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Macario Camacho - One of the best experts on this subject based on the ideXlab platform.
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oropharyngeal and tongue exercises myofunctional therapy for Snoring a systematic review and meta analysis
European Archives of Oto-rhino-laryngology, 2018Co-Authors: Macario Camacho, Christian Guilleminault, Camilo Fernandezsalvador, Justin M Wei, Sungjin A Song, Michael W Noller, Lauren K Reckley, Soroush ZaghiAbstract:Oropharyngeal and tongue exercises (myofunctional therapy) have been shown to improve obstructive sleep apnea. However, to our knowledge, a systematic review has not been performed for Snoring. The study objective is to perform a systematic review, with a meta-analysis, dedicated to Snoring outcomes after myofunctional therapy. PubMed/MEDLINE and three other databases were searched through November 25, 2017. Two authors independently searched the literature. Eligibility (1) patients: children or adults with Snoring, (2) intervention: oropharyngeal and/or tongue exercises, (3) comparison: pre and post-treatment data for Snoring, (4) outcomes: Snoring frequency and Snoring intensity, (5) study design: publications of all study designs. A total of 483 articles were screened, 56 were downloaded in their full text form, and nine studies reported outcomes related to Snoring. There were a total of 211 patients (all adults) in these studies. The Snoring intensity was reduced by 51% in 80 patients from pre-therapy to post-therapy visual analog scale values of 8.2 ± 2.1 (95% CI 7.7, 8.7) to 4.0 ± 3.7 (95% CI 3.2, 4.8). Berlin questionnaire Snoring intensity reduced by 36% in 34 patients from 2.5 ± 1.0 (95% CI 2.2, 2.8) to 1.6 ± 0.8 (95% CI 1.3, 1.9). Finally, time spent Snoring during sleep was reduced by 31% in 60 patients from 26.3 ± 18.7% (95% CI 21.6, 31.0) to 18.1 ± 20.5% (95% CI 12.9, 23.3) of total sleep time. This systematic review demonstrated that myofunctional therapy has reduced Snoring in adults based on both subjective questionnaires and objective sleep studies.
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the relationship of the uvula with Snoring and obstructive sleep apnea a systematic review
Sleep and Breathing, 2018Co-Authors: Edward T Chang, Grace Baik, Scott E Brietzke, Carlos Torre, Macario CamachoAbstract:Currently, the relationship between uvula size and sleep-disordered breathing (Snoring and obstructive sleep apnea) lacks data for objective interpretation. This study conducted a systematic review of the international literature for research describing the measurable characteristics of the uvula (i.e., size, length, width) and any association with Snoring and obstructive sleep apnea (OSA). PubMED, Scopus, Google Scholar, Embase, and the Cochrane Library were each systematically searched from inception through November 15, 2016. We screened 1037 titles and abstracts. We conducted a full review of 54 downloaded articles. Sixteen articles met inclusion and exclusion criteria. The 16 studies included a total of 2604 patients. The selected articles included data and information for (1) normative data for uvular size in the control groups, (2) Snoring and uvula size, (3) OSA and uvula size, and (4) overall uvula function. Our review noted variability in findings; however, in general, a uvular length > 15 mm was considered elongated and a uvular width > 10 mm was considered to be wide. The studies included in this systematic review reveal a relationship between uvula size, Snoring, and OSA. Further, larger uvulas appear associated with more severe Snoring and OSA. The direct correlation between uvula size and its relationship specifically to Snoring and OSA remain as topics for future prospective research.
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treatment of Snoring with a nasopharyngeal airway tube
Case Reports in Medicine, 2016Co-Authors: Macario Camacho, Edward T Chang, Camilo Fernandezsalvador, Robson CapassoAbstract:Objective. To study the feasibility of a standard nasopharyngeal airway tube (NPAT) as treatment for Snoring. Methods. An obese 35-year-old man, who is a chronic, heroic snorer, used NPATs while (1) the patient’s bedpartner scored the Snoring and (2) the patient recorded himself with the smartphone Snoring app “Quit Snoring.” Baseline Snoring was 8–10/10 (10 = Snoring that could be heard through a closed door and interrupted the bedpartner’s sleep to the point where they would sometimes have to sleep separately) and 60–200 snores/hr. Several standard NPATs were tested, consisting of soft polyvinyl chloride material raging between 24- and 36-French (Fr) tubes. Results. The 24 Fr tube did not abate Snoring. The 26 Fr tube was able to abate the Snoring sound most of the night (smartphone app: 11.4 snores/hr, bedpartner VAS = 2/10). The 28 and 30 Fr tubes abated the Snoring sound the entire time worn (smartphone app: 0 snores, bedpartner VAS 0/10) but could not be tolerated more than 2.5 hours. The tube of 36 Fr size could not be inserted, despite several attempts bilaterally. Conclusion. Appropriately sized nasopharyngeal airway tubes may abate the Snoring sound; however, as in this patient, they may be too painful and intolerable for daily use.
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Smartphone apps for Snoring
The Journal of laryngology and otology, 2015Co-Authors: Macario Camacho, Scott E Brietzke, M Robertson, Jose Abdullatif, Victor Certal, Yoseph A. Kram, Chad Ruoff, Robson CapassoAbstract:Department of Otolaryngology –Head and Neck Surgery, Sleep Surgery Division, Stanford Hospital and Clinics, Stanford, California, USAAbstractObjective: To identify and systematically evaluate user-friendly smartphone Snoring apps.Methods: TheAppleiTunesappstorewassearchedforSnoringappsthatallowrecordingandplayback.Snoringappsweredownloaded,evaluatedandratedindependentlybyfourauthors.Twopatientsunderwentpolysomnography,andthe datawere compared with simultaneous Snoring app recordings, and one patient used the Snoring app at home.Results: Of 126 Snoring apps, 13 met the inclusion and exclusion criteria. The most critical app feature was theabilitytographicallydisplaytheSnoringevents.TheQuitSnoringappreceivedthehighestoverallrating.Whenthisapp’srecordingswerecomparedwithin-laboratorypolysomnographydata,appSnoringsensitivitiesrangedfrom64to 96 per cent, and Snoring positive predictive values ranged from 93 to 96 per cent. A chronic snorer used the appnightlyforonemonthandtrackedmedicalinterventions.Snoringdecreasedfrom200to10snoresperhour,andbedpartner Snoring complaint scores decreased from 9 to 2 (on a 0–10 scale).Conclusion: Select smartphone apps are user-friendly for recording and playing back Snoring sounds.Preliminary comparison of more than 1500 individual snores demonstrates the potential clinical utility of suchapps; however, further validation testing is recommended.Key words: Smartphone; Mobile Apps; Snoring; Respiratory Sounds; Treatment
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Snoring exclusively during nasal breathing a newly described respiratory pattern during sleep
Sleep and Breathing, 2014Co-Authors: Jennifer C Hsia, Macario Camacho, Robson CapassoAbstract:The aim of this study is to describe a distinctive respiratory pattern seen in subjects with inferior turbinate hypertrophy, nasal obstruction, and a polysomnogram-proven diagnosis of primary Snoring or mild obstructive sleep apnea. These subjects demonstrated increased Snoring with purely nasal breathing and alleviation of Snoring with oral breathing. The study design is case series with chart review. The setting was a university-based tertiary care hospital. A retrospective chart review was performed for patients with complaints of nasal obstruction with associated inferior turbinate hypertrophy and a polysomnogram-proven diagnosis of mild obstructive sleep apnea or primary Snoring. Demographic and polysomnography information were collected and analyzed. Snoring and airflow patterns were reviewed. Twenty-five subjects were identified as having met the inclusion and exclusion criteria on polysomnography for either primary Snoring or mild obstructive sleep apnea with inferior turbinate hypertrophy and no other significant nasal deformity or abnormality. Seventeen (68 %) of these patients had polysomnograms which demonstrated Snoring during nasal breathing and alleviation of Snoring with oral breathing. Of the 17 who snored during nasal breathing, ten of the subjects were female and seven of the subjects were male. The mean age was 27 years (range 18 to 68 years). The mean apnea–hypopnea index was 2.3 events/h (range 0 to 9.7 events/h). The mean body mass index was 25 kg/m2 (range 20 to 43 kg/m2). Our study describes a newly recognized pattern of Snoring in patients with a polysomnogram-proven diagnosis of either primary Snoring or mild obstructive sleep apnea. This pattern of breathing demonstrates patients who snore during nasal breathing even with known nasal obstruction present and subsequently have resolution or improvement of the Snoring with oral breathing.
Robson Capasso - One of the best experts on this subject based on the ideXlab platform.
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treatment of Snoring with a nasopharyngeal airway tube
Case Reports in Medicine, 2016Co-Authors: Macario Camacho, Edward T Chang, Camilo Fernandezsalvador, Robson CapassoAbstract:Objective. To study the feasibility of a standard nasopharyngeal airway tube (NPAT) as treatment for Snoring. Methods. An obese 35-year-old man, who is a chronic, heroic snorer, used NPATs while (1) the patient’s bedpartner scored the Snoring and (2) the patient recorded himself with the smartphone Snoring app “Quit Snoring.” Baseline Snoring was 8–10/10 (10 = Snoring that could be heard through a closed door and interrupted the bedpartner’s sleep to the point where they would sometimes have to sleep separately) and 60–200 snores/hr. Several standard NPATs were tested, consisting of soft polyvinyl chloride material raging between 24- and 36-French (Fr) tubes. Results. The 24 Fr tube did not abate Snoring. The 26 Fr tube was able to abate the Snoring sound most of the night (smartphone app: 11.4 snores/hr, bedpartner VAS = 2/10). The 28 and 30 Fr tubes abated the Snoring sound the entire time worn (smartphone app: 0 snores, bedpartner VAS 0/10) but could not be tolerated more than 2.5 hours. The tube of 36 Fr size could not be inserted, despite several attempts bilaterally. Conclusion. Appropriately sized nasopharyngeal airway tubes may abate the Snoring sound; however, as in this patient, they may be too painful and intolerable for daily use.
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Smartphone apps for Snoring
The Journal of laryngology and otology, 2015Co-Authors: Macario Camacho, Scott E Brietzke, M Robertson, Jose Abdullatif, Victor Certal, Yoseph A. Kram, Chad Ruoff, Robson CapassoAbstract:Department of Otolaryngology –Head and Neck Surgery, Sleep Surgery Division, Stanford Hospital and Clinics, Stanford, California, USAAbstractObjective: To identify and systematically evaluate user-friendly smartphone Snoring apps.Methods: TheAppleiTunesappstorewassearchedforSnoringappsthatallowrecordingandplayback.Snoringappsweredownloaded,evaluatedandratedindependentlybyfourauthors.Twopatientsunderwentpolysomnography,andthe datawere compared with simultaneous Snoring app recordings, and one patient used the Snoring app at home.Results: Of 126 Snoring apps, 13 met the inclusion and exclusion criteria. The most critical app feature was theabilitytographicallydisplaytheSnoringevents.TheQuitSnoringappreceivedthehighestoverallrating.Whenthisapp’srecordingswerecomparedwithin-laboratorypolysomnographydata,appSnoringsensitivitiesrangedfrom64to 96 per cent, and Snoring positive predictive values ranged from 93 to 96 per cent. A chronic snorer used the appnightlyforonemonthandtrackedmedicalinterventions.Snoringdecreasedfrom200to10snoresperhour,andbedpartner Snoring complaint scores decreased from 9 to 2 (on a 0–10 scale).Conclusion: Select smartphone apps are user-friendly for recording and playing back Snoring sounds.Preliminary comparison of more than 1500 individual snores demonstrates the potential clinical utility of suchapps; however, further validation testing is recommended.Key words: Smartphone; Mobile Apps; Snoring; Respiratory Sounds; Treatment
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Snoring exclusively during nasal breathing a newly described respiratory pattern during sleep
Sleep and Breathing, 2014Co-Authors: Jennifer C Hsia, Macario Camacho, Robson CapassoAbstract:The aim of this study is to describe a distinctive respiratory pattern seen in subjects with inferior turbinate hypertrophy, nasal obstruction, and a polysomnogram-proven diagnosis of primary Snoring or mild obstructive sleep apnea. These subjects demonstrated increased Snoring with purely nasal breathing and alleviation of Snoring with oral breathing. The study design is case series with chart review. The setting was a university-based tertiary care hospital. A retrospective chart review was performed for patients with complaints of nasal obstruction with associated inferior turbinate hypertrophy and a polysomnogram-proven diagnosis of mild obstructive sleep apnea or primary Snoring. Demographic and polysomnography information were collected and analyzed. Snoring and airflow patterns were reviewed. Twenty-five subjects were identified as having met the inclusion and exclusion criteria on polysomnography for either primary Snoring or mild obstructive sleep apnea with inferior turbinate hypertrophy and no other significant nasal deformity or abnormality. Seventeen (68 %) of these patients had polysomnograms which demonstrated Snoring during nasal breathing and alleviation of Snoring with oral breathing. Of the 17 who snored during nasal breathing, ten of the subjects were female and seven of the subjects were male. The mean age was 27 years (range 18 to 68 years). The mean apnea–hypopnea index was 2.3 events/h (range 0 to 9.7 events/h). The mean body mass index was 25 kg/m2 (range 20 to 43 kg/m2). Our study describes a newly recognized pattern of Snoring in patients with a polysomnogram-proven diagnosis of either primary Snoring or mild obstructive sleep apnea. This pattern of breathing demonstrates patients who snore during nasal breathing even with known nasal obstruction present and subsequently have resolution or improvement of the Snoring with oral breathing.
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Snoring exclusively during nasal breathing a newly described respiratory pattern during sleep
Sleep and Breathing, 2014Co-Authors: Jennifer C Hsia, Macario Camacho, Robson CapassoAbstract:Purpose The aim of this study is to describe a distinctive respiratory pattern seen in subjects with inferior turbinate hypertrophy, nasal obstruction, and a polysomnogram-proven diagnosis of primary Snoring or mild obstructive sleep apnea. These subjects demonstrated increased Snoring with purely nasal breathing and alleviation of Snoring with oral breathing. The study design is case series with chart review. The setting was a university-based tertiary care hospital.
Nimrod Maimon - One of the best experts on this subject based on the ideXlab platform.
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Snoring intensity and excessive daytime sleepiness in subjects without obstructive sleep apnea
Laryngoscope, 2016Co-Authors: Or Kalchiemdekel, Roi Westreich, Adi Regev, Victor Novack, Mordechai Goldberg, Nimrod MaimonAbstract:Objectives/Hypothesis Snoring and excessive daytime sleepiness (EDS) are major obstructive sleep apnea (OSA) symptoms. Snorers with apnea/hypopnea index < 5 are designated “simple snorers” and do not meet OSA criteria. This study aimed to explore a possible association between Snoring intensity and EDS defined as Epworth Sleepiness Scale (ESS) scores ≥ 11 in non-OSA subjects. Study Design Prospective cohort study. Methods From a total of 2,225 subjects who underwent polysomnography (PSG), 307 simple snorers qualified for the study and were assessed for Snoring intensity and ESS score. The correlation between PSG-based Snoring intensity measurements and ESS score was evaluated. A prediction model for EDS was derived using multivariate logistic regression. Results Subjects with EDS tended to be male and of heavier body habitus. Although both genders exhibited similar Snoring intensities, men had higher ESS scores than women. A strong linear correlation was demonstrated between the maximal Snoring intensity and the ESS score. Maximal Snoring sound and male gender were shown to be predictors of EDS, with odds ratios of 1.93 (95% confidence interval [CI]:1.63-2.26, P < .001) and 3.70 (95% CI: 1.29-12.5, P = .01), respectively. Conclusions In a population of non-OSA subjects referred to a PSG study, Snoring intensity was associated with EDS in both men and women. A positive linear correlation was observed between Snoring intensities and ESS scores. Additional studies are needed to further consolidate the evidence regarding the implications of simple Snoring for public health. Level of Evidence 2b Laryngoscope, 126:1696–1701, 2016
Rain Jogi - One of the best experts on this subject based on the ideXlab platform.
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Nasal symptoms increase the risk of Snoring and Snoring increases the risk of nasal symptoms. A longitudinal population study
Sleep and Breathing, 2021Co-Authors: Maria Värendh, Christer Janson, Caroline Bengtsson, Johan Hellgren, Mathias Holm, Vivi Schlünssen, Ane Johannessen, Karl Franklin, Torgeir Storaas, Rain JogiAbstract:Purpose Humans have a preference for nasal breathing during sleep. This 10-year prospective study aimed to determine if nasal symptoms can predict Snoring and also if Snoring can predict development of nasal symptoms. The hypothesis proposed is that nasal symptoms affect the risk of Snoring 10 years later, whereas Snoring does not increase the risk of developing nasal symptoms. Methods In the cohort study, Respiratory Health in Northern Europe (RHINE), a random population from Denmark, Estonia, Iceland, Norway, and Sweden, born between 1945 and 1973, was investigated by postal questionnaires in 1999–2001 (RHINE II, baseline) and in 2010–2012 (RHINE III, follow-up). The study population consisted of the participants who had answered questions on nasal symptoms such as nasal obstruction, discharge, and sneezing, and also Snoring both at baseline and at follow-up ( n = 10,112). Results Nasal symptoms were frequent, reported by 48% of the entire population at baseline, with Snoring reported by 24%. Nasal symptoms at baseline increased the risk of Snoring at follow-up (adj. OR 1.38; 95% CI 1.22–1.58) after adjusting for age, sex, BMI change between baseline and follow-up, and smoking status. Snoring at baseline was associated with an increased risk of developing nasal symptoms at follow-up (adj. OR 1.22; 95% CI 1.02–1.47). Conclusion Nasal symptoms are independent risk factors for development of Snoring 10 years later, and surprisingly, Snoring is a risk factor for the development of nasal symptoms.
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the influence of active and passive smoking on habitual Snoring
American Journal of Respiratory and Critical Care Medicine, 2004Co-Authors: Karl A Franklin, Thorarinn Gislason, E Omenaas, Rain Jogi, E J Jensen, Eva Lindberg, Maria Gunnbjornsdottir, Lennarth Nystrom, Birger Norderud Laerum, E BjornssonAbstract:The impact of active smoking, passive smoking, and obesity on habitual Snoring in the population is mainly unknown. We aimed to study the relationship of habitual Snoring with active and passive tobacco smoking in a population-based sample. A total of 15,555 of 21,802 (71%) randomly selected men and women aged 25–54 years from Iceland, Estonia, Denmark, Norway, and Sweden answered a postal questionnaire. Habitual Snoring, defined as loud and disturbing Snoring at least 3 nights a week, was more prevalent among current smokers (24.0%, p < 0.0001) and ex-smokers (20.3%, p < 0.0001) than in never-smokers (13.7%). Snoring was also more prevalent in never-smokers exposed to passive smoking at home on a daily basis than in never-smokers without this exposure (19.8% vs. 13.3%, p < 0.0001). The frequency of habitual Snoring increased with the amount of tobacco smoked. Active smoking and passive smoking were related to Snoring, independent of obesity, sex, center, and age. Ever smoking accounted for 17.1% of the a...
David Gozal - One of the best experts on this subject based on the ideXlab platform.
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increased morning brain natriuretic peptide levels in children with nocturnal enuresis and sleep disordered breathing a community based study
Pediatrics, 2008Co-Authors: Oscar Sans Capdevila, Valerie Mclaughlin Crabtree, Leila Kheirandishgozal, David GozalAbstract:INTRODUCTION Habitual Snoring and obstructive sleep apnea have been associated with bed-wetting in children, and effective obstructive sleep apnea treatment may improve enuresis. OBJECTIVES The purpose of this work was to assess whether habitual Snoring is associated with increased incidence of enuresis and whether severity of obstructive sleep apnea correlates with enuretic frequency and to evaluate brain natriuretic peptide levels. METHODS Parental surveys of 5- to 7-year-old children were reviewed for habitual Snoring and enuresis. Enuresis was also assessed in a cohort of 378 children with habitual Snoring undergoing overnight polysomnographic evaluation, and brain natriuretic peptide plasma levels were determined in 20 children with obstructive sleep apnea, 20 with habitual Snoring without obstructive sleep apnea, and 20 nonSnoring children, matched for enuresis. RESULTS There were 17,646 surveys completed (50.6% boys; 18.3% black). A total of 1976 (11.2%) of these children were habitual Snoring (53% boys; 25.2% black). A total of 531 habitual Snoring children also had enuresis (26.9%), with a predominant representation of boys (472 boys [87.5%]). Among the 15670 nonSnoring children, enuresis was reported in 1821 children (11.6%), of whom 88.8% were boys. However, enuresis among 378 children with habitual Snoring did not correlate with the magnitude of sleep respiratory disturbances. Indeed, enuresis was reported in 33 of 149 children with obstructive sleep apnea (obstructive apnea hypopnea index: >2 per hour of total sleep time; 53% boys) as compared with 36 habitual Snoring children with enuresis (62% boys) and obstructive apnea hypopnea index <2 per hour of total sleep time. Brain natriuretic peptide levels were elevated among children with enuresis and were marginally increased among children with obstructive sleep apnea. CONCLUSIONS Habitual Snoring is associated with increased prevalence of enuresis, and brain natriuretic peptide levels are increased in enuretic children with further increases with obstructive sleep apnea. However, the prevalence of enuresis is not modified by severity of sleep disturbance. Even mild increases in sleep pressure because of habitual Snoring may raise the arousal threshold and promote enuresis, particularly among prone children, that is, those with elevated brain natriuretic peptide levels.
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Snoring and sleep disordered breathing in young children subjective and objective correlates
Sleep, 2004Co-Authors: Hawley E Montgomerydowns, Louise M Obrien, Cheryl R Holbrook, David GozalAbstract:Study Objectives: We sought to assess the predictive validity of parental report of Snoring and other behaviors by comparing such reports with objective findings from overnight polysomnography for the evaluation of sleep-disordered breathing in 2 nonclinical samples, namely, at-risk preschoolers and an older group reflective of the general community. Predictive validity of Snoring alone and a score based on multiple child behaviors were compared to outcome at different levels of severity of sleep-disordered breathing. Design: Retrospective observational study. Setting: Questionnaires were distributed through school programs; polysomnography was performed at Kosair Children's Hospital in Louisville, Kentucky. Participants: One hundred twenty-two preschoolers and 172 5- to 7-year-olds, and their parents, participated in both subjective-report and objective-recording portions of the study. Measurements and Results: Compared to the presence of Snoring on polysomnography, parental report of frequent Snoring was highly sensitive and specific for both age groups. At all but the lowest level of severity of sleep-disordered breathing, predictive ability was higher for both groups when a parental-report score based on multiple measures of child behavior was applied, compared to parental report of Snoring alone. The profiles of these predictive child behaviors differed between the 2 groups, as did their sensitivity and specificity, at their high ranges of parental report. Conclusions: Scores derived from parental-report questionnaires of children's Snoring and other sleep and wake behaviors can be used as surrogate predictors of Snoring or sleep-disordered breathing in children. However, design and interpretation should consider age, risk status, and the purpose of the screening assessment. Citation: Montgomery-Downs HE; O'Brien LM; Holbrook CR; Gozal D. Snoring and sleep-disordered breathing in young children: subjective and objective correlates.
