Control Snoring With Exercise! New Study Shows Effectiveness. Oral Appliance and CPAP still more definitive treatment.

A new study in Chest (abstract below) shows the effectiveness of oropharyngeal exercises in eliminating snoring. The study concludes that these exercises can be effective for a large population of snorers. A previous study in the British Medical Journal (abstract below) showed learning to pay the didgeridoo was effective in decreasing snoring and the AHI in sleep apnea. They believed this was due to learning circular breathing. There have also been studies showing improvement in snoring and AHI in singers.

Another study looked at nasal surgery to improve Obstructive Sleep Apnea and showed “showed that isolated nasal surgery for patients with nasal obstruction and obstructive sleep apnea improved some sleep parameters, as shown by significant improvements in ESS and RDI, but had no significant improvements on AHI. It should be expected that combining this data that increasing nasal airway along with exercises should increase this effect.

The most effective method of treating simple snoring or mild to moderate sleep apne and snoring is the use of an intra-oral appliance that stents the airway open during sleep. This ca be very effectively combined with either nasal surgery or exercises . The standard medical treatment of CPAP is extremely successful but only tolerated by 60% of patients. Only about 25% use it on a regular basis all night and many consider the CPAP as a bigger problem then the snoring.

Learn more about sSeep Apnea and Snoring Treatment at www.IHateCPAP.com and at WWW.ThinkBetterLife.com

Severe Sleep Apnea is still considered a reason to utilize CPAP but when it is not tolerated oral appliance are the initial go to alternative.

Chest. 2015 Sep;148(3):683-91. doi: 10.1378/chest.14-2953.
Effects of Oropharyngeal Exercises on Snoring: A Randomized Trial.
Ieto V, Kayamori F, Montes MI, Hirata RP, Gregório MG, Alencar AM, Drager LF, Genta PR, Lorenzi-Filho G.
Abstract
BACKGROUND:
Snoring is extremely common in the general population and may indicate OSA. However, snoring is not objectively measured during polysomnography, and no standard treatment is available for primary snoring or when snoring is associated with mild forms of OSA. This study determined the effects of oropharyngeal exercises on snoring in minimally symptomatic patients with a primary complaint of snoring and diagnosis of primary snoring or mild to moderate OSA.
METHODS:
Patients were randomized for 3 months of treatment with nasal dilator strips plus respiratory exercises (control) or daily oropharyngeal exercises (therapy). Patients were evaluated at study entry and end by sleep questionnaires (Epworth Sleepiness Scale, Pittsburgh Sleep Quality Index) and full polysomnography with objective measurements of snoring.
RESULTS:
We studied 39 patients (age, 46 ± 13 years; BMI, 28.2 ± 3.1 kg/m2; apnea-hypopnea index (AHI), 15.3 ± 9.3 events/h; Epworth Sleepiness Scale, 9.2 ± 4.9; Pittsburgh Sleep Quality Index, 6.4 ± 3.3). Control (n = 20) and therapy (n = 19) groups were similar at study entry. One patient from each group dropped out. Intention-to-treat analysis was used. No significant changes occurred in the control group. In contrast, patients randomized to therapy experienced a significant decrease in the snore index (snores > 36 dB/h), 99.5 (49.6-221.3) vs 48.2 (25.5-219.2); P = .017 and total snore index (total power of snore/h), 60.4 (21.8-220.6) vs 31.0 (10.1-146.5); P = .033.
CONCLUSIONS:
Oropharyngeal exercises are effective in reducing objectively measured snoring and are a possible treatment of a large population suffering from snoring.
TRIAL REGISTRY:
ClinicalTrials.gov; No.: NCT01636856; URL: www.clinicaltrials.gov.

Didgeridoo playing as alternative treatment for obstructive sleep apnoea syndrome: randomised controlled trial
BMJ 2006; 332 doi: http://dx.doi.org/10.1136/bmj.38705.470590.55 (Published 02 February 2006)
Cite this as: BMJ 2006;332:266
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Milo A Puhan, research fellow1, Alex Suarez, didgeridoo instructor2, Christian Lo Cascio, resident in internal medicine3, Alfred Zahn, sleep laboratory technician3, Markus Heitz, specialist in respiratory and sleep medicine4, Otto Braendli, specialist in respiratory and sleep medicine (otto.braendli@zhw.ch)3
Author affiliations
Correspondence to: O Braendli
Accepted 24 November 2005
Abstract
Objective To assess the effects of didgeridoo playing on daytime sleepiness and other outcomes related to sleep by reducing collapsibility of the upper airways in patients with moderate obstructive sleep apnoea syndrome and snoring.

Design Randomised controlled trial.

Setting Private practice of a didgeridoo instructor and a single centre for sleep medicine.

Participants 25 patients aged > 18 years with an apnoea-hypopnoea index between 15 and 30 and who complained about snoring.

Interventions Didgeridoo lessons and daily practice at home with standardised instruments for four months. Participants in the control group remained on the waiting list for lessons.

Main outcome measure Daytime sleepiness (Epworth scale from 0 (no daytime sleepiness) to 24), sleep quality (Pittsburgh quality of sleep index from 0 (excellent sleep quality) to 21), partner rating of sleep disturbance (visual analogue scale from 0 (not disturbed) to 10), apnoea-hypopnoea index, and health related quality of life (SF-36).

Results Participants in the didgeridoo group practised an average of 5.9 days a week (SD 0.86) for 25.3 minutes (SD 3.4). Compared with the control group in the didgeridoo group daytime sleepiness (difference −3.0, 95% confidence interval −5.7 to −0.3, P = 0.03) and apnoea-hypopnoea index (difference −6.2, −12.3 to −0.1, P = 0.05) improved significantly and partners reported less sleep disturbance (difference −2.8, −4.7 to −0.9, P < 0.01). There was no effect on the quality of sleep (difference −0.7, −2.1 to 0.6, P = 0.27). The combined analysis of sleep related outcomes showed a moderate to large effect of didgeridoo playing (difference between summary z scores −0.78 SD units, −1.27 to −0.28, P < 0.01). Changes in health related quality of life did not differ between groups.

Conclusion Regular didgeridoo playing is an effective treatment alternative well accepted by patients with moderate obstructive sleep apnoea syndrome.

Otolaryngol Head Neck Surg. 2015 Sep;153(3):326-33. doi: 10.1177/0194599815594374. Epub 2015 Jul 16.
Does Nasal Surgery Improve OSA in Patients with Nasal Obstruction and OSA? A Meta-analysis.
Ishii L1, Roxbury C2, Godoy A3, Ishman S4, Ishii M2.
Author information
Erratum in
Corrigendum. [Otolaryngol Head Neck Surg. 2015] Abstract
OBJECTIVE:
To perform a systematic review and meta-analysis to determine if isolated nasal surgery in patients with obstructive sleep apnea and nasal airway obstruction improves obstructive sleep apnea.
DATA SOURCES:
Computerized searches were performed in PubMed, EMBASE, and the Cochrane Library through October 2014. Manual searches and subject matter expert input was also solicited.
REVIEW METHODS:
A search protocol was defined a priori, and 2 independent investigators performed the data extraction, focusing on relevant data, including quality data polysomnography data, and taking note of methodological quality and risk for bias.
RESULTS:
The 10 studies meeting criteria included a total of 320 patients. There were 2 randomized controlled trials, 7 prospective studies, and 1 retrospective study. There was a significant improvement in the pooled results of both Epworth Sleepiness Scale (ESS; difference 3.53, 95% confidence interval [CI] [0.64, 6.23]) and Respiratory Disturbance Index (RDI; 11.06, 95% CI [5.92, 16.19]) scores with isolated nasal surgery. There was no significant improvement in the Apnea Hypopnea Index (AHI) in the random effects model (4.83, 95% CI [-1.6, 11.62]).
CONCLUSIONS:
The pooled results showed that isolated nasal surgery for patients with nasal obstruction and obstructive sleep apnea improved some sleep parameters, as shown by significant improvements in ESS and RDI, but had no significant improvements on AHI. Future controlled studies with larger groups are needed to confirm the benefits of isolated nasal surgery in this patient population.
© American Academy of Otolaryngology—Head and Neck Surgery Foundation 2015.
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