The Upper Airway Resistance Syndrome: Oral Appliances

The Upper Airway Resistance Syndrome: Oral AppliancesOral Appliances
Oral appliances that advance the mandible and tongue are already used to treat OSAS. These devices hold promise for treating UARS because of good patient acceptance and low morbidity, but, unfortunately, there are almost no data available to support their use. Loube et al reported a well-documented case of a 40-year-old man with UARS who was successfully treated using an oral appliance. The patient had declined CPAP at 9 cm H2O after a 2-month trial because of subjective increased sleep fragmentation. A repeat PSG following 2 weeks of therapy with a mandibular advancement device showed a decreased arousal index from 53 to 10/h, a decreased IUAR index from 44 to 2 events/h, an improved mean (± SD) Pes nadir from —5 ± 2 to —5 ± 3 cm H2O, and improved sleep efficiency. The patient’s ESS score decreased from 17 to 6, and he denied any side effects or complications. If an extensive series or a similarly well-documented prospective trial can show a reasonable percentage of patients with this type of result, this may become a very important treatment modality for UARS.
Other Therapies
Levy et al were unable to find any data on the efficacy of weight loss for UARS in their 1996 review of the management of snoring, UARS, and moderate OSAS. Braver and Block studied the efficacy of oxymetazoline nasal spray and positional therapy in asymptomatic snorers. Although they found no effect on snoring, they did find a decrease in the AHI with combined therapy, especially in patients with lower pretreatment AHIs. The similarity of these patients to the patients studied by Guilleminault and col-leagues in 1991 suggests the possibility of this type of conservative therapy for UARS patients who are not amenable to other therapies. canadian health care mall

Future Directions
Given the growing interest in UARS, it is clear that much more work is needed to further our understanding of several aspects of this disorder. Epidemiologic investigation is needed to first understand the magnitude of this problem. Standardized criteria for the diagnosis of UARS are still lacking, hampering the epidemiologic investigation. The wide adoption of standardized criteria likely awaits the validation of a reliable, noninvasive means of making this diagnosis that will be practical and acceptable for both clinicians and patients. Finally, the treatment of this condition seems to be the area most in need of further study (using clearly defined criteria and endpoints), so that a rational comparative evaluation of available modalities will be possible.

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