studied whether a head-positioning pillow could reduce snoring sounds in patients with mild and moderate positional OSA. There are several studies that have looked at the effect of PT in apneic snorers using old-generation positional devices: tennis ball techniques and pillows. Since the literature suggests that a 68% of snorers are position dependent, new-generation PT could be very promising. Non-apneic snoring is a prevalent problem with clinical and social implications. Non-apneic snorers were defined as subjects with a snoring index > 1 and an AHI < 5/h sleep. In accordance with the prevailing definition from the American Academy of Sleep Medicine (AASM) at that time, a hypopnea was scored whenever there was a greater than 30% reduced oronasal airflow for at least 10 s, accompanied by ≥ 4% oxygen desaturation from pre-event baseline. To exclude OSA patients, an apnea was defined as the cessation of nasal airflow of more than 90% for a period of 10 s or longer in the presence of respiratory efforts.
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The recorded data were analyzed using special software (Somnologica™ studio) and manually edited. This sensor was placed at the midline of the abdomen to discriminate between the different positions: supine, lateral right, lateral left, prone, and upright position. Sleeping position was registered using a position sensor (Sleepsense, St Charles, IL, USA). This resulted in an index of snoring events per hour, which could be differentiated between the various sleeping positions. These sensors detected snoring sounds lasting longer than 300–3000 ms. Snoring was assessed using a nasal cannula and a piezo element sensor attached to the cricoid. To define the apnea–hypopnea index (AHI), airflow was measured using a sensor in the nasal cannula. During an overnight stay, various parameters were measured. PSG was performed in the Sleep Laboratory of OLVG West using a digital PSG (Embla A10, Broomfield, CO, USA). Hence, the proportion of position dependency may be highest in non-apneic snorers, followed by mild and moderate OSA, and lowest in severe OSA. Approximately 56% of patients with mild OSA is position dependent, defined as having at least twice as many events in supine position compared to the other sleeping positions, while in severe OSA position dependency only occurs in 6%. These results are in line with studies performed in OSA patients, which show position dependency to be inversely related to disease severity. looked at position dependency in non-apneic snorers seeking clinical care and found that 65.8% of this group is position dependent. A retrospective study performed by Benoist et al. described that in non-apneic snorers, snoring decreased when a subject adopted a non-supine position.
found that snoring time and snoring intensity were lower in the lateral position than in the supine position in non-apneic snorers. Sleeping position can influence the severity of snoring however, few studies have looked at position dependency in non-apneic snorers. These aspects can have a negative impact on the psychosocial aspects and the intimacy in a couple’s relationship, and even may trigger marital disharmony or result in divorce. Habitual loud snoring may result in couples choosing to sleep apart or resort to using earplugs to counteract the sound. Besides these comorbidities affecting the primary snorer, snoring can also have negative impact on the sleep quality of the bed partner. Some research suggests that self-reported non-apneic snoring also has important clinical implications such as increased risk for cardiovascular disease. Primary (self-reported) snoring could, just like OSA, be associated with excessive daytime sleepiness and negative sleep pattern behaviors. Non-apneic snoring or primary snoring is defined as snoring with less than five apneic and/or hypopneic events per hour of sleep. Significant gender differences are observed with an higher prevalence in men than in women.
The prevalence of snoring in the general population is between 20 and 60%, depending on the definition, measurements, and population variables. It is indicative of increased resistance in the upper airway and is often associated with obstructive sleep apnea (OSA). Snoring is the result of airflow passing through the upper airway, which in turn causes vibrations in the soft tissues.
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