Upper Airway Resistance Syndrome Patients Research Articles

Long term oral appliance therapy improves daytime function and mood in upper airway resistance syndrome patients

Long term oral appliance therapy improves daytime function and mood in upper airway resistance syndrome patients

Long-Term Oral Appliance Therapy Improves Daytime Function and Mood in Upper Airway Resistance Syndrome Patients.

To evaluate the long-term effects of an oral appliance on clinical symptoms, respiratory sleep parameters, sleep quality, and sustained attention in patients with upper airway resistance syndrome (UARS) were compared with placebo. This study was a randomized placebo-controlled clinical trial. Thirty UARS patients were randomized in two groups: placebo and mandibular advancement device (MAD) groups. UARS criteria were presence of sleepiness (Epworth Sleepiness Scale ≥ 10) and/or fatigue (Modified Fatigue Impact Scale ≥ 38) associated with an apnea/hypopnea index ≤ 5 and a respiratory disturbance index (RDI) > 5 events/hour of sleep, and/or flow limitation in more than 30% of total sleep time. All patients completed the Pittsburgh Sleep Quality Index (PSQI), the Functional Outcomes of Sleep Questionnaire, the Beck Anxiety and Depression Inventories, underwent full-night polysomnography, multiple sleep latency test, and Psychomotor Vigilance Test (PVT). Evaluations were performed before and after 1.5 years of treatment. RDI, number of respiratory effort-related arousal, percentage of total sleep time with flow limitation, and arousal index significantly decreased after 1.5 years of MAD treatment. PSQI total score improved, severity of depression symptoms decreased, and mean reaction time in the PVT, based on the first measurement taken at 8:00 am, significantly decreased (p = .03) at the end of the protocol. The MAD was effective in decreasing respiratory events in UARS patients. For UARS, 1.5 years of oral appliance therapy also improved sleep quality and sustained attention, and decreased the severity of depression symptoms. Efficacy of Oral Appliance for Upper Airway Resistance Syndrome: Randomized, Parallel, Placebo-Controlled Study, NCT02636621.

An overlooked cause of resistant hypertension: upper airway resistance syndrome - preliminary results

OBJECTIVE:Upper airway resistance syndrome is a sleep-disordered breathing syndrome that is characterized by repetitive arousals resulting in sympathetic overactivity. We aimed to determine whether upper airway resistance syndrome was associated with poorly controlled hypertension.METHODS:A total of 40 patients with resistant hypertension were enrolled in the study. All of the patients underwent polysomnographic examinations and 24-hour ambulatory blood pressure monitoring to exclude white coat syndrome and to monitor treatment efficiency. Among 14 upper airway resistance syndrome patients, 2 patients had surgically correctable upper airway pathologies, while 12 patients were given positive airway pressure therapy.RESULTS:All patients underwent polysomnographic examinations; 22 patients (55%) were diagnosed with obstructive sleep apnea and 14 patients (35%) were diagnosed with upper airway resistance syndrome, according to American Sleep Disorders Association criteria. The patients with upper airway resistance syndrome were younger and had a lower body mass index compared with other patients, while there were no difference between the blood pressure levels and the number of antihypertensive drugs. The arousal index was positively correlated with systolic blood pressure level (p = 0.034; rs = 0.746), while the Epworth score and AHI were independent of disease severity (p = 0.435, rs = 0.323 and p = 0.819, rs = -0.097, respectively). Eight patients were treated with positive airway pressure treatment and blood pressure control was achieved in all of them, whereas no pressure reduction was observed in four untreated patients.CONCLUSIONS:We conclude that upper airway resistance syndrome is a possible secondary cause of resistant hypertension and that its proper treatment could result in dramatic blood pressure control.

OP-346 An Overlooked Cause of Resistant Hypertension; Upper Airway Resistance Syndrome

ObjectiveUpper airway resistance syndrome is a sleep disordered breathing syndrome characterized by repetetive arousals resulting in sympathetic overactivity. We aimed to determine whether upper airway resistance syndrome is related to resistant hypertension.MethodsFourty patients with resistant hypertension were enrolled in the study. All patients underwent polysomnographic examination. All patients underwent 24 hours ambulatory blood pressure monitoring in order to rule out white coat syndrome and to monitor treatment efficiency.ResultsTwenty-two patients (55%) were diagnosed with obstructive sleep apnoea and 14 patients (35%) were diagnosed with upper airway resistance syndrome according to American Sleep Disorders Association criteria. Upper airway resistance syndrome patients were younger and had a lower BMI when compared to other patients while there were no difference between the blood pressure levels and the number of antihypertensive drugs. Arousal index was determined to be positively correlated with systolic blood pressure level (p=0.034; r=0.746 ) while epword score and apnea-hypopnea index were independent of disease severity (p=0.435, r=0.323 and p=0.819, r= -0.097 respectively). Eight patients were treated with positive airway pressure treatment and blood pressure control was achieved in all whereas no pressure reduction was observed in 4 untreated patients.ConclusionsWe concluded that upper airway resistance syndrome is a possible secondary cause of resistant hypertension and its proper treatment can result in dramatic blood pressure control. ObjectiveUpper airway resistance syndrome is a sleep disordered breathing syndrome characterized by repetetive arousals resulting in sympathetic overactivity. We aimed to determine whether upper airway resistance syndrome is related to resistant hypertension. Upper airway resistance syndrome is a sleep disordered breathing syndrome characterized by repetetive arousals resulting in sympathetic overactivity. We aimed to determine whether upper airway resistance syndrome is related to resistant hypertension. MethodsFourty patients with resistant hypertension were enrolled in the study. All patients underwent polysomnographic examination. All patients underwent 24 hours ambulatory blood pressure monitoring in order to rule out white coat syndrome and to monitor treatment efficiency. Fourty patients with resistant hypertension were enrolled in the study. All patients underwent polysomnographic examination. All patients underwent 24 hours ambulatory blood pressure monitoring in order to rule out white coat syndrome and to monitor treatment efficiency. ResultsTwenty-two patients (55%) were diagnosed with obstructive sleep apnoea and 14 patients (35%) were diagnosed with upper airway resistance syndrome according to American Sleep Disorders Association criteria. Upper airway resistance syndrome patients were younger and had a lower BMI when compared to other patients while there were no difference between the blood pressure levels and the number of antihypertensive drugs. Arousal index was determined to be positively correlated with systolic blood pressure level (p=0.034; r=0.746 ) while epword score and apnea-hypopnea index were independent of disease severity (p=0.435, r=0.323 and p=0.819, r= -0.097 respectively). Eight patients were treated with positive airway pressure treatment and blood pressure control was achieved in all whereas no pressure reduction was observed in 4 untreated patients. Twenty-two patients (55%) were diagnosed with obstructive sleep apnoea and 14 patients (35%) were diagnosed with upper airway resistance syndrome according to American Sleep Disorders Association criteria. Upper airway resistance syndrome patients were younger and had a lower BMI when compared to other patients while there were no difference between the blood pressure levels and the number of antihypertensive drugs. Arousal index was determined to be positively correlated with systolic blood pressure level (p=0.034; r=0.746 ) while epword score and apnea-hypopnea index were independent of disease severity (p=0.435, r=0.323 and p=0.819, r= -0.097 respectively). Eight patients were treated with positive airway pressure treatment and blood pressure control was achieved in all whereas no pressure reduction was observed in 4 untreated patients. ConclusionsWe concluded that upper airway resistance syndrome is a possible secondary cause of resistant hypertension and its proper treatment can result in dramatic blood pressure control. We concluded that upper airway resistance syndrome is a possible secondary cause of resistant hypertension and its proper treatment can result in dramatic blood pressure control.

The association of somatic arousal with the symptoms of upper airway resistance syndrome

ObjectivesWe tested the hypothesis that the symptoms of upper airway resistance syndrome (UARS) are manifestations of chronic stress. To accomplish this, we utilized the score on a self-report questionnaire for somatic arousal (a component of stress) to compare somatic arousal between UARS patients and healthy controls and, among all participants, to correlate the level of somatic arousal with the severity of UARS symptoms. MethodsWe administered the Mood and Anxiety Symptom Questionnaire anxious arousal subscale (MASQaas; a 17-item questionnaire with increasing levels of arousal scored 17–85) to 12 UARS patients and 12 healthy controls and compared scores between groups. For all participants, we correlated the MASQaas scores with scores for the Epworth Sleepiness Scale (ESS), Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-Fatigue) scale, Pittsburgh Sleep Quality Index (PSQI), SF-36 Health Survey, and Perceived Deficits Questionnaire (PDQ; assessing cognitive function). ResultsCompared to healthy controls, UARS patients demonstrated increased somatic arousal (MASQaas scores of 18±2 and 28±7, respectively; p<0.0001). For all participants, the MASQaas scores correlated significantly with scores of the ESS (r=0.64; p=0.0008), the FACIT-Fatigue scale (r=−0.89; p<0.0001), the PSQI (r=0.70; p=0.0002), SF-36 Physical component (r=−0.78; p<0.0001), SF-36 Mental component (r=−0.74; p<0.0001), and the PDQ (r=0.89; p<0.0001). ConclusionsOur findings suggest that UARS patients have increased levels of the stress component, somatic arousal, proportionate to the severity of their symptoms.

A comparison of inspiratory airflow dynamics during sleep between upper airway resistance syndrome patients and healthy controls

A test of the hypothesis that upper airway resistance syndrome (UARS) patients have an increased prevalence of inspiratory airflow limitation (IFL) during sleep compared to healthy controls. We compared inspiratory airflow dynamics during sleep between 12 UARS patients (nine females and three males) and 12 healthy controls matched for age, gender and obesity with maximal age limited at 45years. A standard clinical polysomnogram (airflow measured with a nasal/oral pressure catheter) was performed to assess the impact of SDB on the participants' natural sleep. A second full-night polysomnogram with a pneumotachograph and a supraglottic pressure catheter to measure airflow and effort was performed to compare the maximal inspiratory airflow and effort and the percentage of flow-limited breaths during supine, continuous stage 2 sleep between groups. During clinical polysomnography, UARS participants did not differ significantly from controls in sleep architecture or fragmentation. We observed a small difference in apnea hypopnea index between UARS participants and controls (1.6 ± 1.9 vs. 0.4 ± 0.3, respectively; p = 0.035). During supine, continuous stage 2 sleep, 64.2% (35.8; mean (SD)) of UARS participants' breaths were flow-limited compared with 34.0% (39.3) of controls' breaths (p = 0.06). The groups did not differ in maximal inspiratory airflow or inspiratory effort. Our findings indicate a less-than-robust difference in respiratory parameters during sleep between UARS patients and healthy controls and no difference in standard sleep parameters or sleep fragmentation. We consider a pathophysiology of UARS that incorporates these findings.

Hypersomnolence, insomnia and the pathophysiology of upper airway resistance syndrome

Objective In order to test the hypothesis that upper airway resistance syndrome (UARS) is merely an extension of the pathophysiology of obstructive sleep apnea/hypopnea (OSA/H) to less severe pharyngeal collapse during sleep, we compared the severity of hypersomnolence and the prevalence of insomnia in UARS patients to the patterns observed for OSA/H patients. Our goal was to determine whether the severity of hypersomnolence and the prevalence of insomnia observed in UARS patients could have been predicted from the patterns observed among OSA/H patients. Methods We performed a retrospective study of a large consecutive patient series evaluated at an academic sleep disorders center, including 220 OSA/H patients and 137 UARS patients. Patients had no other sleep-related diagnosis and underwent an initial evaluation that included a measure of hypersomnolence [a multiple sleep latency test (MSLT); 95%] or insomnia questionnaire (87%). Patients were characterized by anthropometric data, polysomnographic descriptive measures of sleep, MSLT data and insomnia questionnaire data. Results Severity of hypersomnolence decreased over the continuum from severe to mild OSA/H. A model fit to the OSA/H patients to predict severity of hypersomnolence significantly underestimated hypersomnolence in UARS patients, which was comparable in severity to that of patients with mild OSA/H. The frequency of sleep-onset insomnia increased over the continuum from severe to mild OSA/H and increased further in UARS. Conclusions UARS is, in some respects, an extension of OSA/H to less severe pharyngeal collapse, but this does not adequately account for the symptom profile of patients with UARS. A physical model is proposed to account for the excess somnolence in UARS relative to expectations and the increasing frequency of sleep-onset insomnia along the continuum from severe OSA/H to UARS.

Differences in clinical features of upper airway resistance syndrome, primary snoring, and obstructive sleep apnea/hypopnea syndrome

Background The clinical features of patients with upper airway resistance syndrome (UARS) have previously been compared to patients with obstructive sleep apnea/hypopnea syndrome (OSAHS). No data regarding differences between patients with primarysnoring (PS) or patients with obstructive sleep apnea/hypopnea without daytime sleepiness (OSAH) are available. We conducted a study to investigate clinical features of UARS, comparing them to those in patients with PS, OSAH, and OSAHS. Methods Retrospective chart analysis of 157 patients with PS, 424 patients with UARS, 562 patients with OSAH, and 1610 patients with OSAHS seen in two sleep disorders clinics between 1996 and 2006. All patients had a diagnostic polysomnography (PSG) and a comprehensive clinical history taken by board-certified sleep specialists. Results PS and UARS patients were significantly younger, less overweight and had lower weight gain during the past 5 years. The female-to-male ratio was highest in the UARS group. UARS patients had significantly less stage non-rapid eye movement sleep (NREM) 1 and NREM 2 and significantly more NREM 3 and NREM 4 sleep than OSAH and OSAHS patients. Arousal indices between PS/UARS and OSAH/OSAHS patients were significantly lower, with no significant difference within these diagnostic categories. Patients with UARS presented the highest degree of subjective impairment. Conclusions UARS patients share some clinical features of patients with OSAHS and PS, although these two groups differ in their presentation of clinical sleepiness. Patients with UARS were most impaired in terms of their daily functioning and perception of sleep quality. This finding could not be corroborated by objective measures.

Silent Upper Airway Resistance Syndrome: Prevalence in a Mixed Military Population

The upper airway resistance syndrome (UARS) is a recently described form of sleep-disordered breathing in which transient increases in upper airway resistance result in repetitive EEG arousals. UARS is not associated with apnea or diminished airflow, although snoring and excessive daytime somnolence (EDS) are common. This report describes a subset of patients with UARS diagnosed by polysomnography who do not manifest snoring, which we define as silent upper airway resistance syndrome (SUARS). A retrospective review of all polysomnographies performed at our sleep disorders center during 2000. Sleep disorders center of a large, academic, military hospital. Our center serves military personnel, military retirees, and their dependent families. Esophageal manometry during polysomnography was routinely performed on patients with hypersomnolence (Epworth sleepiness scale > 10) who demonstrated a total arousal index >or= 10/h and a respiratory disturbance index of < 5/h on prior polysomnography. UARS was definitely diagnosed in patients who demonstrated repetitive increased upper airway resistance (IUAR) associated with brief EEG arousals followed by normalization of esophageal pressure (Pes). IUAR was defined by a pattern of crescendo negative inspiratory Pes of <or= - 12 cm H(2)O. During calendar year 2000, we performed 724 polysomnographies in 527 patients. Obstructive sleep apnea was diagnosed in 383 patients (72.6%), and 44 patients (8.4%) were found to have UARS. In four patients with UARS (0.8% of total and 9.1% of UARS), snoring was not reported by history or observed during polysomnography, and SUARS was ultimately diagnosed. UARS may occur in the absence of clinically significant snoring and may be an occult cause of EDS. We report a prevalence of SUARS of 9% among UARS patients and nearly 1% of all patients studied for hypersomnolence by polysomnography.

Cephalometric comparison of pharyngeal changes in subjects with upper airway resistance syndrome or obstructive sleep apnoea in upright and supine positions.

The aim of the present study was to cephalometrically compare pharyngeal changes between upright and supine positions in patients with upper airway resistance syndrome (UARS) or obstructive sleep apnoea (OSA). Eighty-two OSA patients, 70 men (mean age 49 +/- 11.8 years) and 12 women (45.9 +/- 8.3 years), underwent cephalometric sleep apnoea analysis. One upright and one supine radiograph were taken of each patient (a total of 164 cephalometric radiographs). The results showed no significant changes either in naso- or hypopharyngeal soft tissues between the two positions. In contrast, the shortest distance from the soft palate (ve1-ve2) and the tip of the soft palate (u1-u2) to the posterior oropharyngeal wall was significantly narrower (P < 0.001) in the supine position. Furthermore, in the supine position a slight thickening in the soft palate (sp1-sp2, P < 0.05) was detected with no change in the length of the soft palate (PNS-u1). The form of the tongue changed significantly: it was shorter (Tt-Tgo, P < 0.001; Tt-va, P < 0.001) and thicker (Ts/Tt-Tgo, P < 0.05) in the supine position. The present results suggest that OSA patients are prone to significant narrowing of their oropharyngeal, but not of their naso- or hypopharyngeal, airways in the supine position. Thus, treatment of OSA and UARS patients should mainly be aimed at preventing further oropharyngeal airway narrowing as a result of supine-dependent sleep.

The role of mean inspiratory effort on daytime sleepiness.

This study has investigated the role of average maximum inspiratory effort in excessive daytime sleepiness in patients with obstructive sleep apnoea syndrome (OSAS) and upper airway resistance syndrome (UARS). Fifteen patients diagnosed with UARS and 32 patients with OSAS, with >5.5 h total sleep time (TST) during 8 h of nocturnal polygraphic recordings, were included in the study. Demographical data, polysomnographical data and data about daytime sleepiness, including Epworth sleepiness scale (ESS) and multiple sleep latency test (MSLT), were evaluated. In order to compute the average maximum inspiratory effort from oesophageal pressure (Poes) measurements, maximum Poes was obtained from 20 representative obstructive respiratory events (obstructive apnoeas, hypopnoeas or flow limitations) for each sleep stage in both supine and side positions. From Poes measurements during sleep, the increase in Poes (deltaPoes) during respiratory events was also calculated. The average maximum Poes, deltaPoes, respiratory disturbance index (RDI) and arousal index were significantly correlated with ESS in OSAS patients. In patients with UARS, the only significant correlation was obtained between average maximum Poes and ESS. The MSLT score did not show any significant correlation with arousal index, number of stage variations, RDI, average Poes, deltaPoes, minimum oxygen saturation (Sa,O2) and percentage of TST with an Sa,O2 <90% in both UARS and OSAS patients. The results of multiple regression analysis showed that average maximum Poes correlates best with the variance in ESS for OSAS patients. In conclusion, the data from this study indicate the possible important role of average inspiratory effort in determining subjective sleepiness in both obstructive sleep apnoea syndrome and upper airway resistance syndrome patients.

Variability of respiratory effort in relation to sleep stages in normal controls and upper airway resistance syndrome patients

Objective: Investigation of the role of sleep states on the respiratory effort of controls and subjects with upper airway resistance syndrome (UARS) using nasal cannula/pressure transducer system and esophageal manometry. Patients and methods: One night's monitoring of sleep and breathing, including the determination of peak end inspiratory esophageal pressure (respiratory effort) with esophageal manometry and flow limitation with nasal cannula. Analysis of the data, breath-by-breath, using visual inspection and a computerized program. Setting – a university sleep laboratory. Patients were nine men with UARS and nine control men matched for age, ethnicity, and body mass index. Results: A modulation of respiratory effort by sleep state and stages is seen in all subjects, the lowest noted during REM sleep and the highest associated with Slow Wave Sleep. When total nocturnal breaths are investigated, a significant difference between peak end inspiratory esophageal pressure [(Pes)-considered as an index of respiratory effort] is noted between normal subjects and UARS. Two specific breathing patterns, seen primarily in UARS patients, are NREM sleep stage dependent. Crescendos (defined as more negative peak end inspiratory Pes with each successive abnormal breath) occur mostly during stages 1–2 NREM sleep, while segments consisting of regular and continuous, breath-after-breath, high respiratory efforts are associated with Slow Wave Sleep. Depending on sleep stage, visually scored arousal response displays differences in Pes negativity. The termination of the abnormal breathing pattern, always well defined with Pes, is not necessarily associated with a pattern of ‘flow limitation’ at the nasal cannula tracing, even when a visually scored EEG arousal is present. Conclusions: UARS patients have significantly more breaths, with more negative peak end inspiratory Pes, than do control subjects. The modulation of peak end inspiratory Pes (an index of respiratory effort) by sleep stage and state differs in UARS patients and control subjects. The nasal cannula/pressure transducer system may not detect all abnormal breathing pattern during sleep. As indicated by the visual sleep scoring, repetitive arousals may lead to more or less severe sleep fragmentation.

A clinical investigation of obstructive sleep apnea syndrome (OSAS) and upper airway resistance syndrome (UARS) patients

Objective: (i) Evaluation of the clinical differences and similarities presented by patients diagnosed as OSAS and UARS subjects. (ii) Evaluation of the ability of a sleep disorders specialist to dissociate the two syndromes based upon clinical evaluation. Population: 314 subjects were included. They were referred to a sleep disorders clinic with complaints of loud snoring during a 3 month period. Method: The evaluation consisted of: (i) Clinical interview and evaluation. (ii) Administration of validated questionnaires (Sleep Disorders Questionnaire and Epworth Sleepiness Scale). (iii) Establishment of clinical diagnostic and results of polygraphic recording. Results: After clinical evaluation and polygraphic recordings (performed within 3 weeks of initial evaluation) patients were subdivided into two groups: 176 OSAS and 128 UARS. The misclassification of patients by specialists correlated with body mass index (BMI) measurement, with an over classification of patient as OSAS when a high BMI was noted and vice-versa for UARS. The only significant difference between OSAS and UARS patients was an older age and a wider neck circumference in the OSAS group than in UARS patients. Conclusion: Clinical presentation including daytime sleepiness complaint and ESS score is similar for patients with and without drop of oxygen saturation below 90% during sleep. There was always a male predominance within both syndromes, but more women were diagnosed with UARS than with OSAS.

Comparison of Respiratory Polysomnographic Parameters in Matched Cohorts of Upper Airway Resistance and Obstructive Sleep Apnea Syndrome Patients

To compare respiratory nocturnal polysomnography (NPSG) characteristics between matched cohorts of upper airway resistance syndrome (UARS) and obstructive sleep apnea syndrome (OSAS) patients. All patients received 13-channel NPSG, including esophageal pressure (Pes) manometry. By definition, OSAS patients had an apnea-hypopnea index (AHI, number of apneas/hypopneas per hour total sleep time) > or = 15, and UARS patients had an AHI < 5. Respiratory effort-related arousal (RERA) was defined as the absence of apnea/hypopnea with > or = 10 s duration of progressive negative Pes, culminating in an arousal or microarousal. UARS patients, by definition, had > or = 15 RERAs per hour. Fifteen consecutively diagnosed UARS patients were matched with OSAS patients on the basis of body mass index (BMI) and gender. Respiratory disturbance index (sum of the AHI and RERA per hour) was the same for both cohorts: UARS, 36+/-4; OSAS, 42+/-6 (p = 0.34). There were no differences between cohorts for mean inspiratory Pes nadirs for each 30-s epoch of sleep compared for each sleep stage over an entire night. For randomly selected breaths from supine stage 2 sleep, the mean inspiratory Pes nadir was the same for the cohorts: UARS, -16.6+/-2 cm H2O; OSAS, -16.1+/-3 cm H2O (p = 0.30). Differences between cohorts for each parameter fell within respective 95% confidence intervals. With the exception of AHI, respiratory NPSG parameters were the same for UARS and OSAS patients when BMI and gender were controlled for.