Adult primary snoring: a modified Delphi consensus among Chinese otolaryngologists with AI-assisted evidence synthesis.
28 affiliations
- 1Department 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.
- 2Department of Otorhinolaryngology, Beijing Tongren Hospital, Capital Medical University, Beijing, China.
- 3Department of Otorhinolaryngology, Shanghai Sixth People's Hospital, Shanghai, China.
- 4Department of Otorhinolaryngology, Beijing Tsinghua Changgung Hospital, Beijing, China.
- 5Department of Otorhinolaryngology, The First Hospital of China Medical University, Shenyang, China.
- 6Department of Otorhinolaryngology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
- 7Department of Otorhinolaryngology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China.
- 8Department of Otorhinolaryngology, Guangdong 999 Brain Hospital, Guangzhou, China.
- 9Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
- 10Department of Otorhinolaryngology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China.
- 11Department of Otorhinolaryngology, Shengjing Hospital of China Medical University, Shenyang, China.
- 12Department of Otorhinolaryngology, Shenzhen Guangming District People's Hospital, Shenzhen, China.
- 13Department of Otorhinolaryngology, Hunan Provincial People's Hospital, Changsha, China.
- 14Department of Otorhinolaryngology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
- 15Department of Otorhinolaryngology, Nanfang Hospital, Southern Medical University, Guangzhou, China.
- 16Department of Otorhinolaryngology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
- 17Department of Otorhinolaryngology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Guangzhou, China.
- 18Department of Otorhinolaryngology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
- 19Department of Otorhinolaryngology, The First Hospital of Hebei Medical University, Shijiazhuang, China.
- 20Department of Otorhinolaryngology, The Second Xiangya Hospital of Central South University, Changsha, China.
- 21Department of Otorhinolaryngology, Qilu Hospital of Shandong University, Jinan, China.
- 22Department of Otorhinolaryngology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
- 23Department of Otorhinolaryngology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China.
- 24Department of Otorhinolaryngology, Gansu Provincial Hospital, Lanzhou, China.
- 25Second Department of Elderly Respiratory, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangdong Provincial Geriatric Institute, Guangzhou, China.
- 26Department of Otolaryngology-Head and Neck Surgery, Loudi Central Hospital, Loudi, China.
- 27Department of Otolaryngology-Head and Neck Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, China.
- 28Department of Otorhinolaryngology-Head and Neck Surgery, Zhongnan Hospital of Wuhan University, Wuhan, China.
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.
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BibTeX
@article{liao2026adult,
title = {{Adult primary snoring: a modified Delphi consensus among Chinese otolaryngologists with AI-assisted evidence synthesis.}},
author = {Wenjing Liao and Yanru Li and Hongliang Yi and Guoping Yin and Lijuan Song and Yan Wang and Xiaoyong Ren and Mang Xiao and Haiwen Hu and Yun Zhu and Ming Xia and Tiancong Liu and Song Zhang and Xuping Xiao and Jin Ye and Huaihong Chen and Min Yin and Zhongming Lu and Yucheng Yang and Jihua Zhang and Shisheng Li and Yanzhong Li and Gui Chen and Di Zhao and Xiaolong Zhao and Yuping Xie and Jian Guan and Zhenli Fu and Jinjing Luo and Fusen Peng and Yehai Liu and Xiong Chen and Xiaowen Zhang},
journal = {Journal of thoracic disease},
year = {2026},
month = sep,
doi = {10.21037/jtd-2026-1341},
url = {https://europepmc.org/article/MED/42996931},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Adult primary snoring: a modified Delphi consensus among Chinese otolaryngologists with AI-assisted evidence synthesis.
AU - Wenjing Liao
AU - Yanru Li
AU - Hongliang Yi
AU - Guoping Yin
AU - Lijuan Song
AU - Yan Wang
AU - Xiaoyong Ren
AU - Mang Xiao
AU - Haiwen Hu
AU - Yun Zhu
AU - Ming Xia
AU - Tiancong Liu
AU - Song Zhang
AU - Xuping Xiao
AU - Jin Ye
AU - Huaihong Chen
AU - Min Yin
AU - Zhongming Lu
AU - Yucheng Yang
AU - Jihua Zhang
AU - Shisheng Li
AU - Yanzhong Li
AU - Gui Chen
AU - Di Zhao
AU - Xiaolong Zhao
AU - Yuping Xie
AU - Jian Guan
AU - Zhenli Fu
AU - Jinjing Luo
AU - Fusen Peng
AU - Yehai Liu
AU - Xiong Chen
AU - Xiaowen Zhang
PY - 2026
DA - 2026/09/23
JO - Journal of thoracic disease
DO - 10.21037/jtd-2026-1341
UR - https://europepmc.org/article/MED/42996931
AB - 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.
SN - 2072-1439
SN - 2077-6624
ER -