The Upper Airway Resistance Syndrome: Sequelae and Associated Disorders

Daytime Somnolence
By definition, daytime somnolence is a component of UARS and may be as severe as that found in OSAS. Guilleminault et al first demonstrated significant daytime somnolence by the MSLT and Wilkinson addition test scores, as well as behavioral abnormalities from UARS in a population of nonap-neic/nonhypopneic snoring children. These daytime sequelae were ameliorated after a tonsillectomy and/or an adenoidectomy. Nearly a decade later, these investigators presented results showing an improvement in MSLT scores in a large proportion of regular heavy adult snorers after the institution of nCPAP. Interestingly, snoring was the primary complaint of the 15 patients in that study. None of the patients spontaneously volunteered a history of daytime somnolence; this information was revealed only after direct questioning. Similarly, in these patients the mean pretreatment MSLT score of 11.29 min was within the normal range; however, after treatment the mean score was 14.59 min (p < 0.0001). Therefore, a wide range of daytime symptoms can be seen in this disorder.
Perhaps more important than sleepiness with regard to the long-term sequelae are the hemodynamic changes that can result from UARS review ventolin inhaler. Lofaso et al recently studied 105 nonapneic patients referred to an ear, nose, and throat clinic for heavy snoring. Sleep disruption, defined as > 10 EEG arousals/h, was found in approximately half of the patients and was significantly associated with increased diurnal diastolic BP, even after adjustment for antihypertensive medication. Age, gender, and BMI did not differ significantly between the groups with and without sleep disruption. However, patients with sleep disruption had significantly less SWS, as is commonly seen in UARS, although their ESS scores were not significantly higher. The authors hypothesized that nocturnal sympathetic surges caused by arousal may be responsible for diurnal hypertension in these patients, as has been proposed in OSA patients. The same group of researchers studied six male nonap-neic/nonhypopneic snorers (an AHI of < 5) with ESS scores of > 10 and multiple episodes of IUAR. These subjects, in essence, had UARS. Elevations in systolic and diastolic BP were found following arousals with IUAR. When the events were stratified by the length of arousal, the authors found a correlation between the arousal length and the magnitude of BP elevation. Even IUAR events with no detectable arousal showed a smaller but significant rise in BP. The authors concluded that undetectable arousals were likely occurring during these events and that it was the autonomic response to arousal that led to BP increases, rather than changes in intrathoracic pressure or ventricular interdependence.


So Many Advances in Medicine, So Many Yet to Come