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.

Keywords: Oropharyngeal exercise; Randomized controlled trial; Smartphone application; Snoring.

Figure 1:

Flow of patients through the study.

Figure 2:

Individual trend lines for snoring rate over time, calculated by using the linear regression of snore rate vs time for each participant. The control group showed no significant change over time while the intervention group did (p-value = 0.019). There was also a significant difference between the absolute change in snoring rate between the control group and experimental group (p-value = 0.037).

Figure 3:

Percent change in snoring rate (snores/hr) between the control group and the intervention group.