Upper airway resistance syndrome: evaluation of patients with excessive day time sleepiness non-invasively
DOI:
https://doi.org/10.18203/2320-6012.ijrms20172482Keywords:
Excessive day time sleepiness, Obstructive sleep apnea, Oesophageal manometry, Snoring, UARSAbstract
Background: Upper airway resistance syndrome (UARS) is a recent concept introduced among sleep disordered breathing (chronic snoring and Obstructive sleep apnea) disorders. UARS also presents with excessive daytime sleepiness (EDS), which is associated with impaired social functioning, work performance and driving ability. However, UARS is not merely a continuum between chronic snoring and obstructive sleep apnea (OSA). Not only UARS patients have equal gender distribution and thin body habitus but they also do not fulfil Polysomnographic criteria of OSA. UARS diagnosis requires oesophageal manometry for diagnosing increased respiratory efforts against increased upper airway resistance (without complete cessation of airflow or hypoxia) and correlating it with EEG arousals to mark an event. Oesophageal manometry is invasive and uncomfortable, therefore, non-invasive means are desirable for evaluation of UARS. The aim of the study is to evaluate the patients with EDS for UARS non-invasively.
Methods: 25 consecutive patients with EDS (Epworth Sleepiness Score >9) visiting sleep clinic at a tertiary level hospital in North India were enrolled after informed consent. It was a non-blinded, interventional trial. All enrolled patients underwent nocturnal polysomnography using VIASYS healthcare sleep screen apnea screen cardio polysomnography machine. After PSG, those patients satisfying criteria for OSA were not analysed further. In remaining patients, greater than 10 alpha EEG arousals/h (Spontaneous Arousals) along with flattening or plateau of inspiratory flow contour (by nasal cannula) was employed to diagnose UARS non-invasively. Epi-info software was used in statistical analysis.
Results: Out of 25 patients with EDS, 60% (15) were diagnosed as OSA based on Apnea-Hypopnea Index (AHI) > 10/hr. Among 15 OSA patients,10 patients had severe (AHI >30); 2 had moderate (AHI 15-30) and 3 had mild OSAS (AHI 10-15). Only one patient was provisionally diagnosed as UARS based on nasal air flow graph and spontaneous arousals/hr >10.
Conclusions: Upper airway resistance syndrome (UARS) is a distinct sleep disorder from obstructive sleep apnea syndrome (OSAS) with unique pathophysiology and it need be evaluated in all patients with unexplained arousals.
References
Newman AB, Spiekerman CF, Enright P, Lefkowitz D, Manolio T, Reynolds CF et al. Daytime sleepiness predicts mortality and cardiovascular disease in older adults. The Cardiovascular Health Study Research Group. J Am Geriatr Soc. 2000;48(2):115-23.
Lugaresi E, Plaza G. Heavy snorer disease: from snoring to the sleep apnea syndrome-an overview. Respiration. 1997;64 Suppl 1:11-4.
Guilleminault C1, Stoohs R, Clerk A, Cetel M, Maistros P. A cause of daytime sleepiness: the upper airway resistance syndrome. Chest. 1993;104(3):781-7.
Diagnostic classification steering committee. The international classification of sleep disorders: diagnostic and coding manual. Rochester. Minn: American Sleep Disorders Association. 1990.
Guilleminault C1, Stoohs R, Clerk A, Simmons J, Labanowski M. From obstructive sleep apnea syndrome to upper airway resistance syndrome: consistency of daytime sleepiness. Sleep 1992;15(suppl 6):S13-6.
Douglas J. Upper Airway Resistance Syndrome is not a distinct syndrome. Am J Respir Crit Care Med. 2000;161:1412-6.
Guilleminault C, Winkle R, Korobkin R, Simmons B. Children and nocturnal snoring: evaluation of the effects of sleep related respiratory resistive load and daytime functioning. Eur J Pediatr. 1982;139(3):165-71.
Stoohs R, Guilleminault C. Obstructive sleep apnea syndrome or abnormal upper airway resistance during sleep? J Clin Neurophysiol 1990;7(1):83-92.
Guilleminault C, Stoohs R, Duncan S. Snoring (I). Daytime sleepiness in regular heavy snorers. Chest. 1991;99(1):40-8.
Votteri BA, Cundiff EF, Yates WA, Shabatura BB, Reichert JA. The incidence of upper airway resistance syndrome (UARS) in a community-based hospital sleep disorders center. Sleep Research 1994;23:339.
Kristo DA, Lettieri CJ, Andrada T, Taylor Y, Eliasson AH. Silent upper airway resistance syndrome: prevalence in a mixed military population. Chest 2005;127(5):1654-7.
LeeT, OhC, Solnic AS, Guilleminault, Black JE. UARS and OSAS: A Comparative study of clinical features. Sleep Res. 1997;26:411-2.
Guilleminault C, Chowdhari S. Upper airway syndrome is a distinct syndrome. Am J Respir Crit Care Med. 2000;161(5):1412-6.
Guilleminault C, Kim YD, Horita M, Tsutumi M, Pelayo R. Power spectral EEG findings in patients with obstructive sleep apnea and upper airway resistance syndromes. Electroencephalogr Clin Neurol. 1999;50(Suppl):S109-12
Martin SE, Engleman HM, Douglas NJ. The effect of sleep fragmentation on daytime function. Am J Respir Crit Care Med. 1996;153(4):1328-32.
Philip P, Stoohs R, Guilleminault C. Sleep fragmentation in normals: a model for sleepiness associated with upper airway resistance syndrome. Sleep 1994;17(3):242-7.
Pelin Z, Karadeniz D, Ozturk L, et al. The role of mean inspiratory effort on day- time sleepiness. Eur Respir J. 2003;21(4):688-94.
The Report of an American Academy of Sleep Medicine Task Force. Sleep-related breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clinical research. Sleep. 1999;22:667-89.
Ayappa I, Norman RG, Krieger AC, et al. Non-invasive detection of respiratory effort related arousals (RERAs) by a nasal cannula pressure/transducer system. Sleep. 2000;23:763-71.
Hosselet J, Ayappa I, Norman RG Krieger AC, Rapoport DM. Classification of sleep-disordered breathing. Am J Respir Crit Care Med. 2001; 163(2):398-405.
Lofaso F, Goldenberg F, d’Ortho MP, Coste A, Harf A. Arterial blood pressure response to transient arousals from NREM sleep in nonapneic snorers with sleep fragmentation. Chest. 1998;113(4):985-91.
