Tag Archives: nasal obstruction

Snoring Is Not Relieved by Nasal Surgery Despite Improvement in Nasal Resistance: Conclusions

It is, of course, possible that our negative findings are only due to the methodology. Discordance between perceived and recorded snoring has been reported. The results may differ depending on the population studied. Whether a single-night recording of snoring is adequate remains unknown as the repeatability of these measurements is also unknown. Furthermore, how much nasal resistance should be reduced to show a possible effect on snoring also is not clear.
In addition to relieving symptoms of nasal stuffiness, the treatment of nasal obstruction has been shown to decrease the needed pressure levels in nasal continuous positive airway pressure therapy, and it may increase adherence to the treatment.

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Snoring Is Not Relieved by Nasal Surgery Despite Improvement in Nasal Resistance: Recommendation

Snoring Is Not Relieved by Nasal Surgery Despite Improvement in Nasal Resistance: RecommendationVariable treatment outcomes can be hypothesized to reflect differences in other obstructive sites. Strifes and coworkers reported better outcomes after nasal surgery in patients with normal cephalometry in 14 patients who were matched for SDB and BMI. In six of seven patients with a wide ph1-ph2 and a short H/MP as criteria for normal cephalometry findings, the AHI returned to < 10 and the number of arousals decreased. In the group of patients with abnormal cephalometry findings, none of the patients were cured by nasal surgery. In consecutive patients taken from our waiting list of patients for nasal surgery, these results could not be confirmed. www.canadian-familypharmacy.com

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Snoring Is Not Relieved by Nasal Surgery Despite Improvement in Nasal Resistance: Symptoms

Hoffstein and coworkers did not find differences in the mean or highest sound intensity across the sleep stages in heavy snorers. However, Nakano and coworkers reported increased snoring time and intensity during slow-wave sleep, when compared to REM sleep in apneic snorers. In the present study, the snoring intensity index was also found to be significantly higher during NREM sleep than during REM sleep in both sleep studies. Snoring seems more prevalent and more intense during stages 2 to 4 of NREM sleep. Since REM sleep is more prevalent in the early morning and sleep onset is followed by stages of NREM sleep, increased intensity of snoring during NREM sleep may have social implications. further

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Snoring Is Not Relieved by Nasal Surgery Despite Improvement in Nasal Resistance: Treatment

Snoring Is Not Relieved by Nasal Surgery Despite Improvement in Nasal Resistance: TreatmentObjective snoring measurement has been performed earlier in one surgical study and in some studies using nasal dilators, nasal decongestants or topical corticosteroids.’’ Some studies have reported the degree of nasal obstruction before and after treatment by objective nasal measurement. Patient samples in nonsurgical studies have varied from subjects without nasal symptoms or signs of nasal pathology to unselected snorers and those with abnormal rhinoscopy findings. www.canadian-familypharmacy.com

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Snoring Is Not Relieved by Nasal Surgery Despite Improvement in Nasal Resistance: Discussion

Table 2 shows preoperative and postoperative PSG data in the overall patient group, and in the subgroups with surgical improvement and no improvement of nasal patency. There were no statistical differences in preoperative breathing or sleep parameters between the subgroups (Table 2). REM sleep increased after the operation in the overall patient group and in the subgroup with surgical improvement (p < 0.05 for both). The change in REM sleep time was not correlated to the change in snoring time. BMI did not change between the sleep studies. ESS score remained unchanged in the overall patient group.
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Snoring Is Not Relieved by Nasal Surgery Despite Improvement in Nasal Resistance: Results

Snoring Is Not Relieved by Nasal Surgery Despite Improvement in Nasal Resistance: ResultsDifferences between the subgroups were evaluated using the Mann-Whitney U test. Comparisons of snoring intensity between REM sleep and NREM sleep, between supine and nonsupine sleep position, and between preoperative and postoperative measurements were analyzed using the Wilcoxon matched-pair test. A Pearson correlation analysis was used to evaluate the relationship between the change in REM sleep time and the change in snoring time.
The computations were performed using a commercial statistical package (Statistica, version 5.1; Statsoft Inc; Tulsa, OK). A p value of < 0.05 was considered to indicate statistical significance.
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Snoring Is Not Relieved by Nasal Surgery Despite Improvement in Nasal Resistance: PSG

Snoring was detected as previously described with a microphone attached to the subject’s throat, and the analog signal was transferred to the monitor screen. Another microphone was attached to the ceiling, 2 m from the patient’s head, to record sounds on a videotape.
During the calibration process, the subjects were asked to imitate snoring as loud as they could while lying supine before the start of the recording. The maximal snoring signal during calibration was given a value of 100 on an arbitrary scale from 0 to 100. With a snoring signal of 50, no snoring was heard on the videotape. A snoring event was scored visually if the signal was at least 50% of the calibration signal. A snoring episode included at least one snoring event and terminated when no snoring event was detected for two breathing cycles. The time spent in snoring episodes was divided by total sleeping time to give the figure for snoring time.
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Snoring Is Not Relieved by Nasal Surgery Despite Improvement in Nasal Resistance: Cephalometry

Snoring Is Not Relieved by Nasal Surgery Despite Improvement in Nasal Resistance: CephalometryCephalometric analysis was carried out before nasal surgery with patients in upright and supine body positions, as has been described. The group of patients with normal cephalometry findings consisted of patients with a posterior airway space (ie, the minimal distance between the base of the tongue and the posterior pharyngeal wall [ph1-ph2]) of > 7.0 mm, and a perpendicular distance from the hyoid bone to the mandibular plain (H/MP) of < 23 mm.

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Snoring Is Not Relieved by Nasal Surgery Despite Improvement in Nasal Resistance: Patients and Study Design

The study population consisted of 40 consecutive men who had been referred to the ENT Hospital at Helsinki University Central Hospital because of a snoring problem or suspicion of sleep apnea and were scheduled for surgical treatment of nasal ob-struction. Only one patient had undergone septoplasty earlier, but other upper airway surgery for SDB had not been performed. The evaluation for nasal surgery had been based on symptoms, and anterior rhinoscopy and anterior rhinomanometry (RMM) findings without strict criteria for nasal resistance. The mean age of the patients was 44.2 years (SD, 9.5 years; age range, 26 to 62 years), and the mean body mass index (BMI) was 27.9 kg/m2 (SD, 3.4 kg/m2; range, 22 to 37 kg/m2). The mean total nasal resistance (TNR) was 0.574 Pa/cm/s (SD, 0.597 Pa/cm/s) without decongestion and 0.355 Pa/cm/s (SD, 0.339 Pa/cm/s) after decongestion of the nasal mucosa. All patients were of Finnish origin. None of the patients used sedatives regularly.

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Snoring Is Not Relieved by Nasal Surgery Despite Improvement in Nasal Resistance

Snoring Is Not Relieved by Nasal Surgery Despite Improvement in Nasal ResistanceA relationship between nasal obstruction and snoring or sleep-disordered breathing (SDB) has been found in several previous studies, suggesting that SDB can be worsened by nasal obstruction and can even result from it. Nasal resistance has been found to be higher in snorers when compared with nonsnorers, and in SDB when compared with primary snoring. However, a causal relationship between nasal obstruction and SDB has not been substantiated beyond controversy due to the lack of qualified prospective follow-up studies. Nocturnal nasal congestion has been shown to be a strong independent risk factor for habitual snoring. In subjects with long-term nasal congestion occurring always or almost always at night, the risk of habitual snoring increased from 3.6-fold to 4.9-fold when compared with subjects without nasal congestion in a 5-year follow-up, Here

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