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Purpose: To compare the intranasal steroid (INS) treatment outcomes in patients with adenoid tissue hypertrophy (ATH) with or without allergic rhinitis (AR)., Materials and Methods: Medical records of 96 children diagnosed with ATH were retrospectively examined. The pediatric version of the Score for Allergic Rhinitis (SFAR) questionnaire was used to determine the AR status of the patients and classify them. The children were divided into two groups based on the questionnaire: Group 1, low probability of AR (SFAR<9); and Group 2, high probability of AR (SFAR≥9). Intranasal mometasone furoate (100 μg/mL) was used to treat ATH for at least 3 months. The severity of nasal obstruction and snoring was evaluated using the visual analog scale (VAS) score, the adenoid/choana (A/C) ratios before and after treatment were compared, and the rate of patient referral to surgery was recorded among groups., Results: The change in the A/C ratio within the group between before and after treatment was significant (both P < 0.001). However, the reduction in the adenoid size was more significant in Group 1 than in Group 2 (P = 0.025). A significant improvement in the VAS scores was observed between before and after treatment in both groups (P < 0.001). Furthermore, the rate of surgical referral of Group 1 was significantly lower than that of Group 2 (P = 0.035)., Conclusions: INS treatment was found more successful for reducing A/C ratio in ATH without AR. Related with this, when considering the INS treatment for ATH, AR status should be kept in mind for predicting the treatment success., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Objective: Chinese herbal medicine has been gradually used to treat pediatric adenoid hypertrophy. This meta-analysis were conducted to evaluate the clinical efficacy and safety of Chinese herbal medicine in the treatment of pediatric adenoid hypertrophy., Methods: Randomized controlled trials involving Chinese herbal medicine in the treatment of pediatric adenoid hypertrophy were identified from Cochrane Central Register of Controlled Trials, PubMed, EMBASE, Chinese National Knowledge Infrastructure, Chinese Biomedical Database, Wanfang Database and VIP Information Database. The methodological quality of trials was evaluated with Cochrane Handbook criteria, and the Cochrane Collaboration's Review Manager 5.3 software was used for Meta-analysis., Results: A total of 13 valid articles involving 1038 patients were included. The meta-analysis showed that: Compared with western medicine treatment, Chinese herbal medicine significantly improved clinical efficacy (RR = 1.33, 95% CI [1.24,1.43]), and significantly decreased A/N ratio (MD = -0.04,95%CI [-0.05,-0.03]). Chinese herbal medicine also prominently improved the quality of life (MD = -4.77,95%CI [-8.35,-1.20]). Meanwhile, it dramatically improved snoring (MD = -0.46,95%CI [-0.62,-0.30]); mouth breathing (MD = -0.52,95%CI [-0.66,-0.39]); nasal obstruction (MD = -0.56,95%CI [-0.68,-0.45])., Conclusion: Chinese herbal medicine has good clinical efficacy and safety on pediatric adenoid hypertrophy, which need to be confirmed by high quality, multiple-centre, large sample randomized controlled trials., (Copyright © 2019. Published by Elsevier B.V.)

Aim: The present study investigated whether intraperitoneal treatment with the herbal formula B210 ([B210]; a herbal composition of Gastrodia elata and Cinnamomum cassia ) can reduce snoring in aged rats. Also, we studied possible neural mechanisms involved in B210 treatment and subsequent reduced snoring in rats., Methods and Result: We compared pressure and frequency of snoring, activities of phrenic nerve (PNA), activities of recurrent laryngeal nerve (RLNA) and activities of hypoglossal nerve (HNA), inspiratory time (T I ) and expiratory time (T E ) of PNA, and pre-inspiratory time (Pre-T I ) of HNA in aged rats between sham and B210 treatment groups (30 mg/mL dissolved in DMSO). We found that aged rats that received B210 treatment had significantly reduced pressure and frequency of snoring than rats who received sham treatment. Also, we observed that aged rats that received B210 treatment had significantly increased PNA, RLNA, and HNA, extended T I and T E of PNA, and prolonged Pre-T I of HNA compared to rats that received sham treatment. In other words, B210 treatment may relieve snoring through modulating activities and breathing time of upper airway related nerves in aged rats., Conclusion: We suggested that the B210 might be a potential herbal formula for snoring remission., Competing Interests: Disclosure The authors report no conflicts of interest in this work.

Objective: This study aimed to examine the effects of carbocysteine in OSAS patients., Methods: A total of 40 patients with moderate to severe obstructive sleep apnea syndrome (OSAS) were randomly divided into two groups. One group was treated with 1500 mg carbocysteine daily, and the other was treated with continuous positive airway pressure (CPAP) at night. Before treatment and after 6 weeks of treatment, all patients underwent polysomnography and completed questionnaires. Treatment compliance was compared between the two groups. Plasma was collected for various biochemical analyses. Endothelial function was assessed with ultrasound in the carbocysteine group., Results: The proportion of patients who fulfilled the criteria for good compliance was higher in the carbocysteine group (n = 17) than in the CPAP group (n = 11; 100% vs. 64.7%). Compared with baseline values, the carbocysteine group showed significant improvement in their Epworth Sleepiness Scale score (10.18 ± 4.28 vs. 6.82 ± 3.66; P ≤ 0.01), apnea-hypopnea index (55.34 ± 25.03 vs. 47.56 ± 27.32; P ≤ 0.01), time and percentage of 90% oxygen desaturation (12.66 (2.81; 50.01) vs. 8.9 (1.41; 39.71); P ≤ 0.01), and lowest oxygen saturation level (65.88 ± 14.86 vs. 70.41 ± 14.34; P ≤ 0.01). Similar changes were also observed in the CPAP group. The CPAP group also showed a decreased oxygen desaturation index and a significant increase in the mean oxygen saturation after treatment, but these increases were not observed in the carbocysteine group. Snoring volume parameters, such as the power spectral density, were significantly reduced in both groups after the treatments. The plasma malondialdehyde level decreased and the superoxide dismutase and nitric oxide levels increased in both groups. The endothelin-1 level decreased in the CPAP group but did not significantly change in the carbocysteine group. Ultrasonography showed that the intima-media thickness decreased (0.71 ± 0.15 vs. 0.66 ± 0.15; P ≤ 0.05) but that flow-mediated dilation did not significantly change in the carbocysteine group., Conclusions: Oral carbocysteine slightly improves sleep disorders by attenuating oxidative stress in patients with moderate to severe OSAS. Carbocysteine may have a role in the treatment of OSAS patients with poor compliance with CPAP treatment. However, the efficiency and feasibility of carbocysteine treatment for OSAS needs further evaluation., Trial Registration: ClinicalTrials.gov NCT02015598.

Chronic snoring (≥4 nights per week) is not benign. Otherwise healthy children with chronic snoring and evidence of adenotonsillar hypertrophy can be referred directly for adenotonsillectomy. Snoring children <30 months or with significant medical comorbidities should be referred for specialist sleep evaluation. Older children with intermittent snoring or without significant medical comorbidities can be managed with a combination of medical and surgical interventions listed herein., (© 2015 The Authors. Journal of Paediatrics and Child Health © 2015 Paediatrics and Child Health Division (Royal Australasian College of Physicians).)

Background: Snoring is the sound produced by the vibration of the soft tissues caused by the air passing through a narrow upper airway during sleep. It is usually associated with the conditions that increase upper airway resistance, but can occur in their absence too (primary snoring). Considering its sheer prevalence, the associated comorbidities, like carotid atherosclerosis and the social disorder that it can represent, treatment for snoring must be considered even in the absence of any other medical condition. Treatment options include conservative approaches like weight reduction, smoking and alcohol cessation, sleep positioning, mechanical nasal dilators, and continuous positive airway pressure (CPAP) to more radical approaches like surgery. Till date, we have no drugs for treating the primary pathology of snoring., Methods: A systematic literature search was carried out in PUBMED and EMBASE, and we found only nine randomized control trial's and one interventional study focusing on the pharmacotherapy of snoring per se, even as the literature is replete with studies evaluating drug therapy for obstructive sleep apnea., Result: Drugs evaluated include protriptyline, pseudoephedrine and domperidone, mometasone, nasal surfactant, Botulinum toxin type A, and some homeopathic and oil-based nasal sprays. The selected studies showed no strength in data and had a great methodological heterogeneity, so it is impossible to compare the analyzed studies., Discussion: Even though there are no consistent data to support pharmacologic treatment for primary snoring, through the critical analysis of these studies, we have discussed about the future directions for clinical trials in this area to arrive at a clinically meaningful decision.

Although it is anecdotally known that nasal obstruction is associated with snoring, it remains unknown whether the application of nasal steroids could decrease oral/oro-nasal breathing and increase nasal breathing, and subsequently decrease snoring indices. This study evaluated the effect of nasal budesonide on breathing route pattern and snoring. Twenty-four snorers were enrolled in a randomized, double-blind, crossover trial of 1-week treatment with nasal budesonide compared with 1-week intervention with nasal placebo. At the start and end of each treatment period, patients underwent nasal resistance measurement and overnight polysomnography with concomitant measurement of breathing route pattern and snoring. Twelve patients were randomly assigned to a 1-week treatment with nasal budesonide, followed by 2-week washout period and a 1-week intervention with the nasal placebo; and 12 patients were randomly assigned to a 1-week intervention with nasal placebo, followed by 2-week washout period and a 1-week treatment with nasal budesonide. Nasal budesonide was associated with a decrease in oral/oro-nasal breathing epochs and concomitant increase in nasal breathing epochs, decrease of snoring frequency by [median (interquartile range)] 15.8% (11.2-18.8%), and an increase of rapid eye movement sleep; snoring intensity decreased only in patients with increased baseline nasal resistance by 10.6% (6.8-14.3%). The change in nasal breathing epochs was inversely related to the change in snoring frequency (Rs = 0.503; P < 0.001). Nasal budesonide in snorers can increase nasal breathing epochs, modestly decrease snoring frequency and increase rapid eye movement sleep., (© 2014 European Sleep Research Society.)

The Aim of the Study: To assess the effectiveness of sodium tetradecyl sulfate injection in the region of the soft palate to treat primary snoring and mild obstructive sleep apnea/hypopnea syndrome. Sodium tetradecyl sulfate, a preparation belonging to detergents, widely applied in Poland to treat varices by the method of compressive sclerotherapy was used in the study., Material and Methods: The procedure of injected snoreplasty was performed in 21 patients, who were diagnosed with primary snoring or mild obstructive sleep apnea/hypopnea syndrome, based on subjective examination and polysomnography. Injected snoreplasty involves administration of sodium tetradecyl sulfate in the form of Fibrovein 1% or 3% preparation in the volume of 2ml, in the region of the soft palate. Injection of the preparation in the area of the soft palate induces the development of aseptic inflammation, which creates a scar which stiffens the soft palate and makes the tissues of this region less susceptible to vibrations., Results: The patients after injected snoreplasty reported a significant decrease in the intensity of snoring. The markedly shortened total time of snoring was found in check-up polysomnography performed six months after the procedure., Conclusions: Injected snoreplasty is an effective procedure, especially, in patients manifesting persistent snoring. It is not indicated in the treatment of obstructive apneas during sleep. The advantages of this method are: minimal invasiveness, the low number of complications and slight pain., (Copyright © 2013 Polish Otorhinolaryngology - Head and Neck Surgery Society. Published by Elsevier Urban & Partner Sp. z.o.o. All rights reserved.)

Aim of this work is to find out whether the symptoms attributable to adenoid hypertrophy in adolescents may be treated with intranasal mometasone furoate (MF) application. To learn if adenoid hypertrophy in adolescents may decrease in size with intranasal MF. A prospective, double blind, randomized, cross-over study was conducted in 28 subjects (12-18 years) with adenoidal hypertrophy. Subjects used intranasal MF or placebo for a duration of 6 weeks with a wash out period of 3 weeks. Subjective symptoms and adenoid size were evaluated. At the initiation of the study, there was no significant difference between the mean symptom scores for any of the sinonasal symptoms between the two treatment groups. There was significant improvement in total subjective symptoms (nasal blockage, rhinorrhea, cough, snoring and disruption of quality of life scores) with MF compared with placebo. Analysis of the symptoms separately showed a significant positive effect of MF on all symptoms except for rhinorrhea. Nasal endoscopic evaluation failed to demonstrate any difference in the reduction of the adenoid size between the two groups. MF has significant advantage over placebo for the symptoms attributable to adenoid hypertrophy in adolescents.

Sleep-disordered breathing (SDB) is a prevalent affliction, which can range from simple snoring to severely obstructive sleep apnea. Compared to current treatment options of SDB, traditional Chinese medicine (TCM) provides a noninvasive way to relieve SDB-related symptoms and deaths. The purpose of this retrospective study was to observe the progression of adult SDB patients who had taken compound formula SZ + NUH (concentrated herbal granules) for four weeks. Depending on subjects' individual needs, minor additions of formulas or single herbs were allowed. We found a significant amount of relief from snoring among the 118 enrolled subjects, according to before-after scores observed through the Snore Outcome Survey (SOS). Furthermore, as projected from the moderate linear correlation in before-after scores, we inferred that those cases with more severe snoring at baseline had greater improvement after treatment. Excessive daytime sleepiness was also significantly improved according to the results of the Epworth Sleepiness Scale (ESS). Assessment, using the SF-36 (Taiwanese version) revealed possible benefits of SZ + NUH in improving multiple facets of subjects' quality of life. During treatment, no significant side effects occurred. In conclusion, the TCM compound formula based on SZ + NUH could be a safe and effective option for SDB treatment.

Objectives: To measure apnea-hypopnea indices and snoring in children diagnosed with attention-deficit hyperactivity disorder (ADHD) in a case-control design. Additionally, the study design allowed us to investigate whether or not methylphenidate had any effect on breathing variables., Methods: Twenty-eight children (22 boys) aged 6-12 years meeting diagnostic criteria for Diagnostic and Statistical Manual of Mental Disorders (DSM)-IV ADHD were studied together with matched controls. Two nights of polysomnography (PSG) were conducted that included recordings of snoring waveforms. A randomly assigned 48-h on-off medication protocol was used for ADHD children. Control children's recordings were matched for PSG night, but medication was not used. A low apnea-hypopnea index (AHI) threshold of >1 event per hour was used to define sleep-disordered breathing (SDB) because of a clinical relevance in ADHD., Results: Categorical analyses for paired binary data showed no significant differences between control and ADHD children for presence of an AHI >1 or snoring. Variables were extracted from a significantly shorter total sleep time (67 min) on the medication night in children with ADHD. Eight (28%) control and 11 (40%) ADHD children snored >60 dB some time during the night. Methylphenidate had no effect on central apneas, AHI, desaturation events, or any snoring data., Conclusions: Our PSG findings show no strong link between ADHD and SDB although our findings could be limited by a small sample size. Findings from PSG studies in the literature argue both for and against an association between ADHD and SDB. Our results suggest medication is not a factor in the debate.

Conclusion: An inflammatory swelling in the uvula and nose due to vibration might be a contributing factor in snoring. The presence of corticosteroid receptors in the uvula indicates the possibility for treatment with local steroids. Use of mometasone furoate (MF) for 3 months reduced snoring and related symptoms in some patients., Objective: To investigate the effect of a nasal steroid, MF, on snoring and related discomfort., Subjects and Methods: In the first part of the study, uvular and nasal biopsies from six patients with social snoring were examined using immunohistochemistry to evaluate whether corticosteroid receptors were present. Then 100 snoring patients were invited to participate in the second part of the study. In all, 72 men and 22 women with a mean age of 47 years and BMI 27 answered a questionnaire about symptoms, had ENT status assessed and reported sleep and related variables for a 7 day period. After randomization to placebo or MF, they used a nasal spray for 3 months at a dosage of 200 microg. Thereafter the procedure was repeated., Results: Corticosteroid receptors were present in the mucous membranes and around the blood vessels in all uvulas examined. A total of 84 patients were evaluated. No decrease in 'mean snoring score' was seen. Daytime sleepiness showed a slight improvement in the MF group and partners were less disturbed. Minor side effects were equal for both groups.

Objectives: The aim of this study was to assess the effectiveness and morbidity of the combined use of bipolar radiofrequency uvulopalatoplasty and a sclerosing agent applied to the soft palate in patients with snoring and apnea during a 1-year follow-up period., Methods: This was a prospective, nonrandomized study. Twenty-eight patients with primary snoring due to palatal flutter who fulfilled the inclusion criteria were enrolled. Under local anesthesia, a single procedure uvulopalatoplasty using bipolar radiofrequency applied with sterilized forceps was undertaken in combination with a sclerosing agent., Results: Four patients required a repeat procedure 6 weeks after the initial operation. The postoperative Epworth Sleepiness Scale score improved significantly 360 days after surgery. Snoring, measured on the Visual Analogue Scale, decreased from 8.9 +/- 0.7 to 4.1 +/- 1.4 (p < 0.005). No complications were reported. The average reduction on the apnea-hypopnea index was from 24.2 +/- 7.1 to 12.8 +/- 4.4 (p < 0.005)., Conclusion: Bipolar radiofrequency uvulopalatoplasty combined with injection snoreplasty is an ambulatory, cost-effective, simple, and safe method to reduce the occurrence and effects of snoring and apnea., (Copyright 2009 S. Karger AG, Basel.)

The objective of this study was to investigate whether injections of botulinum toxin into the soft palate reduce snoring in a subgroup of patients that present an active process causing habitual snoring. The study was conducted in eight patients with habitual snoring but without evidence of obstructive sleep apnea. Polysomnography was performed for diagnostic purposes and to monitor sleep quality before and after treatment. The patients and their partners completed a questionnaire before and after treatment. Recordings of snoring noise before and after treatment were evaluated on a visual analog scale by a blinded assessor. Doses of 20 U of botulinum toxin type A (Dysport) were injected unilaterally into the muscles of the soft palate. Snoring was reduced in eight cases. The patients reported no major adverse effects. These results justify further studies of botulinum toxin therapy in patients with habitual snoring. The scheme presented for injections of botulinum toxin into the levator veli palatini muscle provides a rational basis for the design of such studies. Therapy with botulinum toxin for habitual snoring is safe, non-invasive, easy to perform, fully reversible, and thus warrants investigation under placebo-controlled, double-blind conditions. This treatment is appropriate for a disorder that is of paramount social importance but does not pose a medical threat to the individuals affected.

High frequency of sleep disturbed breathing in adults is increasingly recognized. Obstructive sleep apnea, defined as the recurring obstruction of the upper airway is documented in 24% of adult males and 9% of females. The highest incidence is in the sixth decade. Snoring accompany 24% of middle aged man and 14% of females of the same age. Sleep apnea with the central origin, defined as the transient and recurrent cessation of breathing during sleep, is less frequent than obstructive sleep apnea. It can be identified in the wide spectrum of patients with medical, neurologic and neuromuscular diseases tightly connected with alveolar hypoventilation.

Study Objectives: Pharmacologic treatment of severe snoring has not been considered to be of great value. The objective of this study was to determine whether the combination of a nasal decongestant and a prokinetic drug would decrease or eliminate severe snoring., Methods: Thirty healthy individuals whose sleeping partners reported that the patients had severe nightly snoring entered an open-label trial of 60 mg of pseudoephedrine and 10 mg of domperidone at bedtime for 30 days. Each night's snoring was scored on a diary by the sleeping partner. At the end of the open-label trial, a subset of subjects whose snoring had recurred were randomized to one or both placebo-controlled trials, either 60 mg of pseudoephedrine sulfate plus 10 mg of domperidone or to 30 mg of pseudoephedrine sulfate plus 10 mg of domperidone. In another placebo-controlled trial, the drug combination was compared with each component., Results: In the open-label trial, 493 of 772 evaluable subject-nights were free of snoring; another 232 nights were scored as mild snoring. In the placebo-controlled trials, low-dose therapy caused a reduction in snoring, and high-dose therapy even a greater reduction in snoring. The drug combination was more effective than either agent alone., Conclusion: Treatment with a prokinetic agent plus a nasal decongestant reduced or eliminated severe snoring in the majority of subjects treated.

Nocturnal enuresis has been associated with obstructive sleep apnea-hypopnea and may resolve after adenotonsillectomy. Nasal corticosteroids have improved symptoms and polysomnography findings in children with snoring. Two children with primary nocturnal enuresis, chronic nasal obstruction, and loud snoring underwent polysomnography. The apnea-hypopnea index was 4.9 and 7.3 episodes/hr, and the oxygen desaturation of hemoglobin index was 4.6 and 5.2 episodes/hr. After administration of budesonide, the frequency of snoring decreased, the polysomnography findings improved, and the enuresis resolved completely. Six months after treatment, both children were still dry at night. Administration of nasal corticosteroids is associated with resolution of enuresis in children with mild obstructive sleep-disordered breathing.

We developed a "Submucosal Ethanol/Steroid (E/S) Injection Method (SEIM)" using an injection prepared by dissolving steroid with powerful antiinflammatory effect, which has the excellent effect of contractile reduction in oral tissues. In this clinical trial, the ablation effect of SEIM on the abnormally elongated uvula and the soft palate was examined in each one clinical case of obstructive sleep apnea syndrome (OSAS) and simple snoring. In the OSAS, we found that the uvula was reduced from 15 to 10mm, the visual analog scale (VAS) of snoring was reduced from 10 to 4 points, and the respiration disturbance index of the apnea-hypopnea index (AHI) improved from 35.3 to 26.1 after treatment. In simple snoring, the uvula was reduced from 11 to 8.5mm and VAS was relieved from 7 to 2 points after treatment. Our approach will produce a great clinical significance for not only OSAS or simple snoring but also treatment of the allergic rhinitis, etc, because the contractile tissue reduction can be attained safely in these diseases without open surgical wounds and unnecessary deformation or destruction of the mucosal structure.

Objective: The efficacy of many of the noninvasive treatments for snoring has not been evaluated in controlled trials. This paper seeks to evaluate the efficacy of an oil-based spray in the treatment of snoring, in a double-blinded, placebo-controlled, crossover trial using objective acoustic analysis and subjective questionnaires., Study Design and Setting: Participants were randomized to use both oil-based oral spray (treatment) and water-based oral spray (placebo) during a two-night in-home study period. Questionnaires were completed by participant and bed-partner in addition to audio-tape recordings which were analyzed for frequency, duration, and mean energy of snoring., Results: Greatest snoring rate demonstrated 30% = benefit; 40% = no change; 30% = adverse effect (n = 20). Percent time snoring yielded: 30% benefit; 15% no change; 55% adverse effect (n = 20). Study data results for mean energy were (n = 12): benefit = 17%, no change = 33%, adverse effect = 50%. Bed-partner observations (n = 17) demonstrated 37% = benefit; 38% = no change; 25% = adverse effect., Conclusion/significance: Objective and subjective evaluation of the performance of the oil-based Snoreless spray in comparison to placebo demonstrated a lack of efficacy in snoring reduction.

Nasal corticosteroids improve polysomnography indices but not symptoms in children with mild to moderate sleep-disordered breathing. We hypothesized that administration of nasal corticosteroids for 4 weeks to snoring children with only mild elevation in their apnea-hypopnea index would improve both polysomnography findings and symptoms of sleep-disordered breathing. Budesonide 50 mcg per nostril twice daily was administered for 4 weeks to children (2-14 years old) with habitual snoring and an apnea-hypopnea index of 1-10 episodes/hr. Subjects were evaluated before treatment and at 2 weeks and 9 months after its completion. Primary outcome variables were changes in apnea-hypopnea index and symptom score. Twenty-seven children were studied. At 2 weeks, the mean apnea-hypopnea index decreased from 5.2 (+/-2.2) episodes/hr to 3.2 (+/-1.5) episodes/hr, and median oxygen desaturation of hemoglobin index fell from 3.1 (0.4-8.2) to 1.9 (0.2-5.4) (P < 0.0001). Mean symptom score was 1.33 (+/-2.11) at baseline, and decreased to -0.008 (+/-2.24) at 2 weeks after treatment and to -1.08 (+/-1.75) at 9 months after treatment (P < 0.05). Four weeks of nasal budesonide improved both polysomnography findings and symptoms in children with mild sleep-disordered breathing. The clinical effect is maintained for several months after treatment., (Copyright 2004 Wiley-Liss, Inc.)

Background: Increased nasal airflow resistance (NAR) may contribute to the pathophysiology of obstructive sleep apnoea syndrome (OSAS) but studies investigating the effects of relieving nasal obstruction in OSAS have produced differing results. There are no reports of intranasal corticosteroid therapy in adult OSAS patients with reversible nasal obstruction., Methods: We evaluated an intranasal corticosteroid, fluticasone propionate, in 24 consecutive snorers with associated rhinitis using a randomised, placebo controlled, crossover design. Patients underwent polysomnography, snoring noise, and NAR measurements at baseline and after each 4 week treatment period., Results: Twenty three patients completed the protocol and were divided into an apnoeic group (group A; 13 patients) and a non-apnoeic snoring group (group S; 10 patients) based on an apnoea-hypopnoea frequency (AHI) of > or =10/h or <10/h. AHI was significantly lower following treatment with fluticasone than with placebo in the total population (median (quartile range) 11.9 (22.6) v 20 (26.3); p<0.05) and in group A (23.3 (21.3) v 30.3 (31.9); p<0.05). Median (95% confidence interval) within subject differences for AHI were -3.2 (-17.7 to -0.2) in the total population and -6.5 (-29.5 to 1.8) in group A. NAR was also lower on fluticasone (2.74 (1.21) v 3.27 (1.38), p<0.01), within subject difference being -0.45 (95% CI -0.87 to -0.21). The changes in AHI and NAR in group A were significantly correlated (r=0.56; p<0.05). Snoring noise and sleep quality were unchanged but daily diary records indicated subjective improvements in nasal congestion and daytime alertness with fluticasone (p<0.02)., Conclusions: Intranasal fluticasone is of benefit to some patients with OSAS and rhinitis. The data suggest that this form of nasal obstruction may contribute to the pathophysiology of OSAS.

Instillation of surfactant into the pharyngeal lumen reduces the pressure required to reopen an occluded airway, and decreases the apnoea/hypopnoea index (AHI). The authors hypothesised that surfactant also reduces the sleep-related increase in pharyngeal resistance. To test this hypothesis two single blind, crossover, placebo-controlled studies were performed. In protocol A seven male, asymptomatic snoring subjects were studied during sleep. Inspiratory pharyngeal resistance was calculated from plots of airflow versus supraglottic pressure (seven breaths) before and after surfactant or saline instillation. In protocol B, in a different group of seven male subjects with sleep apnoea (AHI 15.2 (12) events x h(-1)) the effect of surfactant or saline on sleep disordered breathing was measured, for 1 h immediately before and after surfactant or saline instillation. Surfactant decreased pharyngeal resistance calculated at peak pressure (group mean (SD): pre versus post 83.7 (76.4) versus 49.4 (71.1) cmH2O x L(-1) x s(-1)) and significantly reduced the respiratory disturbance index (RDI pre versus post 79.7 (58.7) versus 59.6 (56.9) events x h(-1)). Saline did not decrease resistance (pre versus post 58.6 (31.1) versus 72.5 (73.4) cmH2O x L(-1) x s(-1)) or RDI (pre versus post 75.3 (42.4) versus 79.9 (46.1) events x h(-1)). Surfactant reduced the collapsibility of the pharynx and led to a modest reduction in respiratory disturbance index. The authors speculate that surfactant may delay occlusion by reducing the liquid "bridging" within the folded pharyngeal lining.

Background: In allergic rhinitis, nasal obstruction is a typical symptom. Reduced nasal ventilation is thought to be one causal factor for sleep breathing disorders. Whether or not snoring individuals with or without sleep apnea show more frequent or stronger reactions in skin prick tests (SPT) compared to non-snorers has not been investigated yet., Method: SPT on 20 most frequent allergens and standardized questionnaires of 412 patients of either sex who received a polysomnography at the sleeplab of the ENT department, University of Würzburg, Germany, were analysed retrospectively. In 351 patients (85 %), data were complete. According to their polysomnography, patients were grouped into snorers (n = 248, 71 %) and non-snorers (n = 103, 29 %) or apnea (apnea-hypopnea-index > 10; n = 171, 49 %) and non-apnea patients (n = 180, 51 %). Average occurrence or strength of skin reactions was compared between these groups., Results: Except plantain (7 % vs. 1 %) and beech (10 % vs. 3 %), there were no statistical increases in the average occurrence or strength of SPT results in snoring individuals. Apnea patients did not show more frequent or stronger allergic skin reactions than non-apnea patients. Three patients suffering from allergic rhinitis by house dust mites were treated with citerizin 10 mg and allergen exposition prophylaxis. Three months after onset of therapy in all three patients, a reduction of snoring was polysomnographically observed. Snorers or apnea patients complaining sneezing, reduced nasal ventilation at night, hyperlacrimation or rhinorrhea showed significant higher numbers of allergic skin reactions for rye, gras and house dust mites compared to patients without these symptoms., Conclusions: The results reveal that only snorers or apnea patients with specific symptoms for allergic rhinitis should be tested by SPT. A general SPT-screening seems not to be indicated. Snoring and apneas in patients with allergic rhinitis due to house dust mites can be eliminated or reduced by an oral antihistaminic treatment.

Snoring is a significant problem both for the patient and for the bed partner. Seventy-two male and female heavy snorers and their bed partners participated in a double-blinded, placebo-controlled study on the effects of a volatile oil administered by gargling. The patients were diagnosed as heavy snorers after they underwent overnight polysomnography showing that their apnea indexes were below 5, thus sleep apnea patients were not included in the study. The participants and their partners filled out evaluations concerning snoring intensity, mouth dryness, nasal stuffiness and the Epworth Sleepiness Scale prior to and after using the volatile oil or placebo for 14 consecutive nights. There were no statistically significant decreases in snoring as graded by the bed partner or in mouth dryness, nasal stuffiness, or the Epworth Sleepiness Scale scores graded by the patients who were randomized to use the volatile oil. The results of this study indicate that this volatile oil is not an effective treatment in patients presenting with symptoms of snoring., (Copyright 2001 S. Karger AG, Basel)

The aim of the present investigation was to comparatively examine the effect of theophylline on various sleep-related breathing disorders of different severity. In a single-blind, placebo-controlled crossover study, 30 patients were polysomnographically diagnosed as suffering from primary snoring (n = 7), obstructive snoring (n = 12) or moderate sleep apnea (n = 11). Subsequent polysomnographic investigations included one baseline, one placebo and one theophylline (Respicur retard 400 mg, Byk Gulden, Konstanz, Germany) night. Subjective sleep and awakening quality was evaluated by means of a test battery completed in the morning. Concerning respiratory variables, theophylline was most effective in patients with moderate sleep apnea. Obstructive snorers only showed a tendency towards improvement and primary snorers remained unchanged. Sleep architecture generally remained unchanged in all three patient groups. Objective awakening quality was partly improved in primary snorers, obstructive snorers, as well as in moderate sleep apnea patients as compared with baseline, but not as compared with placebo. Regarding subjective sleep and awakening quality, only primary snorers and obstructive snorers showed an improvement, as compared with baseline while moderate sleep apnea patients remained unchanged. Based on intergroup comparison, we conclude that patients with moderate sleep apnea showed the most pronounced improvement in regard to respiratory events. Concerning sleep initiation and maintenance, sleep architecture and subjective sleep and awakening quality, no significant intergroup differences were found. Regarding objective awakening quality, attention showed a significantly greater improvement in primary than in obstructive snorers and sleep apnea patients, while motor performance was most improved in obstructive snorers.

We measured nasal resistance (Rn) while awake, during midazolam-induced sedation and after antagonism with flumazenil (n = 9). Nasal and oral airflow were measured. Rn was calculated by dividing the difference between maximal nasal mask and oropharyngeal pressures by inspiratory airflow at minimum pharyngeal pressure. During sedation, two subjects developed obstructive apnoeic events and four subjects had snoring events. Each apnoea was ended by mechanisms other than a change in breathing route. After antagonism with flumazenil, apnoeic and snoring events were abolished. Rn during midazolam sedation (median 1.46 (25th percentile 1.00, 75th 2.61) kPa litre-1 s) was significantly greater than before midazolam (0.29 (0.25, 0.48) kPa litre-1 s) and after flumazenil (0.41 (0.25, 0.58) kPa litre-1 s) (P < 0.01 in each subject). We conclude that midazolam increased Rn, sometimes leading to obstruction, and flumazenil abolished this increase in Rn.

Previous research has suggested that nicotine may be therapeutically useful in the treatment of sleep-disordered breathing. The development of transdermal nicotine delivery systems has allowed us to test the overnight effectiveness of nicotine. Twenty nonsmoking subjects (10 men, 10 women) were recruited on the basis of a history of habitual snoring that was confirmed by overnight laboratory monitoring. Subjects were then randomized (double-blind crossover design) to receive either placebo or an active patch that delivers 11 mg of nicotine over a 24-h period. Patches were applied at 6 P.M. and removed at 6 A.M. the following morning, at which time venous blood was obtained for determination of serum nicotine concentrations. Polysomnography was performed using standard techniques to assess sleep architecture and sleep-disordered breathing. Snoring was monitored with a sound-level meter and quantitatively analyzed to determine the snoring index (SI) (number of snores per hour of sleep) and mean and maximum snoring intensities. The age of the subjects was 46.9 +/- 11.4 yr (mean +/- SD) and their mean body mass index (BMI) 33.3 +/- 4.6 kg/m2. A mean nicotine level was nondetectable with placebo and 7.8 +/- 2.3 ng/ml with wearing of an active patch. Nicotine decreased total sleep time (TST) by 33 min (p < or 0.01), sleep efficiency from 89.7 to 83.5% (p < or = 0.01), and percent rapid eye movement (REM) sleep from 18.8 to 15.1% (p < or = 0.01), and prolonged initial sleep latency (ISL) from 6.7 to 18.2 min (p < or = 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

We evaluated the effects of protriptyline on snoring characteristics in 14 nonapneic snorers (age range, 23 to 54 years; body mass index, 27.4 +/- 0.9 kg/m2, mean +/- SEM). The study design was a double-blind placebo-controlled crossover trial. Patients were evaluated during a polysomnographic study after each 2 weeks of treatment. Breathing sounds were recorded with two microphones symmetrically placed on each side of the bed, the signal being preamplified, equalized, and analyzed by using a real time analyzer. A snoring event was defined as a breathing sound with a sound pressure level (SPL) greater than 60 dB SPL. The snoring index (number/sleep hour) and the sound intensity of each event were automatically determined. Mild side effects were observed in ten subjects, but no subject interrupted the study because of them. The REM sleep time decreased with protriptyline with a parallel increase in stages 1 to 2. There was no difference in body position during sleep between the placebo and protriptyline trials. The snoring index decreased from 335 +/- 40 with placebo to 238 +/- 41 with protriptyline (p < 0.05) with important individual differences. Among the different sleep stages, the highest values of the snoring index were observed in slow-wave sleep with placebo. The snoring index decreased in each sleep stage with protriptyline, the highest decrease occurring in slow-wave sleep. The percentage of total sleep time (TST) spent above 60 dB SPL was significantly lower with protriptyline (6.1 +/- 1.2 percent TST) than with placebo (8.6 +/- 1.2 percent TST). Changes in snoring characteristics were not correlated with snoring severity, the drug blood level, the body mass index, or the drug-induced modifications in sleep architecture. We conclude that protriptyline can improve both snoring frequency and loudness in some nonapneic snorers, and that this improvement occurs mostly in the sleep stages where snoring is worst.

The effects of enalapril maleate were studied in a group of 6 patients with arterial hypertension, hypertensive cardiopathy, multiple metabolic disorders and habitual snoring. Earlier treatment with antihypertensive drugs (diuretics, antiadrenergics, calcium antagonists) had been suspended when a marked deterioration was noted in metabolic parameters and plasmatic electrolytes as well as extremely disturbed sleep. The latter is probably attributable to increased respiratory obstruction during the night as a result of the increased hypertonia of the muscles of the upper air ways due to low blood potassium as well as the central and peripheral effects of the antiadrenergic drugs. After the wash-out period there was a marked improvement in laboratory parameters that continued after treatment with enalapril maleate. In particular, apart from a further slight fall in blood cholesterol and uricaemia there was a statistically significant drop in triglyceride levels. The improvement in the laboratory parameters made it possible to reduce the doses of the drugs being taken for the metabolic disorders. A distinct improvement was also noted in the sleep disturbances especially the excessive drowsiness during the day. There was also a statistically significant drop in arterial, systolic, diastolic and mean blood pressure without any significant change in heart beat. The results indicate that enalapril maleate should be the treatment of choice for those patients in whom high blood pressure is accompanied by alterations to the main metabolic parameters and habitual snoring.

The efficacy of a long-acting lubricating and coating agent, phosphocholinamin, in reducing snoring was tested in 12 persons, six of whom received the agent as nose drops and six of whom received a placebo (tap water nose drops). In all subjects, the noise level was measured continuously by using a microphone taped near the cricothyroid notch. In the group treated with phosphocholinamin, the maximum nocturnal decibel level was reduced by a mean +/- SD of 13 +/- 3%, and the snoring index (defined as the number of snores per hour of sleep) was reduced by 25 +/- 12%. In the group treated with placebo, the maximum nocturnal decibel level increased 9 +/- 22% and the snoring index increased 1 +/- 20%. The differences between the two groups were statistically significant (P less than .05). It is concluded that phosphocholinamin can provide a useful medical alternative in the treatment of snoring and that further trials of this agent are indicated.