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Physiology of Sleep and Sleep Disorders
Published in John C Watkinson, Raymond W Clarke, Terry M Jones, Vinidh Paleri, Nicholas White, Tim Woolford, Head & Neck Surgery Plastic Surgery, 2018
Upper airway resistance syndrome (UARS) is classified as a variant of OSA, characterized by increased airway resistance to breathing during sleep, without cessation of breathing. The primary symptoms are similar to those in OSAS although snoring may not be noted. Sleepiness and excessive fatigue develop due to arousals in sleep with changes in pulse transit time associated with respiratory flow limitation, and increased negative intra-thoracic pressure.37
Evidence-Based Approach to Therapy
Published in Mark A. Richardson, Norman R. Friedman, Clinician’s Guide to Pediatric Sleep Disorders, 2016
Nira A. Goldstein, Richard M. Rosenfeld
Childhood obstructive SDB used to be neatly categorized into obstructive sleep-apnea syndrome (OSAS), which required therapy, and benign primary snoring, which was believed to be clinically insignificant. PSG was considered the “gold standard” diagnostic test to separate the two entities. With the recognition of upper airway resistance syndrome (UARS), SDB is now viewed as a continuum of sleep-related airway obstruction with snoring on one end and complete upper airway obstruction and obstructive hypoventilation on the other.
Major Sleep Disorders
Published in Clete A. Kushida, Sleep Deprivation, 2004
Christian Guilleminault, Dawn Daniel
The upper airway resistance syndrome (UARS) (28) does not lead to complete collapse of the upper airway, but to increased respiratory effort and often nasal flow limitation without a drop in oxygen saturation below 94%. But the abnormal breathing leads to important change in sleep EEG (29). Short EEG arousals may be present but the use of a computerized technique of EEG analysis, spectral analysis on 2–4-sec windows of the EEG, indicates that there is a large overall increase in alpha EEG frequency during the night. The alpha power (amount of alpha frequencies during a given time window compared to other EEG frequencies) is much higher than age- and gender-matched controls (30). Thus, in this syndrome, there are not only visually recognizable EEG arousals and behavioral awakenings that leads to sleep deprivation, but also a change in the underlying EEG frequency distribution. This pattern is not visually recognizable but it impacts the sleep quality and the individual’s behavior the following day (29,30).
Objective assessment of obstructive sleep apnea in normal pregnant and preeclamptic women
Published in Hypertension in Pregnancy, 2018
Farahnaz Keshavarzi, Shervin Mehdizadeh, Habibolah Khazaie, Mohammad Rasoul Ghadami
Pregnancy is associated with hormonal, physiological, and anatomic changes which can alter sleep patterns and sleep quality (1), and may increase the risk for sleep-related breathing disorders (SRBD) or exacerbate preexistent sleep apnea (2,3). SRBD, including obstructive sleep apnea (OSA) and upper airway resistance syndrome, is associated with upper airway obstruction and hypoxemia during sleep which is significantly associated with long-term cardiovascular complications. OSA is characterized by recurrent airway narrowing during sleep that leads to respiratory disruption, intermittent nocturnal hypoxia, hypoventilation, and sleep fragmentation (4). The prevalence of OSA among female population in reproductive age is approximately 0.6–15% (5), but it remains widely underdiagnosed. The occurrence of OSA in pregnancy and its consequences on the mother and fetus are not clearly understood. However, several studies have shown association between OSA in pregnant women and low birth weight (LBW) (6,7), preterm birth (8), small for gestational age (SGA) (9,10), lower Apgar scores at birth (6,11), and preeclampsia (2,10).
Improving the diagnosis of obstructive sleep apnea in children with nocturnal oximetry-based evaluations
Published in Expert Review of Respiratory Medicine, 2018
Annelies Van Eyck, Stijn L. Verhulst
Sleep-disordered breathing (SDB) includes a spectrum of clinical entities that can be defined as a clinically relevant disturbance of nocturnal breathing patterns, and includes primary snoring, upper airway resistance syndrome, and obstructive sleep apnea (OSA). OSA is considered the end of the spectrum of SDB [1], and is characterized by intermittent cycles of upper airway collapse usually associated with intermittent desaturations and arousal during sleep. It is a prevalent disorder in childhood, affecting 2–3% of children [2]. Several factors can predispose children to OSA, including adenotonsillar hypertrophy, neuromuscular disorders, craniofacial abnormalities, and obesity. Consequently, certain subgroups of children for example children with obesity and Down syndrome exhibit a higher prevalence of OSA [1].
Upper airway resistance syndrome 2018: non-hypoxic sleep-disordered breathing
Published in Expert Review of Respiratory Medicine, 2019
William C. Arnold, Christian Guilleminault
While studying sleep apnea in pediatric patients in the 1970s Guilleminault et al. observed that during nocturnal polysomnogram (PSG) there were short (1–3 s) alpha (7–9 Hz) arousals preceded by 3–20 second periods of increasing intrathoracic pressure measured using an esophageal pressure probe or Pes [1–4]. Later the team showed that these arousals were not associated with oxygen desaturations, apneas, or hypopneas but the patients often exhibited increased respiratory effort with inspiratory flow limitation (IFL) during PSG and were experiencing significant daytime symptoms and developmental impairments [5]. Described as Upper Airway Resistance Syndrome (UARS) it was broadly introduced to the medical community when applied to adults in 1993 [6]. These patients were presenting differently than obstructive sleep apnea (OSA) patients. UARS patients were younger, leaner and had fewer comorbidities than OSA patients [7]. UARS patients were experiencing unrefreshing sleep and daytime sleepiness like OSA patients but were more likely to also suffer from a variety of less specific somatic, psychosomatic and psychiatric conditions (i.e. headache, inattention, hyperactivity, chronic fatigue syndrome, insomnia, anxiety, and depression) [6,8]. On their sleep studies UARS patients had clear arousals related to events seen with Pes, however, these were not considered ‘scorable events’ by traditional apnea and hypopnea definitions (AHI). Sleep-disordered breathing has become synonymous with obstructive sleep apnea and over the past 45 years, with the continued clinical under-appreciation and the loss of the esophageal pressure probe(Pes) during routine PSG, the diagnosis of UARS has lost recognition.