The Upper Airway Resistance Syndrome: Surgery

The Upper Airway Resistance Syndrome: SurgeryRauscher and colleagues also studied nCPAP in nonapneic snorers, defined as patients with EDS and an AHI of < 5. These patients had a mean (± SD) 3- to 15-s EEG arousal index of 20 ± 10/h. Therefore, this was a more homogeneous population, and many of them likely had UARS, although, again, no invasive monitoring was used. Only 19% of the patients (n = 11) accepted nCPAP therapy, with a mean (± SD) daily use time at 6 months of 2.8 ± 1.5 h. Surprisingly, 73% of the acceptors reported decreased sleepiness with therapy. Again, the patients were offered the option of surgical therapy, and 11 chose UPPP. Although the acceptors had slightly more apneas and hypopneas than the refusers, they did not differ in arousal index, initial EDS, BMI, age, or percent of SWS. Thus, the authors were unable to determine any reliable criteria that could predict CPAP acceptance or compliance.
The available data support nCPAP as an efficacious form of therapy in UARS, although compliance is much less certain. Further research is needed to resolve the issue of compliance in patients having cases of this syndrome that are clearly and unquestionably documented. ventolin inhaler

In 1996, Pepin and colleagues reviewed surgical therapy for snoring, UARS, and OSAS. They noted, in general, that the studies included small patient numbers and were of a descriptive rather than a comparative nature. They found no randomized studies involving UARS patients. They also identified poorly defined entry criteria and population characteristics, as well as a lack of clearly defined procedures for surgery, anesthesia, perioperative management, and endpoints. For example, they described a study of UPPP in nonapneic snorers wherein questionnaires and nocturnal oximetry were the only assessments performed. They cited two studies of the severe complications of UPPP; one study demonstrated an approximate 10% incidence of upper airway obstruction, and another study showed a 15% incidence of significant hemorrhage.
Krespi et al published data on the efficacy of laser-assisted uvulopalatoplasty (LAUP) in snoring, OSAS, and UARS. Forty-two of the 423 patients who underwent the procedure were reported to have UARS, although no specific diagnostic criteria were cited. In a collective group of UARS and mild OSAS patients, significant improvements were reported in sleep quality (28%) and daytime somnolence (24%); slight improvements were reported in sleep quality (46%) and daytime somnolence (49%). These factors were assessed by questionnaire. Statistically significant improvements in sleep maintenance, fatigability, daytime alertness, irritability, restlessness, sleeptime nasal obstruction, and nocturnal choking and gasping were also reported in UARS and OSAS. Unfortunately, no comparable pre- and postoperative polysomnographic data were presented for the UARS group and the mild OSAS group, nor were any data on UARS patients alone presented.

Category: Airway Resistance

Tags: arousals, continuous positive airway pressure, esophageal pressure, excessive daytime somnolence, laser-assisted uvulopalatoplasty, snoring, somnoplasty, upper airway resistance syndrome, UPPP