Analysis of snoring to determine the site of obstruction in obstructive sleep apnea syndrome
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SLEEP BREATHING PHYSIOLOGY AND DISORDERS • ORIGINAL ARTICLE
Analysis of snoring to determine the site of obstruction in obstructive sleep apnea syndrome Berk Gürpınar 1
&
Ziya Saltürk 2 & Tolgar Lutfi Kumral 1 & Senol Civelek 3 & Oyku Izel 1 & Yavuz Uyar 1
Received: 13 July 2020 / Revised: 5 November 2020 / Accepted: 12 November 2020 # Springer Nature Switzerland AG 2020
Abstract Background The aim of this study was to integrate the physical findings of drug-induced sleep endoscopy with snoring sound analysis in patients with obstructive sleep apnea/hypopnea syndrome (OSAS) and to compare the findings with previously published data. Methods This was a prospective, non-randomized study. Participants were all candidates for surgical treatment of OSAS and formed three groups, retropalatal (RP) obstructions, retrolingual (RL) obstructions, and multilevel (ML) obstructions. At the time of DISE, recordings of concurrent snoring sounds were made. Mean pitch frequency, peak sound frequency, and fundamental frequency (Fo) components were determined. Results A total of 55 participants had mean age 46.2 ± 7.3 years, mean BMI 30.0 ± 3.7 kg/m2, and included 11 women (20%). Differences in mean pitch frequency, Fo, and peak sound frequency were all statistically significant between the RP and RL (p = 0.001), between ML and RL (p = 0.025) but were not significantly different between RP and ML. Mean pitch frequency of RP was lower than RL, and ML frequency was between RL and RP. The sound analysis graphics revealed RP waves with sharp peaks and lower frequencies and RL with smooth curves and higher frequencies. ML showed irregular patterns. Mean pitch frequency of RL was always above 400 Hz, whereas RP was below this value. Conclusions It is feasible to apply sound analysis to determine the site of obstruction during DISE. Combining the data may help surgeons make more accurate assessments of the pattern of the disease. Keywords Acoustics . Obstruction . Pitch . Sleep apnea syndromes
Introduction Determining the site of obstruction in the human upper airway has always been the most challenging issue effecting surgical outcomes of obstructive sleep apnea/hypopnea syndrome (OSAS). It is evident that accurately identifying the site of obstruction will help to improve the results and the cure rate of OSAS surgery while concurrently reducing the number of
* Berk Gürpınar [email protected] 1
Department of Otolaryngology, Cemil Tascioglu City Hospital, Darulaceze Cad. No: 25 Okmeydani, Istanbul, Turkey
2
Department of Otolaryngology, Anadolu Medical Center, Gebze, Turkey
3
Department of Otolaryngology, Beykent University, Istanbul, Turkey
ineffective surgeries. Vigorous discussion and ongoing research have yielded many different methods to manage this localization problem and many others are being investigated. These techniques can be divided basically into three as those performed when the patient is awake, asleep, or both. Techniques used when the patient is awake are the Fujita classification, Friedman staging system, M
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