Silent upper airway resistance syndrome - Prevalence in a mixed military population

Pulmonary and Critical Care Medicine Service, Walter Reed Army Medical Center, Washington DC 20307, USA. <>
Chest (Impact Factor: 7.48). 06/2005; 127(5):1654-7. DOI: 10.1378/chest.127.5.1654
Source: PubMed


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.

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    • "Sleep-onset insomnia is also frequently associated [8]. While collapse of the pharyngeal airway during sleep occurs in all patients with UARS, not all patients with UARS snore audibly [9]. Therefore, anyone with sleep-onset insomnia, restless sleep and daytime sleepiness/fatigue, symptoms that are common among depressed individuals, may have UARS. "
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    ABSTRACT: Introduction To the best of our knowledge, this is the first report of a case of treatment-resistant depression in which the patient was evaluated for sleep disordered breathing as the cause and in which rapid palatal expansion to permanently treat the sleep disordered breathing produced a prolonged symptom-free period off medication. Case presentation An 18-year-old Caucasian man presented to our sleep disorders center with chronic severe depression that was no longer responsive to medication but that had recently responded to electroconvulsive therapy. Ancillary, persistent symptoms included mild insomnia, moderate to severe fatigue, mild sleepiness and severe anxiety treated with medication. Our patient had no history of snoring or witnessed apnea, but polysomnography was consistent with upper airway resistance syndrome. Although our patient did not have an orthodontic indication for rapid palatal expansion, rapid palatal expansion was performed as a treatment of his upper airway resistance syndrome. Following rapid palatal expansion, our patient experienced a marked improvement of his sleep quality, anxiety, fatigue and sleepiness. His improvement has been maintained off all psychotropic medication and his depression has remained in remission for approximately two years following his electroconvulsive therapy. Conclusions This case report introduces the possibility that unrecognized sleep disordered breathing may play a role in adolescent treatment-resistant depression. The symptoms of upper airway resistance syndrome are non-specific enough that every adolescent with depression, even those responding to medication, may have underlying sleep disordered breathing. In such patients, rapid palatal expansion, by widening the upper airway and improving airflow during sleep, may produce a prolonged improvement of symptoms and a tapering of medication. Psychiatrists treating adolescents may benefit from having another treatment option for treatment-resistant depression.
    Journal of Medical Case Reports 12/2012; 6(1):415. DOI:10.1186/1752-1947-6-415
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    • "The absence of decreased oxygen saturation and sometimes even the cornerstone symptom of snoring makes a diagnostic challenge and requires a high index of suspicion. It is estimated that 1% of all patients undergoing sleep studies for hypersomnolence suffer from silent UARS [5]. The rigorous diagnostic criteria for the specific diagnosis of UARS require Apnea/Hypopnea Index<5, oxygen saturation >92%, and esophageal manometry to record negative intrathoracic pressures during respiratory related arousals and associated limitation of air flow [6]. "
    The Open Otorhinolaryngology Journal 04/2008; 2(1):44-45. DOI:10.2174/1874428100802010044
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    ABSTRACT: Upper airway resistance syndrome (UARS) is a condition where the apnea-hypopnea index is less than 5 and respiratory-effort related arousal index is more than 10. The clinical presentation of UARS may be the same as obstructive sleep apnea-hypopnea syndrome (OSAS); it sometimes shows up with symptoms hardly suggestive of a sleep-disordered breathing. A 17 year-old male patient had applied to a local psychiatry clinic and complained of chronic fatigue, insomnia, behavioral and academic problems and was treated for anxiety and depression. After a period of unresponsive treatment, he was sent to a sleep center for evaluation of insomnia, which turned out to be a fragmented, unrefreshing sleep episode. Polysomnographical evaluation revealed that he had UARS without OSAS. His complaints decreased dramatically after he received CPAP treatment. This case shows that UARS should be considered in young patients with functional somatic syndromes even if the clinical presentation does not apparently imply the condition. KeywordsUpper airway resistance syndrome-Functional somatic syndromes
    Central European Journal of Medicine 01/2010; 5(6):712-715. DOI:10.2478/s11536-009-0127-1 · 0.15 Impact Factor
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