Smartphone-based delivery of oropharyngeal exercises for treatment of snoring: a randomized controlled trial

Abstract

Purpose

Upper airway exercises for snoring treatment can be effective but difficult to administer and monitor. We hypothesized that a brief, relatively simple daily upper airway exercise regimen, administered by a smartphone application, would reduce snoring and encourage compliance.

Methods

Targeted vowel sounds causing tongue base movements were incorporated into a voice-controlled smartphone game application. Participants with habitual snoring, apnea hypopnea index (AHI) ≤ 14 events/h, and BMI ≤ 32 kg/m2 were randomly assigned to perform 15 min of daily gameplay (intervention group) or 5 s of daily voice recording (control group) and to audio record their snoring for 2 nights/week for up to 12 weeks. Sounds above 60 dB were extracted from recordings for snore classification with machine learning support vector machine classifiers.

Results

Sixteen patients (eight in each group) completed the protocol. Groups were similar at baseline in gender distribution (five males, three females), mean BMI (27.5 ± 3.8 vs 27.4 ± 3.8 kg/m2), neck circumference (15.1 ± 1.6 vs 14.7 ± 1.7 in.), Epworth Sleepiness Score (8 ± 3.5 vs 7 ± 4.0), and AHI (9.2 ± 4.0 vs 8.2 ± 3.2 events/h). At 8 weeks, the absolute change in snoring rate (> 60 dB/h) was greater for the intervention group than the control group (− 49.3 ± 55.3 vs − 6.23 ± 23.2; p = 0.037), a 22 and 5.6% reduction, respectively. All bed partners of participants in the intervention group reported reduced snoring volume and frequency, whereas no change was reported for the control group.

Conclusions

Smartphone application-administered upper airway training reduces objective and subjective snoring measures and improves sleep quality.

Trial registration

ClinicalTrials.gov; no.: NCT03264963; URL: www.clinicaltrials.gov

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References

  1. 1.

    Young T, Palta M, Dempsey J, Skatrud J, Weber S, Badr S (1993) The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med 328:1230–1235

    Article  CAS  Google Scholar 

  2. 2.

    Deeb R, Judge P, Peterson E, Lin JC, Yaremchuk K (2014) Snoring and carotid artery intima-media thickness. Laryngoscope 124:1486–1491. https://doi.org/10.1002/lary.24527

    Article  PubMed  Google Scholar 

  3. 3.

    Jahn C, Gouveris H, Matthias C (2016) Systemic inflammation in patients with compromised upper airway anatomy and primary snoring or mild obstructive sleep apnea. Eur Arch Otorhinolaryngology 273:3429–3433. https://doi.org/10.1007/s00405-016-4103-5

    Article  Google Scholar 

  4. 4.

    Dunai A, Keszei AP, Kopp MS, Shapiro CM, Mucsi I, Novak M (2008) Cardiovascular disease and health-care utilization in snorers: a population survey. Sleep 31:411–416

    Article  PubMed  PubMed Central  Google Scholar 

  5. 5.

    Beninati W, Harris CD, Herold DL, Shepard JW (1999) The effect of snoring and obstructive sleep apnea on the sleep quality of bed partners. Mayo Clin Proc 74:955–958. https://doi.org/10.4065/74.10.955

    Article  CAS  PubMed  Google Scholar 

  6. 6.

    Puhan MA, Suarez A, Lo Cascio C et al (2006) Didgeridoo playing as alternative treatment for obstructive sleep apnoea syndrome: randomised controlled trial. BMJ 332:266–270. https://doi.org/10.1136/bmj.38705.470590.55

    Article  PubMed  PubMed Central  Google Scholar 

  7. 7.

    Guimarães KC, Drager LF, Genta PR, Marcondes BF, Lorenzi-Filho G (2009) Effects of oropharyngeal exercises on patients with moderate obstructive sleep apnea syndrome. Am J Respir Crit Care Med 179:962–966. https://doi.org/10.1164/rccm.200806-981OC

    Article  PubMed  Google Scholar 

  8. 8.

    Ieto V, Kayamori F, Montes MI, Hirata RP, Gregório MG, Alencar AM, Drager LF, Genta PR, Lorenzi-Filho G (2015) Effects of oropharyngeal exercises on snoring. Chest 148:683–691. https://doi.org/10.1378/chest.14-2953

    Article  PubMed  Google Scholar 

  9. 9.

    Lawson E, Stuart-Smith J, Scobbie JM, Nakai S, Beavan D, Edmonds F, Edmonds I, Turk A, Timmins C, Beck J, Esling J, Leplatre G, Cowen S, Barras W, Durham M (2015) Seeing speech: an articulatory web resource for the study of phonetics. University of Glasgow. In: http://www.seeingspeech.ac.uk/. http://www.seeingspeech.ac.uk/ipachart/display.php?chart=4&datatype=1&speaker=1. Accessed 18 Apr 2018

  10. 10.

    Bilici S, Engin A, Ozgur Y, Ozlem Onerci C, Ahmet Gorkem Y, Aytul Hande Y (2017) Submental ultrasonographic parameters among patients with obstructive sleep apnea. Otolaryngol Head Neck Surg 156:559–566. https://doi.org/10.1177/0194599816684109

    Article  PubMed  Google Scholar 

  11. 11.

    Berry RB, Brooks R, Gamaldo CE, Harding SM, Lloyd RM, Marcus CL, Vaughn BV for the American Academy of Sleep Medicine (2015) The AASM manual for the scoring of sleep and associated events: Rules, terminology and technical specifications, version 2.2. www.aasmnet.org. American Academy of Sleep Medicine, Darien

  12. 12.

    Ng AK, Koh TS (2008) Using psychoacoustics of snoring sounds to screen for obstructive sleep apnea. In: 2008 30th Annual International Conference of the IEEE Engineering in Medicine and Biology Society. IEEE, pp 1647–1650

  13. 13.

    Rohrmeier C, Herzog M, Haubner F, Kuehnel TS (2012) The annoyance of snoring and psychoacoustic parameters: a step towards an objective measurement. Eur Arch Otorhinolaryngology 269:1537–1543. https://doi.org/10.1007/s00405-011-1878-2

    Article  Google Scholar 

  14. 14.

    Rohrmeier C, Fischer R, Merz A-K, Ettl T, Herzog M, Kuehnel TS (2015) Are subjective assessments of snoring sounds reliable? Eur Arch Otorhinolaryngology 272:233–240. https://doi.org/10.1007/s00405-014-3211-3

    Article  Google Scholar 

  15. 15.

    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 Otorhinolaryngology 266:1315–1322. https://doi.org/10.1007/s00405-008-0858-7

    Article  Google Scholar 

  16. 16.

    Giannakopoulos T (2015) pyAudioAnalysis: an open-source Python library for audio signal analysis. PLoS One 10:e0144610. https://doi.org/10.1371/journal.pone.0144610

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. 17.

    Pai I, Lo S, Wolf D, Kajieker A (2008) The effect of singing on snoring and daytime somnolence. Sleep Breath 12:265–268. https://doi.org/10.1007/s11325-007-0159-1

    Article  PubMed  Google Scholar 

  18. 18.

    Pierce R, White D, Malhotra A, Edwards JK, Kleverlaan D, Palmer L, Trinder J (2007) Upper airway collapsibility, dilator muscle activation and resistance in sleep apnoea. Eur Respir J 30:345–353. https://doi.org/10.1183/09031936.00063406

    Article  CAS  PubMed  Google Scholar 

  19. 19.

    McGinley BM, Schwartz AR, Schneider H et al (2008) Upper airway neuromuscular compensation during sleep is defective in obstructive sleep apnea. J Appl Physiol 105:197–205. https://doi.org/10.1152/japplphysiol.01214.2007

    Article  PubMed  PubMed Central  Google Scholar 

  20. 20.

    Brown EC, Cheng S, McKenzie DK et al (2013) Respiratory movement of upper airway tissue in obstructive sleep apnea. Sleep 36:1069–1076. https://doi.org/10.5665/sleep.2812

    Article  PubMed  PubMed Central  Google Scholar 

  21. 21.

    Bilston LE, Gandevia SC (2014) Biomechanical properties of the human upper airway and their effect on its behavior during breathing and in obstructive sleep apnea. J Appl Physiol 116:314–324. https://doi.org/10.1152/japplphysiol.00539.2013

    Article  CAS  PubMed  Google Scholar 

  22. 22.

    Eckert DJ, Lo YL, Saboisky JP, Jordan AS, White DP, Malhotra A (2011) Sensorimotor function of the upper-airway muscles and respiratory sensory processing in untreated obstructive sleep apnea. J Appl Physiol 111:1644–1653. https://doi.org/10.1152/japplphysiol.00653.2011

    Article  PubMed  PubMed Central  Google Scholar 

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Acknowledgements

The authors would like to acknowledge Dr. Peter Watson for his guidance in ultrasound imaging studies, Andrew Byrne for helping with microphone calibration, Dr. Steven Reinitz for contribution to study design, Max Anderson for contribution to participant recruitment, and Dr. Anne Webber-Main for feedback on manuscript writing.

Funding

This study was funded by NIH Research Evaluation and Commercialization Hub (MN-REACH) Grant no. 5U01HL127479-03.

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Corresponding author

Correspondence to Umesh Goswami.

Ethics declarations

The protocol was approved by the University of Minnesota’s Institutional Review Board (IRB#1606S88671).

Ethical approval

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.

Informed consent

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

Conflict of interest

Umesh Goswami: holds equity in the entity aimed at commercialization of the technology described in this manuscript; Adam Black: holds the provisional patent of the technology described in this manuscript and holds equity in the entity aimed at commercialization of the technology; Brian Krohn: holds the provisional patent of the technology described in this manuscript and holds equity in the entity aimed at commercialization of the technology; Wendy Meyers: none; Conrad Iber: none.

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Goswami, U., Black, A., Krohn, B. et al. Smartphone-based delivery of oropharyngeal exercises for treatment of snoring: a randomized controlled trial. Sleep Breath 23, 243–250 (2019). https://doi.org/10.1007/s11325-018-1690-y

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Keywords

  • Snoring
  • Oropharyngeal exercise
  • Smartphone application
  • Randomized controlled trial