Adult primary snoring: a modified Delphi consensus among Chinese otolaryngologists with AI-assisted evidence synthesis

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.