Major Research Findings

This study aimed to evaluate sleep patterns and investigate differences in clinical features among young individuals with snoring and obstructive sleep apnea (OSA). 1

Chronic insomnia and obstructive sleep apnea are both common sleep disorders. Chronic insomnia is thought to result from stress-related physiologic hyperarousal (somatic arousal) that makes it difficult for an individual to fall or stay asleep. Obstructive sleep apnea is thought to result from obstructive respiratory events causing arousals, sleep fragmentation, and recurrent oxygen desaturation. Although the two disorders seem different, they predispose to the same long-term, stress-related illnesses, and when they occur in the same individual, each affects the other's response to treatment; they interact. This report of three cases describes patients with both chronic insomnia and obstructive sleep apnea in whom the chronic insomnia remitted with no specific treatment following treatment of obstructive sleep apnea with maxillomandibular advancement.

The prevalence of sleep disorders in the Lebanese population is unknown. We assessed the prevalence of insomnia and sleep apnea risk and examined their relationship with sociodemographic, lifestyle, and health characteristics in a sample from Greater Beirut. 3

OSA is a major cause in children. Severe OSAHS contributes to or aggravates thoracic deformity, which is rarely reported.

This study explored the feasibility of using smartphones to analyze snoring sounds in the 20Hz-22kHz band to identify events of upper airway obstructions.

Snoring is a sleep phenomenon due to the partial upper airway obstruction during sleep which causes vibration of the tissues of the rhino-oro-hypopharynx and less frequently the larynx. This study evaluated the use and effectiveness of the erbium:YAG 2940-nm laser as an adjunctive in providing treatment for patients suffering from chronic snoring-related sleep disorders.

Sleep disordered breathing is extremely common in pregnancy and is a risk factor for maternal complications. Animal models demonstrate that intermittent hypoxia causes abnormal fetal growth. However, there are conflicting data on the association between maternal sleep disordered breathing and offspring growth in humans. We investigated this association by conducting a systematic review and meta-analysis.

In 2003, the JNC 7 reported obstructive sleep apnea (OSA) as a cause of secondary hypertension. The prevalence of OSA in hypertension ranges from 30-80%. There are limited data on the prevalence and risk factors of OSA in hypertensive patients. This study thus aimed to evaluate prevalence and clinical predictors of obstructive sleep apnea (OSA) in these patients.

This 10-year prospective cephalometric study evaluates the influence of a mandibular protruding device (MPD) in people with obstructive sleep apnea and snoring. 2

Adenotonsillar hypertrophy is one of the commonest causes of upper airway obstruction in children. It can cause hypoxic state by impairing pulmonary functions. Peak expiratory flow rate is a basic, convenient and reliable indicator of pulmonary function in children. To study the improvement in pulmonary functions by assessing Peak expiratory flow rate, before and after adenotonsillectomy in children.

One of the major causes of pediatric morbidity today at the community level is infection involving the ear, nose, and throat. Maximum of these patients respond well initially on general regular medications, but then recurrent complaints are not very uncommon. One of the major causes for such recurrence is hypertrophy of adenoids, the evaluation of which requires a battery of sophisticated investigative tools and expertise which are lacking at the community level. The aim of the study is to evaluate various symptoms related to adenoid hypertrophy and its correlation to the size of the adenoid seen in the lateral view nasopharyngeal X-ray.

Sleep disorders refer to physiological and psychological states that cause adverse consequences due to the inability to fall asleep or poor sleep quality. The prevalence of sleep disorders varies greatly in different countries and regions due to different causes. This study aimed to investigate the prevalence and influencing factors of sleep disorders among preschool children in Urumqi city, China.

Globally, rates of obesity have trebled in the past four decades. India has more than 9.8 million men and 20 million women classified as obese. While poor diet and sedentary lifestyles are major causes, growing evidence suggests other factors like sleep-disordered-breathing may also be contributors. 6

Backgrounds: Adenoidectomy is widely used to cure sleep-disordered breathing symptoms in children, torus tubarius hypertrophy (TTH) after adenoidectomy causing recurred snoring, sleep apnea, nasal obstruction, or mouth breathing was rarely reported, and the causes of TTH are still unclear. Objectives: To report a rare complication TTH after adenoidectomy, and the features of TTH. Material and Methods: A total of 36 pediatric patients with TTH diagnosed by our hospital from January 2017 to 2023 were included in this study. All children were treated conservatively for a month at first, and 13 patients underwent partial resection of TTH. The influencing factors (sex, age, allergic rhinitis [AR], and first operation way) were analyzed. Results: There were 36 patients with TTH: 27 boys and 9 girls. The age of the first operation ranged from 20 to 63 months, and the interval time of TTH after operation ranged from 3 to 55 months. Thirteen patients underwent partial resection of TTH. Thirteen children had definite symptoms and signs of AR. Conclusions and Significance: TTH is a rare complication after adenoidectomy, which is common in male children (75.0%) and in patients who took adenoidectomy before the age of 5 years (94.4%). TTH can occur as early as 3 months after adenoidectomy. AR and the operation way might have relationships with TTH.

Patients with Chiari type I malformation may also present with sleep disordered breathing mainly central sleep apnea. Here, we report a patient with Chiari I malformation referred to our clinic because of snoring and sleep disordered breathing. He was a 28-year-old man referred to us for evaluation of snoring. An overnight polysomnography revealed central sleep apnea. On further evaluation of central sleep apnea, the patient found to have Chiari malformation type I on brain MRI. The patient developed obstructive sleep apnea after surgery for Chiari malformation. Accordingly, pap titration was performed for the patient's obstructive sleep apnea. In patients with central sleep apnea comprehensive evaluation of predisposing causes is required. Lesions of central nervous system including Chiari malformation should not be overlooked. Furthermore, after treatment of central sleep apnea follow up PSG is warranted to confirm newly emerged sleep breathing disorder such as obstructive sleep apnea.

Superior vena cava syndrome (SVCS) is a medical emergency which can also be seen in Behçet's syndrome (BS). Having noted that BS patients with SVCS frequently complained of sleep disturbances, snoring and sleep apnea, suggesting obstructive sleep apnea (OSA), we formally surveyed the risk for OSA among BS patients.

Obstructive sleep apnea (OSA) is less prevalent among women and is associated with different symptoms and consequences to OSA in men. The reasons for these differences are unknown and difficult to tease apart in clinical populations. If OSA could be temporarily induced in healthy men and women, the causes of some of these differences could be investigated. Nasal blocking has been used to induce OSA in healthy men but its effect in women has not been reported.

Use of general anaesthesia or deep sedation during magnetic resonance imaging (MRI) studies leads to pharyngeal muscle relaxation, often resulting in snoring and subsequent vibrations with head micromotion. Given that MRI is very susceptible to motion, this causes artifacts and image quality degradation. The purpose of our study was to determine the effectiveness of different airway management techniques in overcoming micromotion-induced MRI artifacts.

Snoring and suspected sleep apneas are the most frequent causes for referral for a sleep study. Snoring varies across night and is usually recorded in all body postures. Here we report a unique patient showing continuous and loud snoring only in the supine posture.

This study aims to investigate the possible relationship between smoking and otorhinolaryngological symptoms in smokers, non-smokers and ex-smokers. 4

One of the most common causes of upper airway obstruction in adults is nasal septum deviation (NSD). The chronic hypoxia caused by this obstruction gradually leads to increased pulmonary vascular resistance, pulmonary hypertension (PHT), and right ventricular (RV) failure. The purpose of this study was to determine changes in RV myocardial functions at the tissue level before, and after surgery in patients with NSD.

This study evaluated the necessity of examining the upper airway in children with nocturnal enuresis. 225 children (aged 5-16 years), who were referred from the urology outpatient clinic between May 2015 and May 2016 and who had completed toilet training, were included in this study. Participants were separated into monosymptomatic nocturnal enuresis (MNE) (group 1) and without MNE (group 2) groups. Tonsil hypertrophy, adenoid vegetation, septal deviation, turbinate hypertrophy, allergic rhinitis, upper airway obstruction, and snoring etiology were assessed. In total, 112 children with MNE (group 1) participated in addition to 113 children selected randomly without MNE (group 2). Adenoid score (p = 0.016), septal deviation (p = 0.017), and snoring (p = 0.007) were significantly different between the groups. No differences in tonsil score (p = 0.618), turbinate hypertrophy (p = 0.424), and allergic rhinitis (p = 0.544) were detected between the groups. Possible causes of upper airway obstruction and snoring which is a symptom of obstructive sleep-disordered breathing in the pediatric population, including adenoid hypertrophy and septal deviation, should be considered as possible etiological factors in children with MNE.

The most common cause of nasal obstruction is a deviated nasal septum. It causes breathing difficulties and may eventually also cause sinusitis, epistaxis, sleep disturbances and snoring. The traditional surgeries of the nasal septum improve the nasal airway but do not fulfil the essential criteria in most instances. Endoscopic septoplasty is a fast-developing concept and gaining popularity as it provides a direct targeted approach to the septal anatomic deformity allowing a minimally invasive procedure under excellent visualization. The aim of this study is to compare the post-operative morbidity among conventional and endoscopic septoplasty.

Although medical checkup data would be useful for identifying unknown factors of disease progression, a causal relationship between checkup items should be taken into account for precise analysis. Missing values in medical checkup data must be appropriately imputed because checkup items vary from person to person, and items that have not been tested include missing values. In addition, the patients with target diseases or disorders are small in comparison with the total number of persons recorded in the data, which means medical checkup data is an imbalanced data analysis. We propose a new method for analyzing the causal relationship in medical checkup data to discover disease progression factors based on a linear non-Gaussian acyclic model (LiNGAM), a machine learning technique for causal inference.

Bimaxillary surgery is the traditional treatment of choice for correcting class III malocclusion which is reported to cause an alteration of oropharyngeal structures and upper airway narrowing that might be a predisposing factor for obstructive sleep apnea (OSA). This study aimed to analyze sleep parameters in class III malocclusion subjects and ascertain the prevalence of snoring or OSA following bimaxillary surgery.

Obstructive sleep apnoea/hypopnoea syndrome: relationship with obesity and management in obese patients.

Causes of Snoring

Snoring is caused by partial obstruction of the upper airway during sleep, which causes vibrations in the tissues of the rhino-oro-hypopharynx and, less often, the larynx.

Stress can lead to chronic insomnia, making it difficult to fall asleep or stay asleep.

Obesity is a major risk factor for OSA. It can narrow the upper airway and make breathing difficult.

Enlarged adenoids are a common cause of OSA in children. Adenoids are small masses of tissue in the back of the nose and throat, and when they grow large, they can narrow the upper airway.

Common Causes

Narrowing of the Upper Airway

Narrowing of the upper airway can make breathing difficult, leading to snoring and OSA.

Enlarged Adenoids

Enlarged adenoids can narrow the upper airway.

Enlarged Tonsils

Enlarged tonsils can narrow the upper airway.

Deviated Septum

A deviated septum can narrow the upper airway.

Enlarged Turbinates

Enlarged turbinates can narrow the upper airway.

Allergic Rhinitis

Allergic rhinitis can cause inflammation in the nose and narrow the upper airway.

Obesity

Obesity can narrow the upper airway and make breathing difficult.

Mandibular Protruding Device

A mandibular protruding device can widen the space in the upper airway by moving the lower jaw forward, helping to improve snoring and OSA symptoms. 2

Sleep Deprivation

Sleep deprivation can increase the risk of snoring and OSA.

Causes of Snoring

Narrowing of the Upper Airway

Surgery can be used to correct physical causes such as a deviated septum or enlarged turbinates.

Enlarged Adenoids

Adenoidectomy can be used to treat enlarged adenoids.

Enlarged Tonsils

Tonsillectomy can be used to treat enlarged tonsils.

Allergic Rhinitis

Medical treatment such as antihistamines and nasal steroid sprays can be used to treat allergic rhinitis.

Obesity

It is important to lose weight through diet and exercise if obesity is a contributing factor.

Sleep Deprivation

It is important to review sleep habits if sleep deprivation is a contributing factor. Making changes to sleep patterns, creating a suitable sleep environment, etc. are essential for improving the quality of sleep.

Comparison Between Studies

Commonalities

These studies share the commonality of investigating the prevalence and risk factors of snoring and OSA. They also examine the impact of these conditions on health.

Differences

These studies differ in terms of the age groups they focus on and their research methodologies. For example, some studies target children while others target adults. Research methods also vary, such as surveys, sleep polysomnography, and cephalometry.

Real-Life Application Notes

Snoring and OSA can negatively affect sleep quality and overall health. It's crucial to detect these conditions early and seek appropriate treatment. If you experience symptoms of snoring or OSA, it's recommended to consult a medical professional for an assessment.

Limitations of Current Research

Due to variations in the study populations and methodologies, it's important to exercise caution when generalizing the findings of these studies. Additionally, these studies highlight the need for further research into the causes and treatment of snoring and OSA.

Future Research Directions

Future research should delve deeper into the causes and treatment of snoring and OSA. Long-term impacts of these conditions on health should also be investigated.

Conclusion

Snoring and OSA are common sleep disorders that can negatively affect sleep quality and health. The causes of these conditions are diverse, and consulting a medical professional is essential for choosing the appropriate treatment. Research in this field continues to evolve, and future advancements are anticipated to lead to more effective treatment options.