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Background: Snoring in adults is a common cause of distress for patients and their bedpartners and calls for appropriate counseling, diagnostic evaluation, and treatment., Methods: A systematic literature search in the PubMed, Cochrane Library, Web of Science Core Collection, and ClinicalTrials.gov databases was carried out in February 2018 and yielded pertinent publications from 2000 onward. The guideline was created according to the methodological requirements of the Association of the Scientific Medical Societies in Germany (Arbeitsgemeinschaft der wissenschaft- lichen medizinischen Fachgesellschaften, AWMF)., Results: The diagnostic evaluation of snoring is based on the history and phyical examination. In certain situations, a specialized sleep study should be performed to obtain objec- tive findings. The recommended methods of conservative treatment include, in particular, positioning therapy and weight loss. Mandibular protrusion splints can lessen snoring in suitable cases. If breathing through the nose is impaired, rhinological or rhinosurgical treatment is recommended; for certain anatomical abnormalities of the soft palate, a suitable minimally invasive surgical procedure can be considered. The level of the available evidence is low, as most of the under- lying clinical studies involved small patient groups and short follow-up., Conclusion: In the treatment of snoring, evidence-based recommendations derived from the findings of randomized trials can be given for selected situations, yet the overall state of the evidence on many diagnostic and therapeutic tech- niques remains limited.

Objectives: This guideline aims to promote high-quality care by medical specialists for subjects who snore and is designed for everyone involved in the diagnosis and treatment of snoring in an in- or outpatient setting., Discussion: To date, a satisfactory definition of snoring is lacking. Snoring is caused by a vibration of soft tissue in the upper airway induced by respiration during sleep. It is triggered by relaxation of the upper airway dilator muscles that occurs during sleep. Multiple risk factors for snoring have been described and snoring is of multifactorial origin. The true incidence of snoring is not clear to date, as the incidence differs throughout literature. Snoring is more likely to appear in middle age, predominantly in males. Diagnostic measures should include a sleep medical history, preferably involving an interview with the bed partner, and may be completed with questionnaires. Clinical examination should include examination of the nose to evaluate the relevant structures for nasal breathing and may be completed with nasal endoscopy. Evaluation of the oropharynx, larynx, and hypopharynx should also be performed. Clinical assessment of the oral cavity should include the size of the tongue, the mucosa of the oral cavity, and the dental status. Furthermore, facial skeletal morphology should be evaluated. In select cases, technical diagnostic measures may be added. Further objective measures should be performed if the medical history and/or clinical examination suggest sleep-disordered breathing, if relevant comorbidities are present, and if the subject requests treatment for snoring. According to current knowledge, snoring is not associated with medical hazard, and generally, there is no medical indication for treatment. Weight reduction should be achieved in every overweight subject who snores. In snorers who snore only in the supine position, positional treatment can be considered. In suitable cases, snoring can be treated successfully with intraoral devices. Minimally invasive surgery of the soft palate can be considered as long as the individual anatomy appears suitable. Treatment selection should be based on individual anatomic findings. After a therapeutic intervention, follow-up visits should take place after an appropriate time frame to assess treatment success and to potentially indicate further intervention.

Introduction: Snoring has received increased attention over the last years. Given its high prevalence and its impact on quality of life, diagnosis and treatment of snoring are of major importance., Aim of the Guideline: This guideline aims to promote high-quality care by medical specialists for adults who snore., Diagnostic Measures: Before every intervention, a medical history, clinical examination and sleep test need to be performed., Interventions: There is no need to treat snoring unless requested by the snorer. Invasive treatments should be selected with care; for surgical treatment, minimally invasive procedures are preferred. Weight reduction; the avoidance of sleeping pills, alcohol and nicotine; and a regular sleep-wake cycle can be recommended, although convincing evidence is lacking. Since currently, there is not enough evidence to confirm the effectiveness of muscle stimulation or other forms of muscle training, these treatments cannot be recommended. Snoring can be treated successfully with intraoral devices, but it is essential to select suitable subjects. Devices preventing sleep in the supine position can also be helpful in selected cases. The data on the success rates of surgical intervention are often limited to short-term follow-up studies, and not all interventions have been sufficiently evaluated. The techniques used to treat nasal obstruction in snorers are identical to those used for general nasal obstruction. Nasal surgery is only indicated when subjects complain about nasal obstruction. A significant amount of data is available for laser-assisted resection of excessive mucosa; however, resections can be performed with other tools. The efficacy of radiofrequency surgery at the soft palate has been documented in placebo-controlled trials. Soft palate implants can reduce snoring. Tonsillectomy or uvulopalatopharyngoplasty should be selected with care, especially as less invasive alternatives are available.

Objectives/hypothesis: The efficacy of combined radiofrequency (RF) surgery of the soft palate (RF-assisted uvulopalatoplasty [RF-UPP]) was demonstrated in a prospective study. Nevertheless, the data is based on short-term follow-up only, as it is the case with the majority of clinical studies regarding surgical treatment of snoring. Long-term follow-up is of particular importance in this context, as snoring relapses in a significant number of patients. The aim of this study was to assess the long-term efficacy of RF-UPP in the treatment of snoring., Study Design: Prospective clinical trial., Methods: Twenty-one patients with primary snoring (apnea/hypopnea index <15, body mass index [BMI] <32) were going through the initial trial. Patients had received two sessions of RF-UPP at the soft palate as previously described. For the present trial, all patients were contacted after approximately 18 months and asked to complete an additional follow-up questionnaire assessing current BMI, snoring (visual analogue scale), and the overall satisfaction with the procedure., Results: From the 21 initial patients, 19 (90%) answered the questionnaire. Mean follow-up was 19.8 +/- 4.9 months. The postoperative snoring scores showed an increase from 2.0 +/- 2.1 to 5.1 +/- 3.3 (P < .05) at long-term follow-up. Seven (37%) patients demonstrated long-term success (1.7 +/- 0.5), whereas seven patients experienced a relapse in snoring (8.1 +/- 1.4). BMI remained unchanged. Age, sex, BMI, or the length of follow-up did not influence long-term outcome., Conclusions: After RF-UPP of the soft palate, a relapse in snoring has to be expected at long-term follow-up in a subgroup of patients. At present, there are no prospective parameters which would predict long-term benefit.

Despite its minimally invasive character and superiority over placebo, the clinical efficacy of interstitial radiofrequency surgery (RF) of the soft palate in primary snoring is limited. In particular, excessive soft tissue at the palatal arches (webbing) and uvula hyperplasia are common phenomena, but cannot be addressed with interstitial RF surgery. Aim of this study was to assess the efficacy and morbidity of combined RF assisted uvulopalatoplasty (RF-UPP) in the treatment of snoring. Twenty-two patients with primary snoring (AHI < 15, BMI < 32) were included in the prospective clinical trial. All patients received two sessions of combined RF procedures at the soft palate, consisting of interstitial bipolar RF-surgery (Celon) and RF-assisted resection of excessive soft tissue (Celon ProCut). Snoring and postoperative pain were assessed with a 10-cm visual analogues scale (VAS), before and at least 6 weeks after every treatment session. Twenty-two patients were included and 21 patients completed the study. Snoring scores were reduced after the first session (8.5 +/- 1.5-4.6 +/- 2.5; P < 0.001) and showed further improvement after the second session (4.6 +/- 2.5-2.0 +/- 2.1; P < 0.001). Postoperative pain levels of 6.6 +/- 2.9 at day 1 decreased to 3.2 +/- 3.0 at day 7 after the first session and from 3.8 +/- 3.2 at day 1 to 0.4 +/- 0.8 at day 7 after the second session. Painkillers were administered for a mean of 2.0 +/- 2.5 days. Complications did not occur. Combined radiofrequency assisted uvulopalatoplasty (RF-UPP) is highly effective in the treatment of snoring.

In a previously published study, a significant reduction of snoring was reported after treatment with radiofrequency surgery of the tongue base in patients suffering from obstructive sleep apnea syndrome. The aim of this study was to investigate the efficacy of radiofrequency surgery of the tongue base in the treatment of primary snoring. Twenty patients suffering from primary snoring (AHI < 10/h, body mass index < 32 kg/m(2)) and an isolated hypertrophic tongue base at clinical examination were enrolled in this clinical trial. The patients underwent bipolar radiofrequency surgery of the tongue base under local anaesthesia. Pre- and post-operative body weight, daytime sleepiness (Epworth sleepiness scale) and snoring scores (visual analogue scales) were evaluated by the patients and their bed partners, respectively. Postoperative follow-up data was collected 6-8 weeks after treatment. A statistically significant reduction of the preoperative snoring levels from 7.5 +/- 2.4 to 6.1 +/- 2.8 was seen after treatment (p < 0.001). Body weight and daytime sleepiness remained unaffected. Only 3 out of 20 patients were satisfied with the result as defined by VAS < 3. Despite statistically significant reduction of the subjective snoring scores after radiofrequency of the tongue base, only minimal clinical improvement was achieved. Only 3 out of 20 patients were satisfied with the results. With regard to the clearly beneficial effect seen in patients with obstructive sleep apnea, this result indicates different pathophysiological principles in the generation of snoring.

Objective: To determine the safety and efficacy of the Pillar Palatal Implant System over a 1-year follow-up period., Study Design and Setting: In this prospective study, 40 healthy adult patients with primary snoring due to palatal flutter were treated after clinical, polysomnographic, and endoscopic examination. Under local anesthesia 3 implants were placed into the soft palate. Postoperative morbidity and functional parameters were assessed. Snoring and daytime sleepiness were assessed before and 90, 180, and 360 days after surgery. Objective data were obtained by polysomnography and SNAP-recording before and 90 days after treatment., Results: All implants were placed without complications. A total of 13 implants partially extruded uneventfully in 10 patients. Functional parameters remained unchanged. After 1 year, snoring was reduced from 7.1 +/- 1.9 to 4.8 +/- 2.5 (Visual-Analogue-Scale, P < 0.05) and daytime sleepiness from 6.1 +/- 3.2 to 4.9 +/- 3.1 (Epworth-Sleepiness-Scale, P < 0.05). SNAP data and polysomnography parameters showed clinically irrelevant changes., Conclusion: Our data demonstrate a significant decrease in snoring and daytime sleepiness over a period of one year.

Study Objectives: Recent publications have demonstrated a reduction in snoring with radiofrequency (RF) surgery of the soft palate. Yet so far, all published data has been based on non-controlled trials., Design: Aim of this study was to assess the efficacy of RF surgery of the soft palate in a randomized, placebo-controlled trial., Setting: Outpatients department at university hospital, department of otorhinolaryngology., Patients: 26 patients with primary snoring (AHI < 15, BMI < 35)., Interventions: Patients were treated with temperature-controlled RF surgery of the soft palate under local anesthesia. In accord with a randomization protocol they received 2 sessions of RF surgery (total amount of energy: 3.300 Joule) or placebo (insertion of device needle without energy delivery)., Measurements and Results: Snoring was evaluated by the bed partner with 10 cm visual analogue scales. 23 patients completed the study; 12 received RF-surgery and 11 received placebo. Snoring scores did not change in the placebo group (8.4 +/- 1.6 to 8.0 +/- 2.3) while improving in the RF-group (8.1 +/- 1.3 to 5.2 +/- 2.4). The difference between the groups was statistically significant (p < 0.05)., Conclusion: RF-surgery was significantly better than placebo, although the reduction in snoring was only moderate in our group of patients. This study underlines the necessity for well-controlled clinical trials in the treatment of snoring.

Objective: To determine the safety and efficacy of a new soft palate implant procedure for the reduction of snoring., Study Design and Setting: Fifteen healthy patients with primary snoring due to palatal flutter were enrolled into this prospective study after clinical and endoscopic examination and polysomnography. The average age of the patients was 41.2 +/- 8.6 years with a body mass index of 26.2 +/- 2.5 kg/m2. The Anti-Snoring Device consists of a delivery tool with a cylindrical implant of braided polyester filaments. Under local anesthesia, three implants intended for permanent implantation were placed into the soft palate. Snoring-related symptoms were assessed by visual analogue scales (VAS), polysomnography, and the SNAP system at baseline and 90 days postoperatively., Results: All implants were placed without complications. Only minor discomfort was reported in four cases within the first three days postprocedure. At the 90-day follow-up snoring was reduced from 7.3 +/- 1.6 to 2.5 +/- 2.1 (VAS, P < 0.01) and from 347 +/- 239 to 264 +/- 168 snoring sounds/hour (SNAP, P > 0.05). Polysomnography did not show any deterioration of sleep or breathing. Speech, swallowing, and taste were unchanged., Conclusion: The Anti-Snoring Device is a new surgical tool offering a simple and minimally invasive procedure. Our data demonstrate that the treatment is safe and effective with good patient acceptance. Further patient follow-ups are needed to evaluate the long-term results.

Study Objectives: Radiofrequency surgery of the soft palate presents a promising alternative for the treatment of snoring. The aim of this study was to give an overview of the current literature and to quantify the results in terms of a meta-analysis of treatment efficacy., Methods: Current databases were searched for publications concerning the treatment of snoring with radiofrequency surgery up to January 2003. Only original articles published in peer-reviewed journals were taken into consideration., Results: The review is based on 22 publications, mostly consisting of prospective noncontrolled clinical trials. Snoring was assessed with the help of visual analogue scales or snoring scores provided by the bed partner. In all these trials, a significant reduction of snoring was reported. Postoperative morbidity was low, but complication rates differed substantially., Conclusions: According to all of the published material, radiofrequency surgery of the soft palate leads to a significant reduction of subjective snoring, and snoring is reduced to a tolerable level. Nevertheless, these findings will have to be confirmed by controlled clinical trials.

Snoring is a widespread disorder, mostly affecting middle-aged men. Snoring is not harmful in itself, but may lead to social impairment. Therefore, snorers often seek for medical advice and effective treatment. Sleep studies are mandatory especially when surgical procedures are intended. Due to the lack of reliable objective snoring analysis, the evaluation by the bed partners is the most relevant criteria in estimating treatment success. Body weight and behaviour patterns are crucial in the treatment of snoring. Furthermore, oral appliances and other implements may be beneficial. Various kinds of surgical procedures are available, soft palate techniques being the most widespread. Minimally invasive procedures are safe and effective in the majority of patients. Temperature controlled radiofrequency tissue ablation offers much potential in the treatment of primary snoring. Furthermore, a system is currently being developed which is supposed to stabilise the soft palate with the help of implants.

Conclusion. The palatal implant method originally designed to reduce snoring can significantly reduce the apnea-hypopnea index (AHI) in some patients with mild to moderate obstructive sleep apnea (OSA) in a single office-based procedure. Objective. An initial study designed to evaluate the short-term efficacy and safety of palatal implants as primary treatment for patients with mild to moderate OSA. Materials and methods. This was a prospective, non-randomized study of 16 previously untreated and undiagnosed patients with sleep apnea. The inclusion criteria were an AHI of 10-30/h and a body mass index (BMI) ≤ 30. Results. The mean AHI was reduced following implantation, from 16.1 to 11.8 (p<0.01). A reduction in AHI was achieved in 13 patients (81%). Ten of 16 patients had their AHI reduced to <10.0. Snoring intensity decreased from 8.3±1.8 to 4.7±2.5 on a visual analog scale (p<0.001) and daytime sleepiness dropped from 7.2±2.5 to 4.6±3.2 on the Epworth Sleepiness Scale (p<0.05). No significant adverse events were reported. [ABSTRACT FROM AUTHOR]

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In recent years a considerable effort has been made to establish the use of different surgical techniques for the treatment of obstructive sleep apnea syndrome (OSAS). Nevertheless, treatment of hypopharyngeal obstruction due to tongue base hypertrophy remains in many ways an unsolved problem. The aim of this study was to evaluate the safety and efficacy of tongue base reduction with temperature-controlled radiofrequency volumetric tissue reduction in the treatment of OSAS. Twenty patients with OSAS and tongue base hypertrophy were treated with radiofrequency tissue ablation. An intensified treatment protocol was used, delivering 2,800 J per treatment session under local anesthesia. Two nights of polysomnography testing were performed before and after treatment. Daytime sleepiness, snoring and postoperative morbidity were assessed using questionnaires. Mean respiratory disturbance index (RDI) was reduced from 32.1 to 24.9/h after a mean of 3.4 treatment sessions. Six patients (33%) were cured after the procedure (reduction in RDI of ≥50% and a postoperative RDI of <15/h) and ten (55%) showed an improvement of >20% in their RDI. Daytime sleepiness and snoring improved significantly. Peri- and postoperative morbidity was low; one severe complication occurred (tongue base abscess). We were able to achieve similar cure and responder rates to those reported in a recently published pilot study but with a reduced number of treatment sessions. We believe that this technique may improve patient acceptance and have beneficial cost implications. [ABSTRACT FROM AUTHOR]