title: Acoustic Analysis of Snoring in the Diagnosis of Obstructive Sleep Apnea Syndrome: A Call for More Rigorous Studies.
abstract: BACKGROUND
  Snoring is a common symptom of obstructive sleep apnea syndrome (OSA) and has recently been considered for diagnosis of OSA.
  
  
  OBJECTIVE
  The goal of the current study was to systematically determine the accuracy of acoustic analysis of snoring in the diagnosis of OSA using a meta-analysis.
  
  
  METHODS
  PubMed, Cochrane Library database, and EMBASE were searched up to July 15, 2014. A systematic review and meta-analysis of sensitivity, specificity, and other measures of accuracy of acoustic analysis of snoring in the diagnosis of OSA were conducted. The median of apneahypopnea index threshold was 10 events/h, range: 5-15 or 10-15 if aforementioned suggestion is adopted.
  
  
  RESULTS
  A total of seven studies with 273 patients were included in the meta-analysis. The pooled estimates were as follows: sensitivity, 88% (95% confidence interval [CI]: 82-93%); specificity, 81% (95% CI: 72-88%); positive likelihood ratio (PLR), 4.44 (95% CI: 2.39-8.27); negative likelihood ratio (NLR), 0.15 (95% CI: 0.10-0.24); and diagnostic odds ratio (DOR), 32.18 (95% CI: 13.96-74.81). χ(2) values of sensitivity, specificity, PLR, NLR, and DOR were 2.37, 10.39, 12.57, 3.79, and 6.91 respectively (All p > 0.05). The area under the summary receiver operating characteristic curve was 0.93. Sensitivity analysis demonstrated that the pooled estimates were stable and reliable. The results of publication bias were not significant (p = 0.30).
  
  
  CONCLUSIONS
  Acoustic analysis of snoring is a relatively accurate but not a strong method for diagnosing OSA. There is an urgent need for rigorous studies involving large samples and single snore event tests with an efficacy criterion that reflects the particular features of snoring acoustics for OSA diagnosis.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, The First Affiliated Hospital, Guangzhou Medical University, Guangzhou, Guangdong, China.
authors.forename: Hui
authors.initials: H
authors.lastname: Jin
authors.affiliation: Department of Otolaryngology, Sleep Center, Chang Gung Memorial Hospital, Chang Gung University, Taipei, Taiwan.
authors.forename: Li-Ang
authors.initials: LA
authors.lastname: Lee
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, The First Affiliated Hospital, Guangzhou Medical University, Guangzhou, Guangdong, China.
authors.forename: Lijuan
authors.initials: L
authors.lastname: Song
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, The First Affiliated Hospital, Guangzhou Medical University, Guangzhou, Guangdong, China.
authors.forename: Yanmei
authors.initials: Y
authors.lastname: Li
authors.affiliation: Department of Physics, School of Science, South China University of Technology, Guangzhou, China.
authors.forename: Jianxin
authors.initials: J
authors.lastname: Peng
authors.affiliation: State Key Laboratory of Respiratory Disease, The First Affiliated Hospital, Guangzhou Medical University, Guangzhou, Guangdong, China.
authors.forename: Nanshan
authors.initials: N
authors.lastname: Zhong
authors.affiliation: Department of Otolaryngology, Sleep Center, Chang Gung Memorial Hospital, Chang Gung University, Taipei, Taiwan.
authors.forename: Hsueh-Yu
authors.initials: HY
authors.lastname: Li
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, The First Affiliated Hospital, Guangzhou Medical University, Guangzhou, Guangdong, China.
authors.forename: Xiaowen
authors.initials: X
authors.lastname: Zhang
mesh_terms: D000162:Acoustics; D000328:Adult; D017677:Age Distribution; D000368:Aged; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D020380:Needs Assessment; D017286:Polysomnography / Q000379:methods; D017410:Practice Guidelines as Topic; D015995:Prevalence; D018570:Risk Assessment; D012720:Severity of Illness Index; D017678:Sex Distribution; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy*; D012913:Snoring / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy*
keywords: acoustic analysis; meta-analysis; obstructive sleep apnea syndrome; review; snoring