The Upper Airway Resistance Syndrome: Treatment

CPAP, surgery, oral appliances, and weight loss are all viable treatment modalities for UARS, and they have received more recent attention in the literature. Unfortunately, the data regarding compliance, efficacy, safety, or a combination of these factors are lacking in many cases. natural asthma treatment

CPAP
In 1991, Guilleminault et al showed that in a group of 15 regular heavy snorers with UARS the institution of nCPAP resulted in significantly fewer arousals and improved MSLT scores. The CPAP values ranged from 3 to 8 cm H2O with a mean of5.8 cm H2O. Interestingly, none of these patients wanted to continue nCPAP beyond the study protocol, although daytime somnolence was not their primary complaint (the mean initial MSLT score was 11.29 min); therefore, these patients likely represented the mild end of the UARS clinical spectrum. In 1993, the same group of researchers studied more somnolent UARS patients. Fifteen patients with a mean MSLT score of 5.3 min were restudied after 1 month of nCPAP therapy, at which time none of them reported EDS. The mean MSLT score increased to 13.5 min, the mean percent of SWS increased from 1.2 to 9.7, and the mean transient EEG arousals/h decreased from 31 to 7. Strollo and Sanders concluded in a 1993 review that the efficacy of CPAP in UARS was not so much the question as was compliance, because of a lack of sufficient data. They recommended offering titration of nCPAP or bilevel ventilation after PSG with Pes if necessary, and to continue its use if sleep fragmentation and daytime performance improved. Furthermore, Guilleminault and colleagues demonstrated the efficacy of nCPAP in treating hypertension, as discussed. The titration of nCPAP was performed in the supine position so that the peak end-inspiratory Pes was never more negative than —7 cm H2O.
Two more recent studies have examined nCPAP compliance in nonapneic snorers. Krieger and col-leagues reported an initial acceptance rate of only 34% in 98 patients with an AHI of < 15 (the so-called “nonapneic snorers”), but the compliance in acceptors was > 60% at 3 years. Furthermore, the mean (± SD) rate of use was 5.6 ± 1.4 h/day. Although the initial acceptance was much lower than that seen in patients with an AHI of > 15, the nonapneic snorers were offered nCPAP as only one of several therapeutic modalities. Unfortunately, this group was not well characterized and likely included patients with mild OSA, UARS, and simple snoring; no Pes or quantitative airflow data appear to have been collected.

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