The Upper Airway Resistance Syndrome: Historical Perspective

Although the two groups did not differ during quiet wakefulness, the PSGs of the patient group showed significantly larger swings in Pes during sleep when compared with the control group, respectively: inspiratory Pes nadirs of —30 to —53 cm H2O vs —11 to —20 cm H2O. The patient group also demonstrated intermittent tachypnea, arrhythmias, and snoring, although none had significant oxyhemoglobin desaturation or met the criteria for obstructive sleep apnea syndrome (OSAS). These parameters, as well as the MSLT and Wilkinson addition test score results, improved both clinically and statistically in all 25 symptomatic patients following tonsillectomy and/or adenoidectomy. Of note, the oronasal airflow was measured by nasal and buccal thermistors, and these data were only used to calculate the respiratory rate in the analysis.
The following year, Lugaresi et al suggested a continuum of sleep-disordered breathing that ranged from snoring, to OSAS, to severe daytime somnolence and hypoventilation, which was based on polysomnographic measurements that included snoring severity, Pes swings, oxyhemoglobin desaturations, and daytime sleepiness. Snoring was an essential component of each stage along this continuum. The authors provided a case history representing the mildest end of this spectrum (stage 0 or the preclinical stage) review zyrtec tablets. The longest period with the lowest Pes nadirs (—25 to —35 cm H2O) from the PSG of this hypersomnolent patient showed no significant oxyhemoglobin desaturation, suggesting that the patient may have had UARS. Curiously, the authors mention “trivial snoring” in their introductory discussion of this continuum, but even the mildest case reported had heavy snoring and EDS. In a 1990 review article, Stoohs and Guilleminault suggested a continuum of severity focusing on partial to complete upper airway obstruction as opposed to snoring. Their data included postpalatopharyngoplasty patients who no longer snored but, despite their diminished palate size, continued to manifest OSAS most likely attributed to retrolingual obstruction.


So Many Advances in Medicine, So Many Yet to Come