Obstructive sleep apnea is a chronic disease whose treatment may require long-term nightly use of relatively cumbersome and expensive breathing equipment that provides continuous positive airway pressure (CPAP) via nasal mask. Compliance with this treatment may be influenced not only by the objective improvement in sleep apnea but also by the patient's subjective perception of the benefit, bed mate or family support, side effects, and cost. The last factor may not be important in Ontario, where 75% of the cost is paid by the Ministry of Health. The goal of this study was to analyze the factors that may influence patient acceptance of nasal CPAP. This was done by tabulating the responses to a detailed questionnaire mailed to 148 patients with obstructive sleep apnea (OSA). There were 96 replies. We were able to contact by telephone an additional 42 patients. The results showed that 105 patients continued to use CPAP at a mean follow-up time of 17 +/- 11 months, some for as long as 6 yr. The majority of patients (81%) perceived CPAP as an effective treatment of the disorder, 5% were unsure, and 14% believed that CPAP was ineffective, despite the resolution of sleep apnea on polysomnography. Subjective improvement reported by the patients was also observed by the family members in 83% of the patients. The most common complaint, voiced by 46% of the patients, was nocturnal awakenings. Nasal problems, such as dryness, congestion, and sneezing, were the second most frequent complaint present in 44% of the responders.(ABSTRACT TRUNCATED AT 250 WORDS)

Summary: Complaint of snoring, which is usually voiced by a patient's bedpartner, frequently leads to investigations in the sleep laboratory that are designed to assess snoring objectively and determine whether it is a symptom of sleep apnea. How well this subjective complaint of the listener is confirmed by the objective measurement of snoring is not known. Consequently, we designed a study i) to test the validity of self-perception of snoring and ii) to compare subjective perception of snoring by the sleep technologist with objective measurement of its frequency and loudness. We studied 613 unselected patients referred to our sleep clinic because of snoring and suspicion of sleep apnea. They all had nocturnal polysomnography that included measurements of snoring, expressed as the number of snores per hour of sleep [snoring index (SI)] and mean (dBmean) and maximum (dBmax) nocturnal sound intensity. Following the sleep study, the technologist (and patient) independently rated a patient's snoring as none, mild, moderate or severe. Kruskall-Wallis test, Spearman rank correlations and Cohen's kappa statistics were used to compare the groups, examine the correlations between subjective and objective measurements, and check the agreement between them. We found that i) most patients who snore (471 of 613) were unaware of this behavior; ii) snoring index increased progressively from the “none” group (median SI = 26) to the “severe” group (median SI = 755), with a significant but moderate correlation between the technologist's impression and SI (r = 0.68, p < 0.0005) and poor correlation between the technologist's impression and dBmean (r = 0.34, p < 0.0005); and iii) most of those patients who claim to be able to judge the severity of their snoring have a different perception of it than the listener, with poor agreement between patient's and technologist's subjective impression (Cohen's kappa = 0.22, 95% confidence limits: 0.14−0.33). We conclude that to a large extent snoring is “in the ear of the beholder”, showing only moderate correlation with objective measurement.

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This study was designed to assess the subjective and objective effects of uvulopalatopharyngoplasty (UPPP) for treatment of snoring. We mailed a questionnaire dealing with snoring, quality of sleep, and interference with bed-partner's sleep to 100 unselected patients who were referred because of snoring. Replies were received from 69 patients. The answers were analyzed, and the subjective impressions were compared with preoperative and postoperative objective measurements of snoring and apnea. The average (+/- SD) length of follow-up was 45 +/- 20 mo. We found no significant differences in the apnea/hypopnea index, snoring index, and mean and maximal nocturnal sound intensity before and after surgery in this group. However, despite this lack of objective improvement. 78% of patients reported reduction in snoring, and 79% reported improvement in the quality of sleep; 18 of 69 bed partners no longer complained of interference with their sleep compared with only one preoperatively. We conclude that if the purpose of UPPP is to reduce the reported health hazards associated with snoring, then comparison between objective preoperative and postoperative measurements of snoring does not indicate success; if, on the other hand, the purpose of surgery is to alleviate the social hazard, then UPPP partially achieves this goal.