From the Guidelines
Snoring treatment should prioritize the use of mandibular advancement devices (MADs) as a first-line treatment for mild to moderate obstructive sleep apnea (OSA) and primary snoring, due to their effectiveness in reducing sleep apneas, subjective daytime sleepiness, and improving quality of life, as recommended by the Portuguese Society of Pulmonology and other relevant institutions 1.
Key Considerations
- MADs are custom-made and titratable devices that stabilize the lower jaw in a forward and downward position, maintaining airway patency during sleep.
- They are indicated for patients with mild to moderate OSA, with no comorbidities and primary snoring, and are accepted as an alternative therapy for patients with severe OSA who do not respond to or are unable or unwilling to tolerate positive airway pressure (PAP) therapies.
- The most recent evidence suggests that MADs can decrease the frequency and/or duration of apneas, hypopneas, respiratory effort-related arousals (RERA), and/or snoring events, as well as improve nocturnal oxygenation and reduce daytime sleepiness 1.
Lifestyle Changes and Other Interventions
- Losing weight if overweight, as excess tissue in the throat can contribute to snoring.
- Sleeping on your side rather than your back to prevent your tongue from blocking your airway.
- Avoiding alcohol and sedatives before bedtime as they relax throat muscles excessively.
- Keeping nasal passages clear using saline sprays or nasal strips like Breathe Right.
Comparison with Other Studies
- A 2011 study published in the European Respiratory Journal found that MADs reduce sleep apnoeas and subjective daytime sleepiness, improve quality of life compared with control treatments, and are recommended in the treatment of patients with mild to moderate obstructive sleep apnoea (OSA) 1.
- A 2015 clinical practice guideline published in the Journal of Clinical Sleep Medicine recommends that sleep physicians prescribe oral appliances, rather than no therapy, for adult patients who request treatment of primary snoring (without obstructive sleep apnea) 1.
Conclusion Not Provided as per Guidelines
Instead, the key points are summarized above, highlighting the importance of MADs in the treatment of snoring and OSA, and the need for a comprehensive approach that includes lifestyle changes and other interventions.
From the Research
Snoring Treatment Options
- Uvulopalatopharyngoplasty (UPPP) is a surgical procedure that has been used to treat snoring, with studies showing its efficacy in controlling the symptom of snoring 2.
- Lifestyle modification, intra-oral devices, and surgical intervention are also management options for snoring, with continuous positive airway pressure being the treatment of choice for moderate-to-severe obstructive sleep apnea 3.
- UPPP is a generally safe and widely accepted surgical procedure for the treatment of obstructive sleep apnea, but it may not always result in success and patients may relapse 4.
Complications of Snoring Treatments
- UPPP may compromise nasal CPAP therapy in sleep apnea syndrome by increasing mouth air leak and reducing the maximal level of pressure that can be tolerated 5.
- Laser-assisted uvulopalatopharyngoplasty (LA-UPPP) and radiofrequency treatments of snoring have been shown to be effective and safe, with rare and manageable complications 6.
- The most common intraoperative complication of LA-UPPP is bleeding, which occurred in 9.5% of patients, and reducing the amount of tissue resected from the soft palate can help reduce or eliminate common complications 6.
Patient Selection and Treatment Outcomes
- Proper patient selection and performing UPPP in conjunction with other surgical procedures may yield favorable outcomes 4.
- A structured history of snoring and its associated symptoms, comprehensive examination, and sleep studies where relevant can lead to the correct diagnosis and appropriate management 3.
- Patients with UPPP may have lower compliance with nasal CPAP therapy compared to patients without UPPP, highlighting the importance of careful patient selection and management 5.