{ "abstract": "Primary snoring is common in adults, but its definition, diagnostic boundaries, and management remain inconsistent. Misclassification between primary snoring and mild obstructive sleep apnea may expose patients to either unnecessary treatment or inadequate evaluation. This expert consensus aimed to develop an evidence-informed framework for adult primary snoring that emphasizes objective exclusion of obstructive sleep apnea and patient- and bed-partner-centered outcomes. A modified Delphi study enrolled a purposive panel of 30 experts in otolaryngology-head and neck surgery and sleep medicine from five Chinese regions. A 25-source targeted evidence corpus, supplemented by question-driven searches and human-verified artificial intelligence-assisted extraction, informed 75 unique candidate items. Four anonymous online rounds used a 9-point scale; consensus was predefined as at least 80% agreement and strong consensus as at least 90%. A pragmatic three-level evidence-basis label distinguished direct evidence from indirect evidence and expert consensus. Round response rates were 93.3% (28/30), 96.7% (29/30), 96.7% (29/30), and 96.7% (29/30). Of 75 unique candidate items, 68 reached consensus; consolidation yielded 54 final statements and seven explicit non-consensus items. The framework separates clinically suspected from objectively confirmed primary snoring, addresses night-to-night diagnostic variability, and prioritizes patient- and bed-partner-centered outcomes. First-line care is proportional and phenotype-informed; custom titratable mandibular advancement devices are the preferred device-based option for suitable patients, while surgery is restricted to selected anatomical targets. This consensus provides a transparent, risk-stratified framework for adult primary snoring and identifies unresolved controversies. Multidisciplinary external validation, standardized outcome definitions, and prospective phenotype-stratified trials are required before broad international adoption.", "abstract_shown": true, "affiliations": [ "Department of Otolaryngology-Head and Neck Surgery, Sleep Medical Center, The State Key Laboratory of Respiratory Disease, Loudi Hospital of First Affiliated Hospital of Guangzhou Medical University, Loudi, China.", "Department of Otorhinolaryngology, Beijing Tongren Hospital, Capital Medical University, Beijing, China.", "Department of Otorhinolaryngology, Shanghai Sixth People's Hospital, Shanghai, China.", "Department of Otorhinolaryngology, Beijing Tsinghua Changgung Hospital, Beijing, China.", "Department of Otorhinolaryngology, The First Hospital of China Medical University, Shenyang, China.", "Department of Otorhinolaryngology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.", "Department of Otorhinolaryngology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China.", "Department of Otorhinolaryngology, Guangdong 999 Brain Hospital, Guangzhou, China.", "Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.", "Department of Otorhinolaryngology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China.", "Department of Otorhinolaryngology, Shengjing Hospital of China Medical University, Shenyang, China.", "Department of Otorhinolaryngology, Shenzhen Guangming District People's Hospital, Shenzhen, China.", "Department of Otorhinolaryngology, Hunan Provincial People's Hospital, Changsha, China.", "Department of Otorhinolaryngology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.", "Department of Otorhinolaryngology, Nanfang Hospital, Southern Medical University, Guangzhou, China.", "Department of Otorhinolaryngology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.", "Department of Otorhinolaryngology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Guangzhou, China.", "Department of Otorhinolaryngology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.", "Department of Otorhinolaryngology, The First Hospital of Hebei Medical University, Shijiazhuang, China.", "Department of Otorhinolaryngology, The Second Xiangya Hospital of Central South University, Changsha, China.", "Department of Otorhinolaryngology, Qilu Hospital of Shandong University, Jinan, China.", "Department of Otorhinolaryngology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.", "Department of Otorhinolaryngology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China.", "Department of Otorhinolaryngology, Gansu Provincial Hospital, Lanzhou, China.", "Second Department of Elderly Respiratory, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangdong Provincial Geriatric Institute, Guangzhou, China.", "Department of Otolaryngology-Head and Neck Surgery, Loudi Central Hospital, Loudi, China.", "Department of Otolaryngology-Head and Neck Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, China.", "Department of Otorhinolaryngology-Head and Neck Surgery, Zhongnan Hospital of Wuhan University, Wuhan, China." ], "article_type": "review article", "arxiv": null, "author_total": 33, "authors": [ { "affs": [ 0 ], "name": "Wenjing Liao" }, { "affs": [ 1 ], "name": "Yanru Li" }, { "affs": [ 2 ], "name": "Hongliang Yi" }, { "affs": [ 3 ], "name": "Guoping Yin" }, { "affs": [ 0 ], "name": "Lijuan Song" }, { "affs": [ 4 ], "name": "Yan Wang" }, { "affs": [ 5 ], "name": "Xiaoyong Ren" }, { "affs": [ 6 ], "name": "Mang Xiao" }, { "affs": [ 7 ], "name": "Haiwen Hu" }, { "affs": [ 8 ], "name": "Yun Zhu" }, { "affs": [ 9 ], "name": "Ming Xia" }, { "affs": [ 10 ], "name": "Tiancong Liu" }, { "affs": [ 11 ], "name": "Song Zhang" }, { "affs": [ 12 ], "name": "Xuping Xiao" }, { "affs": [ 13 ], "name": "Jin Ye" }, { "affs": [ 14 ], "name": "Huaihong Chen" }, { "affs": [ 15 ], "name": "Min Yin" }, { "affs": [ 16 ], "name": "Zhongming Lu" }, { "affs": [ 17 ], "name": "Yucheng Yang" }, { "affs": [ 18 ], "name": "Jihua Zhang" }, { "affs": [ 19 ], "name": "Shisheng Li" }, { "affs": [ 20 ], "name": "Yanzhong Li" }, { "affs": [ 0 ], "name": "Gui Chen" }, { "affs": [ 21 ], "name": "Di Zhao" }, { "affs": [ 22 ], "name": "Xiaolong Zhao" }, { "affs": [ 23 ], "name": "Yuping Xie" }, { "affs": [ 2 ], "name": "Jian Guan" }, { "affs": [ 24 ], "name": "Zhenli Fu" }, { "affs": [ 0 ], "name": "Jinjing Luo" }, { "affs": [ 25 ], "name": "Fusen Peng" }, { "affs": [ 26 ], "name": "Yehai Liu" }, { "affs": [ 27 ], "name": "Xiong Chen" }, { "affs": [ 0, 25 ], "name": "Xiaowen Zhang" } ], "bibtex": "https://research.draconitic.com/paper/9r948mwgnvx6a.bib", "cited_by": 0, "doi": "10.21037/jtd-2026-1341", "fulltext_url": "https://europepmc.org/articles/PMC13740709", "id": "9r948mwgnvx6a", "issns": [ "2072-1439", "2077-6624" ], "landing_url": "https://europepmc.org/article/MED/42996931", "language": "eng", "licence": "CC-BY-NC-ND", "licence_label": "CC BY-NC-ND", "licence_source": "article", "licence_url": "https://creativecommons.org/licenses/by-nc-nd/4.0/", "metadata_licence": null, "native_subjects": [ [ "heading", "Expert Consensus" ], [ "openalex", "2737|Obstructive Sleep Apnea Research" ] ], "openalex": "W7221152287", "pdf_url": "https://europepmc.org/articles/PMC13740709?pdf=render", "pmcid": "PMC13740709", "pmid": "42996931", "published": "2026-09-23", "publisher": "AME Publications", "ris": "https://research.draconitic.com/paper/9r948mwgnvx6a.ris", "sources": [ { "first_seen": "2026-11-09T15:20:41Z", "native_id": "MED:42996931", "source": "europepmc", "url": "https://europepmc.org/article/MED/42996931" }, { "first_seen": "2026-11-10T12:21:54Z", "native_id": "PMC13740709", "source": "pmc", "url": "https://doi.org/10.21037/jtd-2026-1341" } ], "subjects": [ { "field": "medicine", "origin": "openalex:2737|Obstructive Sleep Apnea Research", "subfield": "physiology" } ], "title": "Adult primary snoring: a modified Delphi consensus among Chinese otolaryngologists with AI-assisted evidence synthesis.", "title_text": "Adult primary snoring: a modified Delphi consensus among Chinese otolaryngologists with AI-assisted evidence synthesis.", "type": "peer-reviewed", "updated_at": "2026-11-10T12:21:54Z", "url": "https://research.draconitic.com/paper/9r948mwgnvx6a", "venue": "Journal of thoracic disease", "versions": [] }