February 23rd, 2021


Treatment of upper airway resistance syndrome in adults: Where do we stand?

Sleep Sci. 2015 Jan-Mar; 8(1): 42–48.
Published online 2015 Mar 20. doi: 10.1016/j.slsci.2015.03.001

Luciana B.M. de Godoy,a Luciana O. Palombini,a,⁎ Christian Guilleminault,b Dalva Poyares,a Sergio Tufik,a and Sonia M. Togeiroa Collapse )

The Upper Airway Resistance Syndrome
Pépin J.L.a, b · Guillot M.a, b · Tamisier R.a, b · Lévy P.a, b Collapse )

Particularities of Polysomnographic Patterns and Diagnosis

RERAs and arousal detection are the key elements during sleep monitoring (fig. 2). RERAs correspond to a sequence of breaths characterized by increasing respiratory effort leading to an arousal from sleep, but which does not meet criteria for an apnea or hypopnea in terms of flow reduction. These events must fulfill both of the following criteria: (1) a pattern of progressively more negative esophageal pressure, terminated by a sudden change in pressure to a less negative level and an arousal, and (2) the event lasts 10 s or longer. The number of events may be underestimated when tools used during this monitoring are not appropriate. By definition, detection of RERAs is based on accurate flow measurement using the nasal cannula or a pneumotachograph [9] and respiratory effort measurement using either oesophageal pressure or pulse transit time [3,22,23]. By using a nasal thermocouple to detect flow a shift between hypopnea to RERA will occur and an authentic OSAS will be misdiagnosed to a UARS. This has been described by Montserrat and Badia [24] as the ‘thermistance syndrome’. We investigated subjects presenting with sleep-disordered breathing and very little oxygen desaturations, thus being either mild OSAS or UARS, using the reference tools (pneumothachograph and esophageal pressure). They exhibited mainly hypopneas but we found only about 5% of true RERAs [7]. RERAs must be considered as specific respiratory events expressed by patients depending on their UA collapsibility. To this extent, it is logical to include RERAs in the respiratory disturbance index. Collapse )