B. Hofauer
B. Braumann
C. Heiser
M. Herzog
J. T. Maurer
S. Plößl
J. U. Sommer
A. Steffen
T. Verse
B. A. Stuck
Publication date
01-06-2021
Publisher
Springer International Publishing
Published in
Sleep and Breathing / Issue 2/2021
Print ISSN: 1520-9512
Electronic ISSN: 1522-1709
DOI
https://doi.org/10.1007/s11325-020-02138-6

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