Abstract
A new outpatient non-surgical method using Er:YAG laser for snoring has been demonstrated. The aim of this systematic review and meta-analysis was to investigate the effects of this treatment on snoring. Relevant 1548 articles were searched from various databases from 1 January 2000 to September 2018 including PubMed, MEDLINE, EMBASE, Cochrane Library, Web of Science, and Scopus and reference lists. Meta-analysis was performed with RevMan software. Cochran’s Q and I2 statistics were used to assess heterogeneity. The overall effect was evaluated using z-tests. Seven studies and two hundred forty-seven participants treated with two to three sessions of Er:YAG 2940 nm laser (long pulse mode, 10 Hz, fluence 1.6 J/cm2) were included. There was a statistically significant reduction of pooled snoring VAS (mean difference (MD) (95% CI), − 6.89 (− 7.62, − 6.15)). Patient satisfaction rate after laser treatment was 80% (95% CI, 70.69, 89.05) of cases. A widening of the upper airway dimension was revealed; however, changes in apnea-hypopnea index (AHI) and respiratory disturbance index (RDI) were not significantly different. Mean follow-up period was 3 to 36 months. Patients tolerated the procedure well without anesthesia. There were minimal side effects without serious adverse effects. Er:YAG laser is shown to be effective in a way to reduce snoring without significant AHI or RDI changes. However, randomized controlled trials, objective data, multicenter cooperation, and long-term outcomes are needed to confirm the benefits of this laser for snoring.
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References
Olson LG, King MT, Hensley MJ, Saunders NA (1995) Community study of snoring and sleep-disordered breathing. Health outcomes. Am J Respir Crit Care Med 152:717–720
Young T, Palta M, Dempsey, Skatrud J, Weber S, Badr S (1993) The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med 328:1230–1235
Achuthan S, Medhi B (2015) A systematic review of the pharmacological approaches against snoring: can we count on the chickens that have hatched? Sleep Breath 19:1035–1042
Benoist LBL, Beelen AMEH, Torensma B, de Vries N (2018) Subjective effects of the sleep position trainer on snoring outcomes in position-dependent non-apneic snorers. Eur Arch Otorhinolaryngol 275:2169–2176
Braver HM, Block AJ, Perri MG (1995) Treatment for snoring. Combined weight loss, sleeping on side, and nasal spray. Chest 107:1283–1288
Camacho M, Guilleminault C, Wei JM, Song SA, Noller MW, Reckley LK, Fernandez-Salvador C, Zaghi S (2018) Oropharyngeal and tongue exercises (myofunctional therapy) for snoring: a systematic review and meta-analysis. Eur Arch Otorhinolaryngol 275:849–855
Demko BG (2018) The evolution of oral appliance therapy for snoring and sleep apnea: where did we come from, where are we, and where are we going? Sleep Med Clin 13:467–487
Herzog M, Riemann R (2004) Alcohol ingestion influences the nocturnal cardio-respiratory activity in snoring and non-snoring males. Eur Arch Otorhinolaryngol 261:459–462
Krieger J (1992) Long-term compliance with nasal continuous positive airway pressure (CPAP) in obstructive sleep apnea patients and nonapneic snorers. Sleep 15:S42–S46
Shokouhi F, Meymaneh Jahromi A, Majidi MR, Salehi M (2015) Montelukast in adenoid hypertrophy: its effect on size and symptoms. Iran J Otorhinolaryngol 27:443–448
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
Trenchea M, Deleanu O, Suta M, Arghir OC (2013) Smoking, snoring and obstructive sleep apnea. Pneumologia 62:52–55
Brietzke SE, Mair EA (2001) Injection snoreplasty: how to treat snoring without all the pain and expense. Otolaryngol Head Neck Surg 124:503–510
Choi JH, Cho JH, Chung YS, Kim JW, Kim SW (2015) Effect of the pillar implant on snoring and mild obstructive sleep apnea: a multicenter study in Korea. Laryngoscope 125:1239–1243
Main C, Liu Z, Welch K, Weiner G, Jones SQ, Stein K (2009) Surgical procedures and non-surgical devices for the management of non-apnoeic snoring: a systematic review of clinical effects and associated treatment costs. Health Technol Assess 13:1–208
Neruntarat C (2001) Laser-assisted uvulopalatoplasty: short-term and long-term results. Otolaryngol Head Neck Surg 124:90–93
Neruntarat C (2003) Uvulopalatal flap for snoring on an outpatient basis. Otolaryngol Head Neck Surg 129:353–359
Veer V, Yang WY, Green R, Kotecha B (2014) Long-term safety and efficacy of radiofrequency ablation in the treatment of sleep disordered breathing: a meta-analysis. Eur Arch Otorhinolaryngol 271:2863–2870
Unver T, Aytugar E, Ozturan O, Kiran T, Ademci E, Usumez A (2016) Histological effects of Er:YAG laser irradiation with snoring handpiece in the rat soft palate. Photomed Laser Surg 34:321–325
Lee CYS, Lee CCY (2015) Evaluation of a non-ablative Er: YAG laser procedure to increase the oropharyngeal airway volume: a pilot study. Dent Oral Craniofac 1:56–59
Kim SY, Park JE, Lee YJ, Seo HJ, Sheen SS, Hahn S, Jang BH, Son HJ (2013) Testing a tool for assessing the risk of bias for nonrandomized studies showed moderate reliability and promising validity. J Clin Epidemiol 66:408–414
Moher D, Liberati A, Tetzlaff J, Altman DG, PRISMA Group (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 6:e1000097
Higgins JP, Thompson SG, Deeks JJ, Altman DG (2003) Measuring inconsistency in meta-analyses. BMJ 327:557–560
Jovanovic J (2011) NightLaseTM – laser –assisted snoring and apnea reduction, 9 months of experience. J Laser Health Acad 1:11
Dovsak D, Gabrijelcic J, Vizintin Z (2011) NightLaseTM –a new laser treatment method for reduction of snoring and sleep apnea-a pilot study. J Laser Health Acad 1:9–10
Miracki K, Vizintin Z (2013) Nonsurgical minimally invasive Er:YAG laser snoring treatment. J Laser Health Acad 1:36–41
Svahnström K (2013) Er:YAG laser treatment of sleep-disordered breathing. J Laser Health Acad 2:13–16
Sippus J (2015) Case report: NightLaseR procedure- laser snoring and sleep apnea reduction treatment. J Laser Health Acad 1:1–5
Cetinkaya EA, Turker M, Kiraz K, Gulkesen HK (2016) Er:Yag laser treatment of simple snorers in an outpatient setting. ORL J Otorhinolaryngol Relat Spec 78:70–76
Storchi IF, Parker S, Bovis F, Benedicenti S, Amaroli A (2018) Outpatient erbium:YAG (2940 nm) laser treatment for snoring: a prospective study on 40 patients. Lasers Med Sci 33:399–406
Drnovsek-Olup B, Beltram M, Pizem J (2004) Repetitive Er:YAG laser irradiation of human skin: a histological evaluation. Lasers Surg Med 35:146–151
Majaron B, Srinivas SM, Huang H, Nelson JS (2000) Deep coagulation of dermal collagen with repetitive Er:YAG laser irradiation. Lasers Surg Med 26:215–222
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Neruntarat, C., Khuancharee, K. & Shoowit, P. Er:YAG laser for snoring: a systemic review and meta-analysis. Lasers Med Sci 35, 1231–1238 (2020). https://doi.org/10.1007/s10103-020-02987-3
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DOI: https://doi.org/10.1007/s10103-020-02987-3