title: Comparative Effectiveness of the Different Treatment Modalities for Snoring.
abstract: 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).
  
  
  METHODS
  Single-institution prospective comparative effectiveness trial.
  
  
  METHODS
  University-affiliated secondary care teaching hospital.
  
  
  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.
  
  
  CONCLUSIONS
  Multidisciplinary agreed-on treatment of snoring is effective across the proposed treatments.
authors.affiliation: ENT Department, AZ Delta, Roeselare, Belgium ENT Department, University Hospitals Leuven, Leuven, Belgium.
authors.forename: Stefanie
authors.initials: S
authors.lastname: Terryn
authors.affiliation: ENT Department, AZ Delta, Roeselare, Belgium ENT Department, University Hospitals Leuven, Leuven, Belgium.
authors.forename: Joris
authors.initials: J
authors.lastname: De Medts
authors.affiliation: ENT Department, AZ Delta, Roeselare, Belgium lieve.delsupehe@azdelta.be.
authors.forename: Kathelijne
authors.initials: K
authors.lastname: Delsupehe
mesh_terms: D057186:Comparative Effectiveness Research; D045422:Continuous Positive Airway Pressure; D004724:Endoscopy; D005260:Female; D006801:Humans; D008297:Male; D019186:Mandibular Advancement; D008875:Middle Aged; D010027:Osteotomy; D017286:Polysomnography; D011446:Prospective Studies; D012913:Snoring / Q000628:therapy*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
keywords: continuous positive airway pressure; mandibular advancement device; sleep-disordered breathing; snoring surgery; snoring treatments