Calculating annoyance: an option to proof efficacy in ENT treatment of snoring?

Abstract

To develop and validate an objective method for calculating the annoyance caused by snoring sounds. 53 subjects assessed 50 different snoring and breath sounds on a visual analog scale for level of annoyance. A linear regression analysis was used to correlate these subjective assessments with objectively calculated psychoacoustic parameters (loudness, roughness, sharpness, and fluctuation strength, calculating the maximum, mean, and 5th percentile in each case). The quality of the resulting formula was checked, and additional validation was performed using subjective assessments of 60 new snoring and breath sounds by 52 new subjects. Receiver operating characteristic (ROC) analysis was used to scale the annoyance ranges obtained with the formula. A score consisting of the 5th percentile of loudness and the mean of roughness was developed. The formula displays high goodness of fit (R 2 = 0.91) and quality. In the validation phase, a highly significant correlation (r s = 0.95; p < 0.01) was obtained between the scores calculated with the formula and the subjective assessments. ROC analysis was able to define the annoyance ranges with a discriminatory power between 52 and 73 % (optimum sensitivity/specificity). The subjective assessments made by the participants were distinctly scaled and were reflected in a psychophysical algorithm. In the setting of polygraphy and polysomnography, this means that a reliable annoyance score that is not dependent on the bed partner can be obtained to establish the indication for anti-snoring treatments and to review their utility.

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References

  1. 1.

    Stuck BA, Dreher A, Heiser C, Herzog M, Kühnel T, Maurer JT, Pistner H, Sitter H, Steffen A, Verse T (2015) Diagnosis and treatment of snoring in adults-S2k Guideline of the German Society of Otorhinolaryngology, Head and Neck Surgery. Sleep Breath 19:135–148

    Article  PubMed  Google Scholar 

  2. 2.

    Pevernagie D, Aarts RM, de Meyer M (2010) The acoustics of snoring. Sleep Med Rev 14:131–144

    Article  PubMed  Google Scholar 

  3. 3.

    Hoffstein V (1996) Snoring. Chest 109:201–222

    CAS  Article  PubMed  Google Scholar 

  4. 4.

    Beck R, Odeh M, Oliven A, Gavriely N (1995) The acoustic properties of snores. Eur Respir J 8:2120–2128

    CAS  Article  PubMed  Google Scholar 

  5. 5.

    Ulfberg J, Carter N, Talbäck M, Edling C (2000) Adverse health effects among women living with heavy snorers. Health Care Women Int 21:81–90

    CAS  Article  PubMed  Google Scholar 

  6. 6.

    Blumen MB, Quera Salva MA, Vaugier I, Leroux K, d’Ortho M, Barbot F, Chabolle F, Lofaso F (2012) Is snoring intensity responsible for the sleep partner’s poor quality of sleep? Sleep Breath 16:903–907

    Article  PubMed  Google Scholar 

  7. 7.

    McArdle N, Kingshott R, Engleman HM, Mackay TW, Douglas NJ (2001) Partners of patients with sleep apnoea/hypopnoea syndrome: effect of CPAP treatment on sleep quality and quality of life. Thorax 56:513–518

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  8. 8.

    Troxel WM, Buysse DJ, Hall M, Matthews KA (2009) Marital happiness and sleep disturbances in a multi-ethnic sample of middle-aged women. Behav Sleep Med 7:2–19

    Article  PubMed  PubMed Central  Google Scholar 

  9. 9.

    Virkkula P, Bachour A, Hytönen M, Malmberg H, Salmi T, Maasilta P (2005) Patient- and bed partner-reported symptoms, smoking, and nasal resistance in sleep-disordered breathing. Chest 128:2176–2182

    Article  PubMed  Google Scholar 

  10. 10.

    Laszlo HE, McRobie ES, Stansfeld SA, Hansell AL (2012) Annoyance and other reaction measures to changes in noise exposure—a review. Sci Total Environ 435–436:551–562

    Article  CAS  PubMed  Google Scholar 

  11. 11.

    van Kempen E, van Kamp I, Nilsson M, Lammers J, Emmen H, Clark C, Stansfeld S (2010) The role of annoyance in the relation between transportation noise and children’s health and cognition. J Acoust Soc Am 128:2817–2828

    Article  PubMed  Google Scholar 

  12. 12.

    Basner M, Babisch W, Davis A, Brink M, Clark C, Janssen S, Stansfeld S (2014) Auditory and non-auditory effects of noise on health. Lancet 383:1325–1332

    Article  PubMed  Google Scholar 

  13. 13.

    Lekaviciute J, Argalasova-Sobotova L (2013) Environmental noise and annoyance in adults: research in Central, Eastern and South-Eastern Europe and Newly Independent States. Noise Health 15:42–54

    Article  PubMed  Google Scholar 

  14. 14.

    Kasess CH, Noll A, Majdak P, Waubke H (2013) Effect of train type on annoyance and acoustic features of the rolling noise. J Acoust Soc Am 134:1071–1081

    Article  PubMed  Google Scholar 

  15. 15.

    Münzel T, Gori T, Babisch W, Basner M (2014) Cardiovascular effects of environmental noise exposure. Eur Heart J 35:829–836

    Article  PubMed  PubMed Central  Google Scholar 

  16. 16.

    Fastl H, Zwicker E (2007) Psychoacoustics: facts and models. Springer, Berlin

    Google Scholar 

  17. 17.

    Durbin J, Watson GS (1951) Testing for serial correlation in least squares regression. Biometrika 38:159–177

    CAS  Article  PubMed  Google Scholar 

  18. 18.

    Hoffstein V, Mateika S, Anderson D (1994) Snoring: is it in the ear of the beholder? Sleep 17:522–526

    CAS  PubMed  Google Scholar 

  19. 19.

    Hoffstein V (2007) Review of oral appliances for treatment of sleep-disordered breathing. Sleep Breath 11:1–22

    Article  PubMed  Google Scholar 

  20. 20.

    Wiggins CL, Schmidt-Nowara WW, Coultas DB, Samet JM (1990) Comparison of self- and spouse reports of snoring and other symptoms associated with sleep apnea syndrome. Sleep 13:245–252

    CAS  PubMed  Google Scholar 

  21. 21.

    Counter P, Wilson JA (2004) The management of simple snoring. Sleep Med Rev 8:433–441

    Article  PubMed  Google Scholar 

  22. 22.

    Miljeteig H, Mateika S, Haight JS, Cole P, Hoffstein V (1994) Subjective and objective assessment of uvulopalatopharyngoplasty for treatment of snoring and obstructive sleep apnea. Am J Respir Crit Care Med 150:1286–1290

    CAS  Article  PubMed  Google Scholar 

  23. 23.

    Sériès F, Marc I, Atton L (1993) Comparison of snoring measured at home and during polysomnographic studies. Chest 103:1769–1773

    Article  PubMed  Google Scholar 

  24. 24.

    Dalmasso F, Prota R (1996) Snoring: analysis, measurement, clinical implications and applications. Eur Respir J 9:146–159

    CAS  Article  PubMed  Google Scholar 

  25. 25.

    Rohrmeier C, Fischer R, Merz A, Ettl T, Herzog M, Kuehnel TS (2015) Are subjective assessments of snoring sounds reliable? Eur Arch Otorhinolaryngol 272:233–240

    Article  PubMed  Google Scholar 

  26. 26.

    Ellermeier W, Mader M, Daniel P (2004) Scaling the unpleasantness of sounds according to the BTL model: ratio-scale representation and psychoacoustical analysis. Acta Acust United Acust 90:101–107

    Google Scholar 

  27. 27.

    Rohrmeier C, Herzog M, Haubner F, Kuehnel TS (2012) The annoyance of snoring and psychoacoustic parameters: a step towards an objective measurement. Eur Arch Otorhinolaryngol 269:1537–1543

    Article  PubMed  Google Scholar 

  28. 28.

    Herzog M, Bremert T, Herzog B, Hosemann W, Kaftan H, Müller A (2011) Analysis of snoring sound by psychoacoustic parameters. Eur Arch Otorhinolaryngol 268:1386–1389

    Google Scholar 

  29. 29.

    Herzog M, Kellner P, Plößl S, Glien A, Rohrmeier C, Kühnel T, Plontke S, Herzog B (2015) Drug-induced sleep endoscopy and simulated snoring in patients with sleep-disordered breathing: agreement of anatomic changes in the upper airway. Eur Arch Otorhinolaryngol 272:2541–2550

    Article  PubMed  Google Scholar 

  30. 30.

    Ng AK, Koh TS, Baey E, Puvanendran K (2009) Role of upper airway dimensions in snore production: acoustical and perceptual findings. Ann Biomed Eng 37:1807–1817

    Article  PubMed  Google Scholar 

  31. 31.

    Caffier PP, Berl JC, Muggli A, Reinhardt A, Jakob A, Möser M, Fietze I, Scherer H, Hölzl M (2007) Snoring noise pollution—the need for objective quantification of annoyance, regulatory guidelines and mandatory therapy for snoring. Physiol Meas 28:25–40

    CAS  Article  PubMed  Google Scholar 

  32. 32.

    Wilson K, Stoohs RA, Mulrooney TF, Johnson LJ, Guilleminault C, Huang Z (1999) The snoring spectrum: acoustic assessment of snoring sound intensity in 1,139 individuals undergoing polysomnography. Chest 115:762–770

    CAS  Article  PubMed  Google Scholar 

  33. 33.

    Ising H, Kruppa B (2004) Health effects caused by noise: evidence in the literature from the past 25 years. Noise Health 6:5–13

    CAS  PubMed  Google Scholar 

  34. 34.

    Menzel D, Fastl H, Graf R, Hellbrück J (2008) Influence of vehicle color on loudness judgments. J Acoust Soc Am 123:2477–2479

    Article  PubMed  Google Scholar 

  35. 35.

    Ellermeier W, Eigenstetter M, Zimmer K (2001) Psychoacoustic correlates of individual noise sensitivity. J Acoust Soc Am 109:1464–1473

    CAS  Article  PubMed  Google Scholar 

  36. 36.

    Kühnel T, Glas S, Herzog M, Gassner H, Rohrmeier C (2014) Psychosocial burden caused by snoring. Somnologie 18:80–86

    Article  Google Scholar 

  37. 37.

    Hoeger R, Schreckenberg D, Felscher-Suhr U, Griefahn B (2002) Night-time noise annoyance: state of the art. Noise Health 4:19–25

    PubMed  Google Scholar 

  38. 38.

    Rohrmeier C, Herzog M, Ettl T, Kuehnel TS (2014) Distinguishing snoring sounds from breath sounds: a straightforward matter? Sleep Breath 18:169–176

    Article  PubMed  Google Scholar 

  39. 39.

    Herzog M, Kühnel T, Bremert T, Herzog B, Hosemann W, Kaftan H (2009) The impact of the microphone position on the frequency analysis of snoring sounds. Eur Arch Otorhinolaryngol 266:1315–1322

    Article  PubMed  Google Scholar 

  40. 40.

    Abeyratne UR, Wakwella AS, Hukins C (2005) Pitch jump probability measures for the analysis of snoring sounds in apnea. Physiol Meas 26:779–798

    Article  PubMed  Google Scholar 

  41. 41.

    Azarbarzin A, Moussavi Z (2013) Intra-subject variability of snoring sounds in relation to body position, sleep stage, and blood oxygen level. Med Biol Eng Comput 51:429–439

    Article  PubMed  Google Scholar 

  42. 42.

    Lee BW, Hill PD, Osborne J, Osman E (1999) A simple audio data logger for objective assessment of snoring in the home. Physiol Meas 20:119–127

    CAS  Article  PubMed  Google Scholar 

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Acknowledgments

We are grateful to Eric Siegel for programming the software for sound sequence playback and to the many subjects who participated in the study.

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Correspondence to René Fischer.

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There are no institutional or corporate affiliations of the authors and there are no funding sources which supported the work.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Fischer, R., Kuehnel, T.S., Merz, AK. et al. Calculating annoyance: an option to proof efficacy in ENT treatment of snoring?. Eur Arch Otorhinolaryngol 273, 4607–4613 (2016). https://doi.org/10.1007/s00405-016-4160-9

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Keywords

  • Snoring
  • Assessment
  • Objective
  • Annoyance
  • Psychoacoustics