Singing Exercises Improve Sleepiness and Frequency of Snoring among Snorers—A Randomised Controlled Trial


Objectives: To assess the effectiveness of regular singing exercises in reducing symptoms of snoring and sleep apnoea. Methods: A prospective single blinded randomised controlled trial was conducted in the otolaryngology department of a UK teaching hospital (Exeter). 127 adult patients with a history of simple snoring or sleep apnoea were recruited. 93 patients completed the study. Patients were excluded because of severe sleep apnoea (apnoea index > 40), or morbid obesity (BMI > 40). The study group completed a self-guided treatment programme of singing exercises contained on a 3CD box set, performed for 20 minutes daily. Outcome measures included the Epworth Sleepiness Scale, the SF-36 generic quality of life assessment tool, visual analogue scales (VAS range 0-10) of snoring loudness and frequency, and visual analogue scale of compliance (for intervention group). Results: The Epworth scale improved significantly in the experimental group compared to the control group (difference -2.5 units; 95% CI -3.8 to -1.1; p = 0.000). Frequency of snoring reduced significantly in the experimental group (difference -1.5; 95% CI -2.6 to -0.4; p = 0.01), and loudness of snoring showed a trend to improvement which was non-significant (difference -0.8; 95% CI -1.7 to 0.1; p = 0.08). Compliance with exercises was good; median 6.6 (quartiles = 4.1, 8.3). Conclusions: Improving the tone and strength of pharyngeal muscles with a 3 months programme of daily singing exercises reduces the severity, frequency and loudness of snoring, and improves symptoms of mild to moderate sleep apnoea.

Share and Cite:

M. Hilton, J. Savage, B. Hunter, S. McDonald, C. Repanos and R. Powell, "Singing Exercises Improve Sleepiness and Frequency of Snoring among Snorers—A Randomised Controlled Trial," International Journal of Otolaryngology and Head & Neck Surgery, Vol. 2 No. 3, 2013, pp. 97-102. doi: 10.4236/ijohns.2013.23023.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] J. R. Stradling, “Obstructive Sleep Apnoea: Definitions, Epidemiology, and Natural History,” Thorax, Vol. 50, 1995, pp. 683-689. doi:10.1136/thx.50.6.683
[2] M. I. Trotter and D. W. Morgan, “Snoring: Referral, Investigation and Treatment,” British Journal of Hospital Medicine (London), Vol. 68, No. 2, 2005, pp. 95-99.
[3] P. Counter and J. A. Wilson, “The Management of Simple Snoring,” Sleep Medicine Reviews, Vol. 8, No. 6, 2004, pp. 433-441. doi:10.1016/j.smrv.2004.03.007
[4] P. Lavie, “Sleep Apnea Causes Cardiovascular Disease,” American Journal of Respiratory and Critical Care Medicine, Vol. 169, No. 2, 2004, pp. 147-148. doi:10.1164/rccm.2310010
[5] J. Wright, R. Johns, I. Watt, et al., “Health Effects of Obstructive Sleep Apnoea and the Effectiveness of Continuous Positive Airways Pressure: A Systematic Review of the Research Evidence,” British Medical Journal, Vol. 314, No. 7084, 1997, pp. 851-860. doi:10.1136/bmj.314.7084.851
[6] K. M. Rex, D. F. Kripke and M. R. Klauber, “Sleep-Disordered Breathing in Middle-Aged Adults Predicts Significantly Higher Rates of Traffic Violations,” Chest, Vol. 119, No. 5, 2001, pp. 1623-1624. doi:10.1378/chest.119.5.1623
[7] J. R. Stradling and R. J. O. Davies, “Obstructive Sleep Apnoea/Hypopnoea Syndrome: Definitions, Epidemiology, and Natural History,” Thorax, Vol. 59, No. 1, 2004, pp. 73-78. doi:10.1136/thx.2003.007161
[8] N. Freedman, “Treatment of Obstructive Sleep Apnea Syndrome,” Clinics in Chest Medicine, Vol. 31, No. 2, 2010, pp. 187-201. doi:10.1016/j.ccm.2010.02.012
[9] T. L. Giles, T. J. Lasserson, B. Smith, J. White, J. J. Wright, C. J. Cates, “Continuous Positive Airways Pressure for Obstructive Sleep Apnoea in Adults,” Cochrane Database of Systematic Reviews, No. 3. 2006, Article ID: CD001106.
[10] J. C. T. Pepperell, S. Ramdassing-Dow, N. Crosthwaite, et al., “Ambulatory Blood Pressure Following Therapeutic and Sub-Therapeutic Nasal Continuous Positive Airway Pressure for Obstructive Sleep Apnoea: A Randomised Prospective Parallel Trial,” Lancet, Vol. 359, No. , 2002, pp. 204-210. doi:10.1016/S0140-6736(02)07445-7
[11] J. F. Faccenda, T. W. Mackay, N. A. Boon, et al., “Randomized Placebo-Controlled Trial of Continuous Positive Airway Pressure on Blood Pressure in the Sleep ApneaHypopnea Syndrome,” American Journal of Respiratory and Critical Care Medicine, Vol. 163, No. 2, 2001, pp. 344-348.
[12] A. E. Sher, K. B. Schechtman and J. F. Piccirillo, “The Efficacy of Surgical Modifications of the Upper Airway in Adults with Obstructive Sleep Apnea Syndrome,” Sleep, Vol. 19, No. 2, 1996, pp. 156-177.
[13] M. W. Johns, “A New Method for Measuring Daytime Sleepiness: The Epworth Sleepiness Scale,” Sleep, Vol. 14, No. 6, 1991, pp. 540-545.
[14] M. W. Johns, “Reliability and Factor Analysis of the Epworth Sleepiness Scale,” Sleep, Vol. 15, No. 4, 1992, pp. 376-381. PMid:1519015
[15] A. M. Garratt, D. A. Ruta, M. I. Abdalla, J. K. Buckingham and I. T. Russell, “The SF36 Health Survey Questionnaire: An Outcome Measure Suitable for Routine Uses within the NHS?” British Medical Journal, Vol. 306, No. 6890, 1993, pp. 1440-1444. doi:10.1136/bmj.306.6890.1440
[16] K. F. Schulz, D. G. Altman and D. Moher for the CON-SORT Group, “CONSORT 2010 Statement: Updated guidelines for reporting parallel group randomised trials,” British Medical Journal, Vol. 340, 2010, p. c332. doi:10.1136/bmj.c332
[17] M. A. Puhan, A. Suarez, C. Lo Cascio, A. Zahn, M. Heitz and O. Braendli, “Didgeridoo Playing as Alternative Treatment for Obstructive Sleep Apnoea Syndrome: Randomised Controlled Trial,” British Medical Journal, Vol. 332, No. 7536, 2006, pp. 266-270. doi:10.1136/bmj.38705.470590.55
[18] J. Lim, T. J. Lasserson and J. Wright, “Oral Appliances for Obstructive Sleep Apnoea,” Cochrane Database of Systematic Reviews, No. 4, 2006, Article ID: CD004435.
[19] S. Sundaram, S. A. Bridgman, J. Lim and T. J. Lasserson, “Surgery for Obstructive Sleep Apnoea,” Cochrane Database of Systematic Reviews, No. 4, 2005, Article ID: CD001004.
[20] M. Friedman, H. Tanyeri, J. W. Lim, R. Landsberg, K. Vaidyanathan and D. Caldarelli, “Effect of Nasal Breathing on Obstructive Sleep Apnea,” Otolaryngology—Head and Neck Surgery, Vol. 122, No. 1, 2000, pp. 71-74. doi:10.1016/S0194-5998(00)70147-1
[21] J. T. Maurer, T. Verse, B. A. Stuck, K. Hormann and G. Hein, “Palatal Implants for Primary Snoring: Short-Term Results of a New Minimally Invasive Surgical Technique,” Otolaryngology—Head and Neck Surgery, Vol. 132, No. 1, 2005, pp. 125-131. doi:10.1016/j.otohns.2004.09.015
[22] L. J. Bäck, M. L. Hytönen, R. P. Roine and A. O. Malmivaara, “Radiofrequency Ablation Treatment of Soft Palate for Patients with Snoring: A Systematic Review of Effectiveness and Adverse Effects,” Laryngoscope, Vol. 119, No. 6, 2009, pp. 1241-1250. doi:10.1002/lary.20215
[23] T. M. Jones, J. E. Earis, P. M. Calverley, S. De and A. C. Swift, “Snoring Surgery: A Retrospective Review,” Laryngoscope, Vol. 115, No. 11, 2005, pp. 201-205. doi:10.1097/01.mlg.0000180178.12972.81

Copyright © 2023 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.