Abstract
Upper airway resistance syndrome (UARS) is characterized by repeated number of arousals at night, and excessive daytime sleepiness or somnolence (EDS). It is often missed in classical polysomnographic diagnostic approaches and misdiagnosed as simple snoring or idiopathic hypersomnia, thereby is often left untreated. We propose that positive airway pressure (PAP), which has shown to be effective against UARS, can be used as a diagnostic tool as well. The study designed to test whether patients with high titration pressures can be diagnosed for UARS, and whether this pressure can be used as the treatment pressure in UARS. This study is a retrospective cohort study. The patients with the following selection criteria: apnea hypopnea index (AHI) < 5, respiratory effort related arousal (RERA) index > 20, excessive daytime sleepiness or somnolence (EDS) without nocturnal oxygen desaturation levels were included to the study. After diagnostic polysomnography (PSG), PAP titrarion was applied to diagnose and treatment. Fourteen (%46.7) of the patients were male, 16 (%53.3) were female, with a mean age of 46.4 ± 9.9 and mean body mass index (BMI) of 26 ± 3.3. The patiens had a mean Epworth sleepiness scale 15.3 ± 3.9, mean AHI: 2.3 ± 1.4 and average RERA: 26.1 ± 4.9. The mean CPAP titration pressure was 7.1 ± 1.1 cmH2O. In the light of current findings, during PAP titration patients required high pressures is the evidence of increased upper airway resistance in UARS. Using the from therapy to diagnosis protocol, the PAP protocol determines the individual therapeutic pressures needed by patients. Following up the clinical outcomes of these patients under the PAP treatment, and including a larger cohort will contribute greatly to treating this syndrome, defined as one of the "unresolved problems in years".
Highlights
The upper airway resistance syndrome (UARS) has been described based on the hypothesis that snoring and repetitive occurrence of related arousal (RERA) without oxygen desaturation might cause a significant disease with symptoms, altered quality of life and cardiovascular morbidity
Upper airway resistance syndrome (UARS) is characterized by repeated number of arousals at night, and excessive daytime sleepiness or somnolence (EDS). It is often missed in classical polysomnographic diagnostic approaches and misdiagnosed as simple snoring or idiopathic hypersomnia, thereby is often left untreated
We propose that positive airway pressure (PAP), which has shown to be effective against UARS, can be used as a diagnostic tool as well
Summary
The upper airway resistance syndrome (UARS) has been described based on the hypothesis that snoring and repetitive occurrence of RERAs without oxygen desaturation might cause a significant disease with symptoms, altered quality of life and cardiovascular morbidity. The description of RERA, American Academy of Sleep Medicine (AASM) has not accepted UARS as a distinct disease among sleep braething disorders. AASM has concluded that the current clinical and pathophysiological data are not sufficient to specifying UARS as a distinct conditon but instead defined it as borderline of Obstructive Sleep apnea (OSA). The International Classification of Sleep Disorders II's (ICSD II) 2005 version is consistent with the AASM in the matter. It is still controversial whether UARS, with its strong relationship with cardiovascular complications, needs to be regarded as a distinct disease [1,2]. With UARS various neuropsychiatric symptoms such as Bruxism, irritable bowel syndrome, insomnia, and somatic problems as well as excessive daytime sleepiness, and major cardiovascular problems are known to occur [3,4,5]
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