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The Upper Airway Resistance Syndrome*

Elliott N. Exar, MD; Nancy A. Collop, MD
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*From the Division of Pulmonary and Critical Care Medicine, Allergy and Clinical Immunology, Medical University of South Carolina, Charleston, SC.



Chest. 1999;115(4):1127-1139. doi:10.1378/chest.115.4.1127
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The upper airway resistance syndrome (UARS) is a recently described form of sleep-disordered breathing in which repetitive increases in resistance to airflow within the upper airway lead to brief arousals and daytime somnolence. This review will first describe the chronological progression of our understanding of UARS within the broader context of sleep-disordered breathing. The primary symptom, daytime somnolence, appears to result directly from repetitive EEG arousals. The level of negative intrathoracic pressure is the most likely stimulus for arousal, possibly mediated by mechanoreceptors in the upper airway. A general consensus regarding the exact clinical definitions and the physiologic measurement techniques leading to a diagnosis does not exist, although esophageal manometry and pneumotachographic airflow measurements taken during polysomnography are the “gold standard.” Less invasive diagnostic modalities have been proposed, but none of them have been well-validated. Aside from daytime somnolence, hypertension is an important sequela of this disorder, likely resulting from autonomic and cardiovascular changes induced by increased negative intrathoracic pressure. Nasal continuous positive airway pressure is the most efficacious form of therapy, although low patient compliance may limit its practical application. The safety and efficacy of surgical treatments are poorly documented in the literature. Palatal tissue reduction by radiofrequency ablation and the use of oral appliances hold promise as safe and effective modalities, but these treatments require further study.

Abbreviations: AHI = apnea/hypopnea index; ASDA = American Sleep Disorders Association; BMI = body mass index; CPAP = continuous positive airway pressure; EDS = excessive daytime sleepiness; EMG = electromyogram; ESS = Epworth sleepiness scale; IUAR = increased upper airway resistance; LAUP = laser-assisted uvulopalatoplasty; MSLT = multiple sleep latency test; nCPAP = nasal continuous positive airway pressure; OSAS = obstructive sleep apnea syndrome; Pes = esophageal pressure; PSG = polysomnogram; RDI = respiratory disturbance index; REM = rapid eye movement; SWS = slow-wave sleep; TST = total sleep time; UARS = upper airway resistance syndrome; UPPP = uvulopalatopharyngoplasty; Vt = tidal volume

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