Surgical procedures and non-surgical devices for the management of non-apnoeic snoring: A systematic review of clinical effects and associated treatment costs

Health Technology Assessment

Volumn 13, Issue 3, 2009, Pages

  Main, C ^a   Liu, Z ^a   Welch, K ^b   Weiner, G ^c   Jones, S Q ^d   Stein, K ^a  

^a UNIVERSITY OF EXETER   (United Kingdom)

^b Southampton Health Technology Assessments Centre   (United Kingdom)

^c ROYAL DEVON AND EXETER HOSPITAL   (United Kingdom)

^d UNIVERSITY DENTAL HOSPITAL   (United Kingdom)

Author keywords

[No Author keywords available]

Indexed keywords

AIRWAY DYNAMICS; AIRWAY PRESSURE; BIOMEDICAL TECHNOLOGY ASSESSMENT; BIOTECHNOLOGICAL PROCEDURES; CAUTERIZATION; CEPHALOMETRY; CLINICAL ASSESSMENT; CLINICAL TRIAL; COST EFFECTIVENESS ANALYSIS; COST OF ILLNESS; DEVICE THERAPY; DISEASE SEVERITY; ENDOSCOPY; EPWORTH SLEEPINESS SCALE; FIBERSCOPE ENDOSCOPY; HUMAN; INTERMETHOD COMPARISON; LASER SURGERY; MANDIBLE RECONSTRUCTION; NON INVASIVE PROCEDURE; NOSE SURGERY; ORTHODONTICS; OXIMETRY; PATHOPHYSIOLOGY; POLYSOMNOGRAPHY; POSITIVE END EXPIRATORY PRESSURE; POSTOPERATIVE COMPLICATION; POSTOPERATIVE PAIN; RADIOFREQUENCY ABLATION; REVIEW; SEDATION; SLEEP; SNORING; SOUND DETECTION; SPEECH DISORDER; SPLINT; SURGICAL TECHNIQUE; SWALLOWING; SYSTEMATIC REVIEW; TONSILLECTOMY; TREATMENT INDICATION; TREATMENT RESPONSE; UPPER RESPIRATORY TRACT; UPPER RESPIRATORY TRACT OBSTRUCTION; UVULOPALATOPHARYNGOPLASTY; AIRWAY OBSTRUCTION; COST BENEFIT ANALYSIS; DEVICES; ECONOMICS; HEALTH CARE COST; LOW LEVEL LASER THERAPY; META ANALYSIS; PALATE; PHARYNX; TREATMENT OUTCOME; VELOPHARYNGEAL SPHINCTER;

AIRWAY OBSTRUCTION; COST-BENEFIT ANALYSIS; EQUIPMENT AND SUPPLIES; HEALTH CARE COSTS; HUMANS; LASER THERAPY; PHARYNX; SNORING; TECHNOLOGY ASSESSMENT, BIOMEDICAL; TREATMENT OUTCOME; UVULA; VELOPHARYNGEAL SPHINCTER;

EID: 65349130852     PISSN: 13665278     EISSN: None     Source Type: Journal    
DOI: 10.3310/hta13030     Document Type: Review

References (229)

1. The Report of an American Academy of Sleep Medicine Task Force. Sleep-related breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clinical research. Sleep 1999;22:667-89.
2. Scottish Intercollegiate Guidelines Network. Management of obstructive sleep apnoea/hypopnoea syndrome in adults - a national clinical guideline. Edinburgh: Scottish Intercollegiate Guidelines Network; 2003.
3. Knuiman M, James A, Divitini M, Bartholomew H. Longitudinal study of risk factors for habitual snoring in a general adult population: the Bussselton Health Study. Chest 2006;130:1779-83.
4. Honsberg AE, Dodge RR, Cline MG, Quan SF. Incidence and remission of habitual snoring over a 5 to 6-year period. Chest 1995; 108:604-9.
5. Peppard PE, Young T, Palta ME, Dempsey J, Skatrud J. Longitudinal study of moderate weight change and sleep-disordered breathing. JAMA 2000;284:3015-21.
6. Tishler PV, Larkin EK, Schluchter MD, Redline S. Incidence of sleep-diordered breathing in an urban adult population: the relative importance of risk factors in the development of sleep-disordered breathing. JAMA 2003;289:2230-7.
7. Redline S, Schluchter MD, Larkin EK, Tishler PV. Predictors of longitudinal change in sleep-disordered breathing in a nonclinic population. Sleep 2003;26:703-709.
8. Stoohs RA, Blum HC, Haselhorst M, Duchna HW, Guilleminault C, Dement WC. Normative data on snoring: a comparison between younger and older adults. Eur Respir J 1998;11:451-7.
9. Schmidt-Nowara WW, Coultas DB, Wiggins CEA, Skipper BE, Samet JM. Snoring in a Hispanic-American population. Risk factors and association with hypertension and other morbidity. Arch Intern Med 1990; 150:597-601.
10. Young T, Palta M, Dempsey J, Skatrud J, Weber S, Badr S. The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med 1993;328:1230-5.
11. Waller P, Bhopal R. Is snoring a cause of vascular disease: an epidemiological review. Lancet 1989;1:143-6.
12. Duran J, Esnaola S, Rubio R, Iztueta A. Obstructive sleep apnea-hypopnea and related clinical features in a population-based sample of subjects aged 30 to 70 years. Am J Respir Crit Care Med 2001; 163:685-9.
13. Jones TM, Swift AC. Snoring: recent developments. Hosp Med 2000; 61:330-5.
14. Hoffstein V. Snoring. Chest 1996;109:201-22.
15. Partinen M, Palomaki H. Snoring and cerebral infarction. Lancet 1985;2:1325-6.
16. Hoffstein V. Blood pressure, snoring, obesity, and nocturnal hypoxemia. Lancet 1994;344:643-5.
17. Schwab R, Ahmedd MM. Dynamic upper airway imaging during respiration in normal subjects and patients with sleep disordered breathing. Am Rev Resp Dis 1993;148:1385-1400.
18. Horner RI, Shea SA, McIvor J, Guz A. Pharyngeal size and shape during wakefulness and sleep in patients with obstructive sleep apnoea. QJ Med 199;72:719-35.
19. Fleetham JA. Upper airway imaging in relation to obstructive sleep apnoea. Clin Chest Med 1992;13:399-416.
20. Young T. Some methodologic and practical issues of reported snoring variability. Chest 1991;99:531-2.
21. Hoffstein V, Mateika S, Anderson D. Snoring: is it in the ear of the beholder? Sleep 1994;17:522-6.
22. Hoffstein V, Mateika S, Nash S. Comparing perceptions and measurements of snoring. Sleep 1996;19:783-9.
23. World Health Organization. Guidelines for community noise. Geneva: World Health Organization; 2000.
24. World Health Organization Regional Office for Europe. Noise and health home. Bonn: WHO European Centre for Environment and Health; 2004.
25. Schwartz AR, Thut DC, Russ B, Seelagy M, Yuan X, Brower RG, et al. Effect of electrical stimulation of the hypoglossal nerve on airflow mechanics in the isolated upper airway. Am Rev Resp Dis 1993; 147:1144-50.
26. Schafer J. Snoring, sleep apnea and upper airway. Stuttgart: Thieme; 1996.
27. Wilson K, Stoohs RA, Mulrooney TF, Johnson LJ, Guilleminault C, Huang Z. The snoring spectrum: acoustic assessment of snoring sound intensity in 1,139 individuals undergoing polysomnography. Chest 1999; 115:762-70.
28. Dalmasso F, Prota R. Snoring: analysis, measurement, clinical implications and applications. Eur Respir J 1996;9:149.
29. Pascualy RA, Soest SW. Snoring and sleep apnea: sleep well, feel better. New York: Demos Medical; 2000.
30. Perez-Padilla J, West P, Kryger M. Snoring in normal young adults: prevalence in sleep stages and associated changes in oxygen saturation, heart rate and breathing pattern. Sleep 1987;10:249-253.
31. Woodson BT, Garancis CJ, Toohill RJ. Histopathologic changes in snoring and OSA syndrome. Laryngoscope 1991;101:1318-22.
32. Barthel SW, Strome M. Snoring, obstructive sleep apnea, and surgery. Med Clin North Am 1999;83:85-96.
33. Scharf MB. Sleep disorders. In Paparella MM, Shumrick DA, Gluckman JL, Meyerhoff WL, editors. Otolaryngology: basic sciences and related principals. 3rd edn. Philadelphia, PA: WB Saunders; 1991.
34. Croft C, Pringle M. Sleep nasendoscopy: a technique for assessment in snoring and obstructive sleep apnoea. Clin Otolaryngol 1991; 16:504-9.
35. Gleadhill IC, Schwartz AR, Schubert NM, Wise RA, Permutt S, Smith PL. Upper airway collapsibility in snorers and in patients with obstructive hypopnea and apnea. Am Rev Respir Dis 1991;143:1300-3.
36. Maltais F, Carrier G, Cormier Y, Series E Cephalometric measurements in snorers, non-snorers, and patients with sleep apnoea. Thorax 1991;46:419-23.
37. de Berry-Borowiecki B, Kukwa A, Blanks RHI, Irvine CA. Cephalometric analysis for diagnosis and treatment of obstructive sleep apnea. Laryngoscope 1988;98:226-34.
38. Fujita S. Pharyngeal surgery for obstructive sleep apnea and snoring. In Fairbanks D, Fujita S, Ikematsu T, editors. Snoring and obstructive sleep apnea. New York: Raven Press; 1987. pp. 101-28.
39. Pepin JL, Levy P, Veale D, Ferretti G. Evaulation of the upper airway in sleep apnea syndrome. Sleep 1992;15(Suppl. 6):$50-5.
40. Isono S, Morrison DL, Launois SH, Feroah TR, Whitelaw WA, Remmers JE. Static mechanics of the velopharynx of patients with obstructive sleep apnoea. J Appl Physiol 1993;75:148-54.
41. El Badawey M, McKee G, Heggie N, Marshall H, Wilson JA. Predictive value of sleep nasendoscopy in the managment of habitual snorers. Ann Otol Rhinol Laryngol 2003;112:40-4.
42. Tvinnereim M, Cole P, Haight JS, Hoffstein V. Diagnostic airway pressure recording in sleep apnoea syndrome. Acta Otolaryngol 1995; 115:449-54.
43. Hudgel DW. Variable site of airway narrowing among obstructive sleep apnea patients. J Appl Physiol 1986;61:1403-9.
44. Jager L, Gunther E, Gauger J, Reiser M. Fluoroscopic MR of the pharynx in patient with obstructive sleep apnoea. Am J Neuroradiol 1998; 19:1205-14.
45. Ryan CF, Lowe AA, Li D, Fleetham JA. Three-dimensional upper airway computed tomography in obstructive sleep apnoea. Am Rev Respir Dis 1991;144:428-32.
46. Shephard JW, Thawley SE. Evaluation of the upper airway by computerised tomography in patients undergoing uvulopalatopharyngoplasty for obstructive sleep apnoea. Am Rev Respir Dis 1989; 140:711-16.
47. Ariyasu L, Young G, Spinelli F. Uvulectomy in the office setting. Ear Nose Throat J 1995;74:721-2.
48. Smithson AJ, White JE, Griffiths CJ, Prichard AJ, Close PR, Drinnan MJ, et al. Comparison of methods for assessing snoring. Clin Otolaryngol Allied Sci 1995;20:443-7.
49. Prichard AJ, Smithson AJ, White JE, Close PR, Drinnan MJ, Griffiths CJ, et al. Objective measurement of the results of uvulopalatopharyngoplasty. Clin Otolaryngol Allied Sci 1995; 20:495-8.
50. Walker RP, Gatti WM, Poirier N, Davis JS. Objective assessment of snoring before and after laser-assisted uvulopalatoplasty [erratum appears in Laryngoscope 1997;107:148]. Laryngoscope 1996; 106:1372-7.
51. Weingarten CZ, Raviv G. Evaluation of criteria for uvulopalatoplasty (UPP) patient selection using acoustic analysis of oronasal respiration (SNAP testing). J Otolaryngol 1995;24:352-7.
52. Quinn SJ, Daly N, Ellis PD. Observation of the mechanism of snoring using sleep nasendoscopy. Clin Otolaryngol Allied Sci 1995; 20:360-4.
53. Berry R, Block A. Effect of nasal spray, positinal therapy, and combination thereof in the asymptomatic snorer. Sleep 1994; 17:5216-22.
54. Stradling JR, Crosssy JH. Predictors and prevalence of obstructive sleep apnoea and snoring in 1001 middle-aged men. Thorax 1991; 6:85-90.
55. Meoli AL, Rosen CL, Kristo D, Kohrman M, Gooneratne N, Aguillard RN, et al. Nonpresciption treatments of snoring or obstructive apnea: an evaluation of products with limited scientific evidence. Sleep 2003;26:619-24.
56. Bennett LS, Davies RJ, Stradling JR. Oral appliances for the management of snoring and obstructive sleep apnoea. Thorax 1998; 53(Suppl. 2):S58-64.
57. McGown AD, Makker HK, Battagel JM, L'Estrange PR, Grant HR, Spiro SG. Long-term use of mandibular advancement splint for snoring and obstructive sleep apnoea: a questionnaire survey. Eur Respir J 2001;17: 462-6.
58. Johnston CD, Gleadhill IC, Cinnamond MJ, Peden WM. Oral appliances for the management of severe snoring: a randomised controlled trial. Eur J Orthod 2001;23:127-34.
59. Ono T, Lowe AA, Ferguson KA, Fleetham JA. A tongue retaining device and sleep-state genioglossus muscle activity in patients with obstructive sleep apnea. Angle Orthod 1996;66:273-80.
60. Ono T, Lowe AA, Ferguson KA, Pae EK, Fleetham JA. The effect of the tongue retaining device on awake genioglossus muscle activity in patients with obstructive sleep apnea. Am J Orthod Dentofacial Orthop 1996;110:28-35.
61. Ikematsu T. Study of snoring, 4th report: therapy. J Jpn Otol Rhinol Laryngol 1964;64:434-5.
62. Fujita S, Conway W, Zorick F, Roth T. Surgical correction of anatomical abnormalities in obstructive sleep apnoea syndromes: UVPP. Otolaryngol Head Neck Surg 1981;89:923-93.
63. Katsantonis GP, Friedman WH, Rosenblum BN, Walsh JK. The surgical treatment of snoring: a patient's perspective. Laryngoscope 1990;100:138-40.
64. 2 for snoring. Preliminary results. Acta Otorhinolaryngol Belg 1990;44:451-6.
65. Maw J, Marsan J. Uvulopalatopharyngoplasty versus laser-assisted uvulopalatopharyngoplasty in the treatment of snoring. J Otolaryngol 1997;26:232-5.
66. Clarke RW, Yardley MP, Davies CM. Palatoplasty for snoring: a randomised controlled trial of three surgical methods. Otolaryngol Head Neck Surg 1998;119:288-92.
67. Astor FC, Hanft KL, Benson C, Amaranath A. Analysis of short-term outcome after office-based laser-assisted uvulopalatoplasty. Otolaryngol Head Neck Surg 1998;118:478-80.
68. Wilde AD, Swift AC. A day-case procedure for treating simple snoring. Clin Otolaryngol 1995;20:486.
69. Coleman J, Rathfoot C. Oropharyngeal surgery in the management of upper airway obstruction during sleep. Otolaryngol Clin North Am 1999; 32:263-76.
70. Stuck BA, Maurer JT, Hein G, Hormann K, Verse T. Radiofrequency surgery of the soft palate in the treatment of snoring: a review of the literature. Sleep 2004;27:551-5.
71. Li KK, Powell N, Riley RW, Troell RJ, Guilleminault C. Radiofrequency volumetric tissue reduction for treatment of turbinate hypertrophy: A pilot study. Otolaryngol Head Neck Surg 1998;119:569-73.
72. Powell NB, Riley RW, Troell R. Radiofrequency volumetric reduction of the tongue: a porcine pilot study for the treatment of obstructive sleep apnoea syndrome. Chest 1997;111:1348-55.
73. National Institute for Health and Clinical Excellence. Radiofrequency ablation of the soft palate for snoring. Interventional Procedure Guidance 124. London: National Institute for Health and Clinical Excellence; 2005.
74. Nordgard S, Stene BK, Skjostad KW. Soft palate implants for the treatment of mild to moderate obstructive sleep apnea. Otolaryngol Head Neck Surg 2006;134:565-70.
75. Aragon S. Surgical management for snoring and sleep apnea. Dent Clin North Am 2001;45:867-79.
76. Avidan AY. The development of central sleep apnea with an oral appliance. Sleep Med 2006;7:187-8.
77. Low WK. Can snoring relief after nasal septal surgery be predicted? Clin Otolaryngol Allied Sci 1994;19:142-4.
78. Woodhead CJ, Allen MB. Nasal surgery for snoring. Clin Otolaryngol Allied Sci 1994; 19:41-4.
79. Audit Commission. Access to care for ear, nose and throat and audilogy services. London: Audit Commission; 2002.
80. NHS Modernisation Agency Demand Management Team. Big Wizard. URL: www.natpact.nhs.uk/demand_management/wizards/big_wizard/index.php. 2002.
81. Prasad KR, Kapoor PK, Kumar A, Reddy KT, Kumar BN. Waiting-list prioritization in the National Health Service. J Laryngol Otol 2004;118:39-45.
82. Khan K, ter Riet G, Glanville J, Sowden A, Kleijnen, J. Undertaking systematic reviews of research on effectiveness: CRD's guidance for those carrying out or comissoning reviews. CRD Report No. 4. University of York: Centre for Reviews and Dissemination; 2001.
83. Popay J, Roberts H, Sowden A, Petticrew M, Arai L, Roen K. Guidance on the conduct of narrative synthesis in systematic reviews. A product from the ESRC Methods Programme. Swindon: ESRC; 2006.
84. NHS Reference Costs 2005-2006. London: Department of Health; 2006. URL: www.dh.gov.uk/en/Publicationsandstatistics/Publications/ PublicationsPolicyAndGuidance/DH_062884.
85. The NHS Information Centre. NHS dental statistics for England quarter 4: 31st March 2007. Issues in Emerging Health Technologies. URL: www.ic.nhs.uk/webfiles/publications/dentalq4/ Quarterly%20publication%20Q4%202006_7.pdf. Accessed 26 November 2007.
86. Osman EZ, Osborne JE, Hill PD, Lee BW, Hammad Z. Uvulopalatopharyngoplasty versus laser assisted uvulopalatoplasty for the treatment of snoring: an objective randomised clinical trial. Clin Otolaryngol Allied Sci 2000;25:305-10.
87. Osman EZ, bo-Khatwa MM, Hill PD, Lee BW, Osborne JE. Palatal surgery for snoring: objective long-term evaluation. Clin Otolaryngol Allied Sci 2003;28:257-61.
88. Prasad KR, Premraj K, Kent SE, Reddy KT. Surgery for snoring: are partners satisfied in the long run? Clin Otolaryngol Allied Sci 2003;28:497-502.
89. Ozmen N, Cebeci BS, Kardesoglu E, Cincik H, Cekin E, Dincturk M, et al. QT dispersion in non-apneic simple snoring patients and the effect of surgical therapy on QT dispersion. Int J Cardiol 2006; 113:82-5.
90. Janson C, Hillerdal G, Larsson L, Hultcrantz E, Lindholm CE, Bengtsson H, et al. Excessive daytime sleepiness and fatigue in nonapnoeic snorers: improvement after UPPP. Eur Respir J 1994;7:845-9.
91. Friberg D, Carlsson-Nordlander B, Larsson H, Svanborg E. UPPP for habitual snoring: a 5-year follow-up with respiratory sleep recordings. Laryngoscope 1995;105:519-22.
92. Miljeteig H, Mateika S, Haight JS, Cole P, Hoffstein V. Subjective and objective assessment of uvulopalatopharyngoplasty for treatment of snoring and obstructive sleep apnea. Am J Respir Crit Care Med 1994;150:1286-90.
93. Neruntarat C. Uvulopalatal flap for snoring on an outpatient basis. Otolaryngol Head Neck Surg 2003;129:353-9.
94. Jones TM, Swift AC, Calverley PM, Ho MS, Earis JE. Acoustic analysis of snoring before and after palatal surgery. Eur Respir J 2005; 25:1044-9.
95. Berger G, Finkelstein Y, Stein G, Ophir D. Laser-assisted uvulopalatoplasty for snoring: medium-to long-term subjective and objective analysis [see comment]. Arch Otolaryngol Head Neck Surg 2001;127:412-17.
96. Lauretano AM, Khosla RK, Richardson G, Matheson J, Weiss JW, Graham C, et al. Efficacy of laser-assisted uvulopalatoplasty. Lasers Surg Med 1997;21:109-16.
97. Skjostad KW, Stene BK, Norgard S. Consequences of increased rigidity in palatal implants for snoring: a randomized controlled study. Otolaryngol Head Neck Surg 2006;134:63-6.
98. Nordgard S, Stene BK, Skjostad KW, Bugten V, Wormdal K, Hansen NV, et al. Palatal implants for the treatment of snoring: long-term results. Otolaryngol Head Neck Surg 2006;134:558-64.
99. Maurer JT, Hein G, Verse T, Hormann K, Stuck BA. Long-term results of palatal implants for primary snoring. Otolaryngol Head Neck Surg 2005;133:573-8.
100. Maurer JT, Verse T, Stuck BA, Hormann K, Hein G. Palatal implants for primary snoring: short-term results of a new minimally invasive surgical technique. Otolaryngol Head Neck Surg 2005;132:125-31.
101. Ho WK, Wei WI, Chung KF. Managing disturbing snoring with palatal implants: a pilot study. Arch Otolaryngol Head Neck Surg 2004; 130:753-8.
102. Brietzke SE, Mair EA. Injection snoreplasty: how to treat snoring without all the pain and expense [see comment]. Otolaryngol Head Neck Surg 2001;124:503-10.
103. Stuck BA, Sauter A, Hormann K, Verse T, Maurer JT. Radiofrequency surgery of the soft palate in the treatment of snoring. A placebo-controlled trial [see comment]. Sleep 2005; 28:847-50.
104. Cartwright R, Venkatesan TK, Caldarelli D, Diaz F. Treatments for snoring: a comparison of somnoplasty and an oral appliance. Laryngoscope 2000;110:1680-3.
105. Hukins CA, Mitchell IC, Hillman DR. Radiofrequency tissue volume reduction of the soft palate in simple snoring. Arch Otolaryngol Head Neck Surg 2000;126:602-6.
106. Boudewyns A, van de Heyning P. Temperature-controlled radiofrequency tissue volume reduction of the soft palate (Somnoplasty®) in the treatment of habitual snoring: results of a European multicenter trial. Acta Otolaryngol 2000;120:981-5.
107. Haraldsson PO, Karling J, Lysdahl M, Svanborg E. Voice quality after radiofrequency volumetric tissue reduction of the soft palate in habitual snorers. Laryngoscope 2002;112:1260-3.
108. Back LJ, Tervahartiala PO, Piilonen AK, Partinen MM, Ylikoski JS. Bipolar radiofrequency thermal ablation of the soft palate in habitual snorers without significant desaturations assessed by magnetic resonance imaging. Am J Respir Crit Care Med 2002;166:865-71.
109. den Herder C, Kox D, van Tinteren H, deVries N. Bipolar radiofrequency induced thermotherapy of the tongue base: its complications, acceptance and effectiveness under local anesthesia. Eur Arch Otorhinolaryngol 2006;263:1031-40.
110. Fransson AM, Isacsson G, Leissner LC, Nasman AB, Alton MK. Treatment of snoring and obstructive sleep apnea with a mandibular protruding device: an open-label study. Sleep Breath 2001;5:23-33.
111. Fransson AM, Tegelberg A, Leissner L, Wenneberg B, Isacsson G. Effects of a mandibular protruding device on the sleep of patients with obstructive sleep apnea and snoring problems: a 2-year follow-up. Sleep Breath 2003;7:131-41.
112. Series F, Marc I. Changes in snoring characteristics after 30 days of nasal continuous positive airway pressure in patients with non-apnoeic snoring: a controlled trial. Thorax 1994;49:562-6.
113. Smith AM, Battagel JM. Non-apneic snoring and the orthodontist: the effectiveness of mandibular advancement splints. J Orthod 2004; 31:115-23.
114. Neruntarat C. Laser-assisted outpatient septoplasty and laser-assisted uvulopalatoplasty for nasal obstruction and snoring. J Med Assoc Thai 2005;88(Suppl. 1):S66-72.
115. Johns MW. A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep 1991;14:540-5.
116. Johnston CD, Gleadhill IC, Cinnamond MJ, Peden WM. Oral appliances for the management of severe snoring: a randomized controlled trial. Eur J Orthod 2001;23:127-34.
117. Gnuechtel MM, Keyser JS, Greinwald JH, Jr, Postma GN. Electrocautery versus carbon dioxide laser for uvulopalatoplasty in the treatment of snoring. Laryngoscope 1997;107:848-54.
118. Truy E, Cote-Deplus I, Morgon A. Effectiveness of musculus palatopharyngeus resection in uvulopalatopharyngoplasty for snoring. J Otolaryngol 1995;24:79-83.
119. Mukai S, Mukai C, Nitta M. Functions of the uvula and Z-pharyngoplasty. Psychiatry Clin Neurosci 2000;54:346-7.
120. Clarke RW, Yardley MR Davies CM, Panarese A, Clegg RT, Parker AJ. Palatoplasty for snoring: a randomized controlled trial of three surgical methods. Otolaryngol Head Neck Surg 1998; 119:288-92.
121. Belloso A, Morar P, Tahery J, Saravanan K, Nigam A, Timms MS. Randomized-controlled study comparing postoperative pain between coblation palatoplasty and laser palatoplasty. Clin Otolaryngol 2006;31:138-43.
122. Uppal S, Nadig S, Jones C, Nicolaides AR, Coatesworth AP. A prospective single-blind randomized-controlled trial comparing two surgical techniques for the treatment of snoring: laser palatoplasty versus uvulectomy with punctate palatal diathermy. Clin Otolaryngol Allied Sci 2004;29:254-63.
123. Banerjee A, Dempster JH. Laser palatoplasty: evaluation of patient benefit using the Glasgow benefit inventory. J Laryngol Otol 2000;114:601-4.
124. Powell N, Riley R, Gulleminault C, Troell R. A reversible uvulopalatal flap for snoring and sleep apnea syndrome. Sleep 1996; 19:593-9.
125. Dierks E, Geller M, Roffwarg H, Johns D. Obstructive sleep apnea syndrome: correction by mandibular advancement. South Med J 1990;83:390-394.
126. Anonymous. Restoring peace - and health - to troubled snorers. Johns Hopkins Med Lett, Health After 50 2002;14(7):3.
127. Maurer JT, Huber K, Verse T, Hormann K, Stuck B. A mandibular advancement device for the ENT office to treat obstructive sleep apnea. Otolaryngol Head Neck Surg 2007;136:231-5.
128. Gentil B, Lienhart A, Fleury B. Enhancement of postoperative desaturation in heavy snorers. Anesth Analg 1995;81:389-92.
129. Taliaferro C. Submucosal radiosurgical uvulopalatoplasty for the treatment of snoring: is the monitoring of tissue impedance and temperature necessary? Otolaryngol Head Neck Surg 2001; 124:46-50.
130. Back L, Palomaki M, Piilonen A, Ylikoski J. Sleep-disordered breathing: radiofrequency thermal ablation is a promising new treatment possibility. Laryngoscope 2001;111:464-71.
131. National Institute for Health and Clinical Excellence. Guide to the methods of technology appraisal. London: National Institute for Health and Clinical Excellence, 2004.
132. Hicklin LA, Tostevin P, Dasan S. Retrospective survey of long-term results and patient satisfaction with uvulopalatopharyngoplasty for snoring. J Laryngol Otol 2000;114:675-81.
133. Cahali MB. Lateral pharyngoplasty: a new treatment for obstructive sleep apnea hypopnea syndrome. Laryngoscope 2003;113:1961-8.
134. Wiggin C, Schmidt-Nowara WW, Coultas D, Samet JM. Comparison of self- and spouse reports on snoring and other symptoms associated with sleep apnea syndrome. Sleep 1990;13:245-52.
135. Beran RG, Plunkett MJ, Holland GJ. Interface of epilepsy and sleep disorders. Seizure 1999;8:97-102.
136. Series F, Marc I, Atton L. Comparison of snoring measured at home and during polysomnographic studies. Chest 1993;103:1769-73.
137. Osman EZ, Osborne J, Hill PD, Lee BW. Snoring assessment: do home studies and hospital studies give different results? Clin Otolaryngol Allied Sci 1998;23:524-7.
138. Mayo E. The human problems of an industrial civilization. New York: Macmillan; 1933.
139. Gillespie R. Manufacturing knowledge: a history of the Hawthorne experiments. Cambridge: Cambridge University Press; 1991.
140. Anonymous. From LAUP to UPPP: a primer on procedures to treat snoring. Clin Laser Monthly 1994;12:184.
141. Abbey NC, Block AJ, Green D, Hellard D, Mancuso A. A method for measuring pharyngeal volumes using magnetic resonance imaging in subjects who snore with and without nasal CPAP. Prog Clin Biol Res 1990;345:283-8.
142. Antila J, Sipila J, Tshushima Y, Polo O, Laurikainen E, Suonpaa J. The effect of laser-uvulopalatopharyngoplasty on the nasal and nasopharyngeal volume measured with acoustic rhinometry. Acta Otolaryngol Suppl 1997;529:202-5.
143. Berry RB, Block AJ. Positive nasal airway pressure eliminates snoring as well as obstructive sleep apnea. Chest 1984;85:15-20.
144. Blythe WR, Henrich DE, Pillsbury HC. Outpatient uvuloplasty: an inexpensive, single-staged procedure for the relief of symptomatic snoring. Otolaryngol Head Neck Surg 1995;113:1-4.
145. Brietzke SE, Mair EA. Injection snoreplasty: extended follow-up and new objective data. Otolaryngol Head Neck Surg 2003;128:605-15.
146. Capper R, Gleadhill I, Cinnamond MJ. Uvulopalatopharyngoplasty for snoring: the Belfast experience. Ulster Med J 1994;63:8-11.
147. Carenfelt C. Laser uvulopalatoplasty in treatment of habitual snoring. Ann Otol Rhinol Laryngol 1991;100:451-4.
148. Casiano RR, Sheth S. Efficacy of cold-steel uvulopalatoplasty. Otolaryngol Head Neck Surg 1996;115:471-3.
149. Chai F, Mitchell I. Snare palatoplasty. Aust J Otolaryngol 1998; 3:149-50.
150. Croft CB, Golding-Wood DG. Uses and complications of uvulopalatopharyngoplasty. J Laryngol Otol 1990;104:871-5.
151. Cheng DS, Weng JC, Yang PW, Cheng LH. Carbon dioxide laser surgery for snoring: results in 192 patients. Otolaryngol Head Neck Surg 1998;118:486-9.
152. Cooke ME, Battagel JM. A thermoplastic mandibular advancement device for the management of non-apnoeic snoring: a randomized controlled trial. Eur J Orthod 2006;28:327-38.
153. Crestinu JM. Intrapalatine resection (IPR) in the treatment of sleep apnea and snoring. Plast Reconstr Surg 1991;87:467-9.
154. den Herder C, van Tinteren H, de Vries N. Sleep endoscopy versus modified mallampati score in sleep apnea and snoring. Laryngoscope 2005;115:735-9.
155. Drinnan MJ, Richardson HC, Close PR, Smithson AJ, White JE, Griffiths C J, et al. Objective benefit of laser palatoplasty for non-apnoeic snoring. Clin Otolaryngol Allied Sci 1999;24:335-8.
156. Ellis PD. Laser palatoplasty for snoring due to palatal flutter: a further report. Clin Otolaryngol Allied Sci 1994;19:350-1.
157. Ellis PD, Williams JE, Shneerson JM. Surgical relief of snoring due to palatal flutter: a preliminary report. Ann R Coll Surg Engl 1993;75:286-90.
158. Emery BE, Flexon PB. Radiofrequency volumetric tissue reduction of the soft palate: a new treatment for snoring. Laryngoscope 2000; 110:1092-8.
159. Ferguson M, Smith TL, Zanation AM, Yarbrough WG. Radiofrequency tissue volume reduction: multilesion vs single-lesion treatments for snoring. Arch Otolaryngol Head Neck Surg 2001;127:1113-18.
160. Finkelstein Y, Talmi YP, Raveh E, Orlin J, Rudnicki C, Fried M, et al. Can obstructive sleep apnoea be a complication of uvulopalatopharyngoplasty? J Laryngol Otol 1995;109:212-17.
161. Fransson AM, Tegelberg A, Johansson A, Wenneberg B. Influence on the masticatory system in treatment of obstructive sleep apnea and snoring with a mandibular protruding device: a 2-year follow-up. Am J Orthod Dentofacial Orthop 2004;126:687-93.
162. Fransson AM, Tegelberg A, Svenson BA, Lennartsson B, Isacsson G. Influence of mandibular protruding device on airway passages and dentofacial characteristics in obstructive sleep apnea and snoring. Am J Orthod Dentofacial Orthop 2002;12:371-9.
163. Gordon AS, Giles ML, Harding DA, Morton RP. Surgery of snoring. J Laryngol Otol 1986;100:1263-7.
164. Guilleminault C, Stoohs R, Clerk A, Simmons J, Labanowski M. Excessive daytime somnolence in women with abnormal respiratory efforts during sleep. Sleep 1993;16(8 Suppl.):S137-8.
165. Hanada T, Furuta S, Tateyama T, Uchizono A, Seki D, Ohyama M. Laser-assisted uvulopalatoplasty with Nd:YAG laser for sleep disorders. Laryngoscope 1996;106:1531-3.
166. Haraldsson PO, Bredbacka S. Laser-uvulopalatoplasty (LUPP) under local anesthesia: effective, safe and comfortable. J Otorhinolaryngol 1996;58:99-104.
167. Hern JD, Hellier WP, Brasher PF. The treatment of snoring in the armed forces. J R Army Med Corps 1999;145:137-9.
168. Hessel NS, de Vries N. Results of uvulopalatopharyngoplasty after diagnostic workup with polysomnography and sleep endoscopy: a report of 136 snoring patients. Eur Arch Otorhinolaryngol 2003; 260:91-5.
169. Hofmann T, Schwantzer G, Reckenzaun E, Koch H, Wolf G. Radiofrequency tissue volume reduction of the soft palate and UPPP in the treatment of snoring. Eur Arch Otorhinolaryngol 2006;263:164-70.
170. Hultcrantz E, Johansson K, Bengtson H. The effect of uvulopalatopharyngoplasty without tonsillectomy using local anaesthesia: a prospective long-term follow-up. J Laryngol Otol 1999; 113:542-7.
171. 2 laser palatoplasty: early results. J Laryngol Otol 1996; 110:754-6.
172. Isberg A, Levring-Jaghagen E, Dahlstrom M, Dahlqvist A. Persistent dysphagia after laser uvulopalatoplasty: a videoradiographic study of pharyngeal function. Acta Otolaryngol 1998;118:870-4.
173. Iseri M, Balcioglu O. Radiofrequency versus injection snoreplasty in simple snoring. Otolaryngol Head Neck Surg 2005;133:224-8.
174. Issa FG, Sullivan CE. Upper airway closing pressures in snorers. J Appl Physiol 1984;57:528-35.
175. Jones TM, Ho MS, Earis JE, Swift AC. Acoustic parameters of snoring sound to assess the effectiveness of the Muller manoeuvre in predicting surgical outcome. Auris Nasus Larynx 2006;33:409-16.
176. 2 laser: laser-assisted UPPP. J Otolaryngol 1994;23:391-4.
177. Kezirian EJ, Powell NB, Riley RW, Hester JE. Incidence of complications in radiofrequency treatment of the upper airway. Laryngoscope 2005;115:1298-1304.
178. Koay CB, Freeland AP, Stradling JR. Short- and long-term outcomes of uvulopalatopharyngoplasty for snoring. Clin Otolaryngol Allied Sci 1995;20:45-8.
179. den Herder C, van Tinteren H, de Vries N. Hyoidthyroidpexia: a surgical treatment for sleep apnea syndrome [reprint in Ned Tijdschr Geneeskd 2006;150(4):98-203]. Laryngoscope 2005; 115:740-5.
180. Krespi YF, Pearlman SJ, Keidar A. Laser-assisted uvula-palatoplasty for snoring. J Otolaryngol 1994;23:328-34.
181. Kuhnel TS, Hein G, Hohenhorst W, Maurer JT. Soft palate implants: a new option for treating habitual snoring. Eur Arch Otorhinolaryngol 2005;262:277-80.
182. Vinaya Kumar EC, RaoJ, Chowdary S, Rao C. Management of tongue base obstruction in obstructive sleep apnoea syndrome. Indian J Otolaryngol 1999;5252:58-62.
183. Kyearmizakis DE, Chimona TS, Papadakis CE, Bizakis JG, Velegrakis GA, Schiza S, et al. Laser-assisted uvulopalatoplasty for the treatment of snoring and mild obstructive sleep apnea syndrome. J Otolaryngol 2003;32:174-9.
184. Lamont J, Baldwin DR, Hay KD, Veale AG. Effect of two types of mandibular advancement splints on snoring and obstructive sleep apnoea. Eur J Orthod 1998;20:293-7.
185. 2 and Nd-YAG laser beams. Lasers Med Sci 1996;11:53-8.
186. Larrosa F, Hernandez L, Morello A, Ballester E, Quinto L, Montserrat JM. Laser-assisted uvulopalatoplasty for snoring: does it meet the expectations? Eur Respir J 2004;24:66-70.
187. Liudahl JJ, Haydon RC, Rodman SM. Snoring and related problems: surgical correction. W V Med J 1986;82:127-30.
188. Lysdahl M, Haraldsson PO. Uvulopalatopharyngoplasty versus laser uvulopalatoplasty: prospective long-term follow-up of self-reported symptoms. Acta Otolaryngol 2002;122:752-7.
189. Macdonald A, Drinnan M, Johnston A, Reda M, Griffiths C, Wilson J, et al. Evaluation of potential predictors of outcome of laser-assisted uvulopalatoplasty for snoring. Otolaryngol Head Neck Surg 2006; 134:197-203.
190. Mair EA, Day RH. Cautery-assisted palatal stiffening operation. Otolaryngol Head Neck Surg 2000;122:547-56.
191. Marklund M, Franklin KA. Dental appliances in the treatment of snoring. A comparison between an activator, a soft-palate lifter, and a mouth-shield. Swedish Dent J 1996;20:183-8.
192. 2 laser uvulo-palato-pharyngoplasty. Aust J Otolaryngol 1996;2:287-9.
193. Myatt HM, Mackay IS. Snoring - a simple surgical solution. Clin Otolaryngol Allied Sci 1996;21:419-24.
194. Nordgard S, Wormdal K, Bugten V, Stene BK, Skjostad KW. Palatal implants: a new method for the treatment of snoring. Acta Otolaryngol 2004;124:970-5.
195. O'Sullivan RA, Hillman DR, Mateljan R, Pantin C, Finucane KE. Mandibular advancement splint: an appliance to treat snoring and obstructive sleep apnea. Am J Respir Crit Care Med 1995;151:194-8.
196. Powell NB, Riley RW, Troell RJ, Li K, Blumen MB, Guilleminault C. Radiofrequency volumetric tissue reduction of the palate in subjects with sleep-disordered breathing [see comment]. Chest 1998; 113:1163-74.
197. Prichard AJ, Marshall J, Ahmed A, Thomas RS, Hanning CD. Uvulopalatopharyngoplasty: the Leicester experience. J Laryngol Otol 1994;108:649-52.
198. Reda M, Marshall HF, Gibson JG, Wilson JA. Objective assessment of soft palate morphology in habitual snoring and its modification by laser assisted uvulopalatoplasty. Clin Otolaryngol Allied Sci 199; 23:285-6.
199. Reda M, Sims AJ, Collins MM, McKee GJ, Marshall H, Kelly PJ, et al. Morphological assessment of the soft palate in habitual snoring using image analysis. Laryngoscope 1999;109:1655-60.
200. 2 laser combined with diode laser. Acta Otorhinolaryngol Belg 2002;56:177-82.
201. Remacle M, Betsch C, Lawson G, Jamart J, Eloy P. A new technique for laser-assisted uvulopalatoplasty: decision-tree analysis and results. Laryngoscope 1999;109:763-8.
202. Robertson C, Herbison P, Harkness M. Dental and occlusal changes during mandibular advancement splint therapy in sleep disordered patients. Eur J Orthod 2003;25:371-6.
203. Robertson MS. A cure for snoring. N Z Med J 1985;98:103-4.
204. Safaya A, Suri JC, Batra K. Uvulopalatopharyngoplasty - surgery for snoring. Indian J Otolaryngol 2002;54:204-7.
205. Sandhu GS, Vatts A, Whinney D, Kotecha B, Croft CB. Somnoplasty for simple snoring - a pilot study. Clin Otolaryngol Allied Sci 2003;28:425-9.
206. Sanner BM, Tepel M, Markmann A, Zidek W. Effect of continuous positive airway pressure therapy on 24-hour blood pressure in patients with obstructive sleep apnea syndrome. Am J Hypertens 2002; 15:251-7.
207. Simmons FB, Guilleminault C, Miles LE. The palatopharyngoplasty operation for snoring and sleep apnea: an interim report. Otolaryngol Head Neck Surg 1984;92:375-80.
208. Skatvedt O. Laser-assisted uvulopalatoplasty: description of the technique and pre- and postoperative evaluation of subjective symptoms. J Otorhinolaryngol Rel Spec 1996;58:243-7.
209. Stradling JR, Negus TW, Smith D, Langford B. Mandibular advancement devices for the control of snoring. Eur Respir J 1998; 11:447-50.
210. Tarabichi M. Microdebrider-assisted uvulopalatoplasty. Otolaryngol Head Neck Surg 1998;119:131-3.
211. Tatla T, Sandhu G, Croft CB, Kotecha B. Celon radiofrequency thermo-ablative palatoplasty for snoring - a pilot study. J Laryngol Otol 2003;117:801-6.
212. Troell RJ, Powell NB, Riley RW, Li KK, Guilleminault C. Comparison of postoperative pain between laser-assisted uvulopalatoplasty, uvulopalatopharyngoplasty, and radiofrequency volumetric tissue reduction of the palate. Otolaryngol Head Neck Surg 2000; 122:402-9.
213. Turnbull NR, Battagel JM. The effects of orthognathic surgery on pharyngeal airway dimensions and quality of sleep. J Orthod 2000;27:235-47.
214. Tvinnereim M, Mitic S, Hansen RK. Plasma radiofrequency preceded by pressure recording enhances success for treating sleep-related breathing disorders. Laryngoscope 2007;117:731-6.
215. Utley DS, Shin EJ, Clerk AA, Terris DJ. A cost-effective and rational surgical approach to patients with snoring, upper airway resistance syndrome, or obstructive sleep apnea syndrome. Laryngoscope 1997;107:726-34.
216. Veres E. Clinical trial of an oral vestibular shield for the control of snoring. J Dent Assoc South Afr 1993;48:15-17.
217. Verse T, Maurer JT, Pirsig W. Effect of nasal surgery on sleep-related breathing disorders. Laryngoscope 2002;112:64-8.
218. Virkkula P, Bachour A, Hytonen M, Salmi T, Malmberg H, Hurmerinta K, et al. Snoring is not relieved by nasal surgery despite improvement in nasal resistance. Chest 2006;129:81-7.
219. Vukovic L, Hutchings J. Patient evaluation of laser-assisted uvulopalatoplasty. J Otolaryngol 1996;25:404-7.
220. Walker RP, Grigg-Damberger MM, Gopalsami C, Totten MC. Laser-assisted uvulopalatoplasty for snoring and obstructive sleep apnea: results in 170 patients. Laryngoscope 1995;105:938-43.
221. Wareing MJ, Callanan VP, Mitchell DB. Laser-assisted uvulopalatoplasty: six and eighteen month results. J Laryngol Otol 1998; 112:639-4 1.
222. Wedman J, Miljeteig H. Treatment of simple snoring using radio waves for ablation of uvula and soft palate: a day-case surgery procedure. Laryngoscope 2002;112:1256-9.
223. Weingarten C. Snare uvulopalatoplasty [see comment]. Laryngoscope 1995;105:1033-6.
224. Welt S, Maurer JT, Hormann K, Stuck BA. Radiofrequency surgery of the tongue base in the treatment of snoring - a pilot study. Sleep Breath 2007;11:39-43.
225. Whinney DJ, Williamson PA, Bicknell PG. Punctate diathermy of the soft palate: a new approach in the surgical management of snoring. J Laryngol Otol 1995;109:849-52.
226. Wilson JA, Lester SE, Gibson GJ, Anari S, Steele JG, Steen IN, et al. Silencing the snorers: no gain without pain? J Laryngol Otol 2006;120:570-4.
227. Woodson BT. A tongue suspension suture for obstructive sleep apnea and snorers. Otolaryngol Head Neck Surg 2001;124:297-303.
228. Wright S, Haight J, Zamel N, Hoffstein V. Changes in pharyngeal properties after uvulopalatopharyngoplasty. Laryngoscope 1989; 99:62-5.
229. Zinder DJ, Postma GN. Outpatient cautery-assisted uvulopalatoplasty. Laryngoscope 1995;105:1256-7.