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The effect on snoring of using a pillow to change the head position

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PurposeAlthough not a disease, primary snoring often leads to social problems. In an earlier retrospective pilot study, we found hints that individuals were snoring less in a lateral versus a supine head position. The aim of this study is to elucidate on the effect of an anti-snoring pillow which changes the head position. Methods We designed an interventional, controlled, and randomized crossover study. It included 22 participants, between 18 and 78 years, who snored, had a BMI ≤ 30, and a sleep partner. Obstructive sleep apnea was ruled out by polysomnography (PSG) or by respiratory polygraphy (PG). Two potential participants dropped out. The first two phases were done at home (4 weeks in total), followed by two nights of polysomnography in our sleep laboratory. During all phases, questionnaires regarding snoring, sleep quality, and pillow tolerance were completed by the patients and, as relevant, by their partners. ResultsThe PSG parameters revealed a significant reduction in the snoring index (p = 0.03) when on the activated pillow without a deterioration in other respiratory parameters. This correlated well with the visual analog scale (VAS) that showed a significant decrease in snoring with the activated pillow according to the bed partners (p < 0.001). Subjective acceptance of the pillow during the study period was 100%. Conclusions This study shows that by using a pillow to change the head position, it is possible to reduce both subjective and objective snoring severity. German Clinical Trial Number: DRKS 00008744 and ethics commission registry number registry number 2013-406 M-MA
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SLEEP BREATHING PHYSIOLOGY AND DISORDERS ORIGINAL ARTICLE
The effect on snoring of using a pillow to change the head position
Dorotheea Cazan
1
&Uwe Mehrmann
2
&Angela Wenzel
1
&Joachim T. Maurer
1
Received: 2 June 2016 /Revised: 20 December 2016 /Accepted: 5 January 2017 /Published online: 27 January 2017
#Springer-Verlag Berlin Heidelberg 2017
Abstract
Purpose Although not a disease, primary snoring often leads
to social problems. In an earlier retrospective pilot study, we
found hints that individuals were snoring less in a lateral ver-
sus a supine head position. The aim of this study is to elucidate
on the effect of an anti-snoring pillow which changes the head
position.
Methods We designed an interventional, controlled, and ran-
domized crossover study. It included 22 participants, between
18 and 78 years, who snored, had a BMI 30, and a sleep
partner. Obstructive sleep apnea was ruled out by
polysomnography (PSG) or by respiratory polygraphy (PG).
Two potential participants dropped out. The first two phases
were done at home (4 weeks in total), followed by two nights
of polysomnography in our sleep laboratory. During all
phases, questionnaires regarding snoring, sleep quality, and
pillow tolerance were completed by the patients and, as rele-
vant, by their partners.
Results The PSG parameters revealed a significant reduction
in the snoring index (p= 0.03) when on the activated pillow
without a deterioration in other respiratory parameters. This
correlated well with the visual analog scale (VAS) that showed
a significant decrease in snoring with the activated pillow
according to the bed partners (p< 0.001). Subjective accep-
tance of the pillow during the study period was 100%.
Conclusions This study shows that by using a pillow to
change the head position, it is possible to reduce both subjec-
tive and objective snoring severity.
German Clinical Trial Number: DRKS 00008744 and ethics
commission registry number registry number 2013-406 M-
MA
Keywords Anti-snoring pillow .Snoring .Head position .
Snoring index .Respiratory effort-related arousals (RERAs)
Introduction
Snoring is a respiratory sound generated in the upper airway
during sleep and typically occurring during inspiration. Primary
snoring is not accompanied by apnea, hypopnea, respiratory
effort-related arousals, or hypoventilation. It is caused by vari-
ous factors that lead to vibrations of the pharyngeal airway
structures (ICSD 3) [American Academy of Sleep Medicine.
International Classification of Sleep Disorders, 3rd edition.
Darien, IL: American Academy of Sleep Medicine, 2014,
139140.] The prevalence of snoring in adulthood ranges from
2 to 86%, generally increasing with age in both sexes. Possible
reasons for this large range might be the various definitions of
snoring and the assessment tools used, which vary from a sim-
ple questionnaire to a full polysomnography (PSG). The nui-
sance value of snoring relies more on the subjective assessment
of a bed partner or on self-evaluation than on any precisely
defined and objective parameters. According to the present state
of knowledge, there is no definite evidence of increased mor-
bidity in snorers unless it is accompanied by obstructive sleep
apnea [1]. However, women living with snorers are more likely
to report daytime sleepiness, morning headache, and fatigue
*Dorotheea Cazan
Dorotheea.Cazan@umm.de
1
Department of Otorhinolaryngology, Head and Neck Surgery, Sleep
Disorders Center, University Hospital Mannheim,
Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
2
Nitetronic GmbH Schenefeld, Prior Consulting Scientist Sissel /
Novacare GmbH Bad Dürkheim The Anti-snoring Distributing
Company, Bad Dürkheim, Germany
Sleep Breath (2017) 21:615621
DOI 10.1007/s11325-017-1461-1
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
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This study followed a small number of men previously studied polysomnographically 10 yr earlier to investigate the relationship between the development of sleep-disordered breathing and age, weight gain, and smoking. In 1984, 3,201 men answered a questionnaire including questions about snoring and excessive daytime sleepiness (EDS). Of those reporting symptoms related to obstructive sleep apnea syndrome (OSAS), a random sample of 61 men was investigated using whole-night polysomnography in 1985. Ten years later, 38 men participated in the present follow-up, which included a structured interview and polysomnography. During the 10-yr period, nine men had been treated for OSAS. Of the 29 untreated subjects, the number of men with OSAS, defined as an apnea–hypopnea index (AHI) of ⩾ 5/h, increased from four in 1985 to 13 in 1995 (p < 0.01). In this small sample, no significant associations were found between Δ AHI (i.e., AHI 1995 − AHI 1985) and age, weight gain, or smoking. We conclude that, among this small group of individuals who were selected for original polysomnographic study and follow-up because they were thought to have symptoms of sleep apnea, sleep-disordered breathing became significantly worse over time.
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Objectives/hypothesis: Currently, drug-induced sleep endoscopy (DISE) in obstructive sleep apnea (OSA) is predominantly performed in supine position. When positional therapy (avoidance of supine sleeping position in positional OSA (POSA) is implemented as (part of the) treatment, one should assess levels of obstruction in the other sleeping positions. Therefore, the current study examined the influence of difference head positions during DISE in patients with OSA and POSA. Study design: Consecutive prospective study. Methods: DISE was performed in patients with an apnea hypopnea index at baseline polysomnography greater than 5 events/h. The upper airway was assessed at velum, oropharynx, tongue base, and epiglottis level in supine position. The patients head were then tilted to the left and the right side and the DISE findings were recorded. Results: One hundred consecutive patients were included. In positional apneics (n = 67), lateral position was associated with decreased frequency of complete anteroposterior collapse at velum (P < 0.01), tongue base (P < 0.01), and epiglottis (P < 0.01) level-and increased frequency of partial anteroposterior collapse at velum (P < 0.01), tongue base (P < 0.01), and epiglottis (P <0.05) level in comparison with supine position. DISE findings showed no difference between the right and left position, whereas findings after head rotation were significantly different in comparison with the supine position. Conclusions: Head rotation improves upper airway collapse during DISE in supine position. This improvement of upper airway patency is more predominant in POSA patients.
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Snoring is considered one of the hallmarks of sleep-disordered breathing, but its determinants remain obscure in both obstructive sleep apnoea (apnoeic) and non-apnoeic snorers. We aimed to document positional dependency of snoring along with its association with clinical and polysomnographic variables. Seventy-seven apnoeic and 27 non-apnoeic snorers who complained for every-night loud snoring and slept in supine and lateral positions in all sleep stages during overnight polysomnography were included. Snoring (i.e. sound intensity > 40 dB) was quantified by measuring the mean and maximum sound intensity, and snoring frequency. In apnoeic and non-apnoeic snorers, mean snoring intensity and snoring frequency were higher in supine than in lateral positions irrespective of sleep stage, and were also usually higher in N3 in comparison to rapid eye movement and/or N2 sleep stage in any given position. Positional change in snoring intensity as expressed by the ratio of mean intensity in the supine to lateral positions was independently and positively correlated with body mass index, tonsils size and age in the total of patients. Snoring is more prominent in the supine position and in N3 sleep stage in apnoeic and non-apnoeic snorers. Snoring positional dependence is determined by body mass index, tonsils size and age.