Adult primary snoring: a modified Delphi consensus among Chinese otolaryngologists with AI-assisted evidence synthesis
Year: 2026
Type: article
Abstract: Background: 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. Methods: 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. Results: 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. Conclusions: 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.
Source: Journal of Thoracic Disease
Authors: Wenjing Liao, Yanru Li, Hongliang Yi, Guoping Yin, Lijuan Song, Yan Wang, Xiaoyong Ren, Mang Xiao, Haiwen Hu, Yun Zhu, Ming Xia, Tiancong Liu, Song Zhang, Xuping Xiao, Jin Ye, Huaihong Chen, Min Yin, Zhongming Lu, Yucheng Yang, Jihua Zhang, Shisheng Li, Yanzhong Li, Gui Chen, Di Zhao, Xiaolong Zhao, Yuping Xie, Jian Guan, Zhenli Fu, Jinjing Luo, Fusen Peng, Yehai Liu, Xiong Chen, Xiaowen Zhang
Institutions: First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, Beijing Tongren Hospital, Shandong University, Capital Medical University, Qilu Hospital of Shandong University, Shanghai Sixth People's Hospital, Beijing Tsinghua Chang Gung Hospital, First Hospital of China Medical University, Second Affiliated Hospital of Xi'an Jiaotong University, Sir Run Run Shaw Hospital, Zhejiang University, Guangdong 999 Brain Hospital, Wuhan Union Hospital, Huazhong University of Science and Technology, Shandong Provincial Hospital, Shandong First Medical University, Sheng Jing Hospital, ShenZhen People’s Hospital, Hunan Provincial People's Hospital, Third Affiliated Hospital of Sun Yat-sen University, Nanfang Hospital, Southern Medical University, Jiangsu Province Hospital, Guangdong Academy of Medical Sciences, Guangdong Provincial People's Hospital, The Affiliated Yongchuan Hospital of Chongqing Medical University, Hebei Medical University, First Affiliated Hospital of Hebei Medical University, Second Xiangya Hospital of Central South University, Second Affiliated Hospital of Zhejiang University, University of Electronic Science and Technology of China, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Gansu Provincial Hospital, Loudi Central Hospital, First Affiliated Hospital of Anhui Medical University, Zhongnan Hospital of Wuhan University
Language: English
Subfield: Physiology (medical)
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W7221152287