Comparative Effectiveness of the Different Treatment Modalities for Snoring.

OBJECTIVE To evaluate what effects treatments of sleep-disordered breathing have on snoring and sleepiness: snoring surgery including osteotomies, mandibular advancement device (MAD), and continuous positive airway pressure (CPAP). STUDY DESIGN Single-institution prospective comparative effectiveness trial. SETTING University-affiliated secondary care teaching hospital. SUBJECTS AND METHODS We prospectively studied 224 patients presenting with snoring at our department. All patients underwent detailed evaluation, including symptom questionnaires, clinical examination, polysomnography, and drug-induced sleep endoscopy. Based on these results, a treatment was proposed after multidisciplinary consultation. Treatment was evaluated through 4 questionnaires before treatment and 6 weeks and 6 months after. Treatment success was defined as a global snoring visual analog scale score ≤3 at 6 months. RESULTS A total of 195 patients complied with full workup and were proposed treatment. The mean age was 46 ± 11 years; the mean body mass index, 27 ± 4; and the median apnea-hypopnea index, 10.0 (interquartile range, 4.7-20.1). After discussion, 116 (59.5%) patients agreed to start treatment (46%, surgery; 26% MAD; 28% CPAP). All symptom scores, including Epworth Sleepiness Scale, decreased significantly for all treatments at 6 weeks and 6 months. Treatment was successful in 67% of the surgery patients, 67% of the MAD group, and 76% of the CPAP group. Only 6.7% reported an unchanged snoring score in the surgery group, compared with 13.6% in the MAD group and 9.6 % in the CPAP group. CONCLUSION Multidisciplinary agreed-on treatment of snoring is effective across the proposed treatments.