Upper Airway Resistance Syndrome
Upper airway resistance syndrome is a sleep condition characterized by airway resistance to breathing during sleep.
The symptoms of upper airway resistance syndrome are daytime sleepiness and excessive fatigue.
The muscles of the airway during sleep become relaxed.
Due to the reduction of these muscles, airways become narrowed. The airway of the person suffering from upper airway resistance syndrome restricts and reduced in size and this relaxation reduces the airway further. Therefore breathing becomes difficult.
Increased upper airway resistance in this syndrome does not lead to cessation of airflow or decrease in airflow, but instead leads to an arousal secondary to increased work of breathing to overcome the resistance.
There is no decrease of oxygen but with measurement of airflow through the nose and mouth, there are signs of decreased breathing.
Arousals and sleep fragmentation resulting with arousals are related to increased effort to breathe. It is detectable with measurement of pressure changes in the esophagus.
The esophageal pressure starts to decrease just before the arousal which indicates increased effort to maintain the flow of air which is only slightly reduced.
Due to the repeated arousals of the patient, which he is usually unaware of, results in an abnormal sleep and daytime sleepiness. Due to multiple arousals, upper airway resistance syndrome causes hypertension similar to obstructive sleep apnea.
Upper airway resistance syndrome diagnosis:
It is difficult to diagnose the syndrome without proper test equipment to recognize the illness. Polysomnography is a diagnostic test conducted to evaluate sleep disorders.
Polysomnography means multiple tests performed on patients while they are asleep. it requires an overnight stay in a sleep laboratory.
The sensors are placed on the patient in order to record brain electrical activity, airflow, oxygen saturation, eye and jaw muscle movement, leg muscle movement and respiratory effort.
It is used to find whether apneas or hypopneas are present or not. Multiple snore arousals can be seen. If an esophageal probe is used, progressive elevation of esophageal pressure fluctuations terminating in arousals is noted.
Upper airway resistance syndrome treatment:
Treatment for upper airway resistance syndrome is same as the sleep apnea treatment. The treatment includes:
- Behavioral therapy includes following a regular sleep schedule and getting 7 to 8 hours of sleep. Therapy also includes avoiding alcohol, caffeine, and other stimulants. Avoid sleeping on the back and sleep with head end of bed elevated.
- Weight loss is beneficial in curing the syndrome as obesity can cause obstructed breathing.
- Oral appliances push the tongue and mandible forward and help in reducing the upper airway resistance syndrome.
- Positive airway pressure therapy works by splinting the airway open from the pressure, thus reducing the upper airway resistance syndrome.
- Various surgical treatments are available including uvulo palato pharyngo plasty (UPPP) to increase the airway and to reduce the airway collapse.