Recognition and surgical management of the upper airway resistance syndrome

Patients with upper airway resistance syndrome (UARS) have clinical signs and symptoms of excessive daytime somnolence (EDS) in the absence of obstructive sleep apnea. These patients have increased upper airway resistance, reflected by an elevated intrathoracic pressure measurement, despite a normal respiratory disturbance index (RDI). Physical findings often include excessive palatal tissue and narrowing of the oropharynx and hypopharynx. Nine patients with UARS who received surgical treatment were prospectively evaluated. The four men and five women had signs of EDS, with or without snoring. The mean (+/- standard deviation) RDI was 2.1 (+/- 1.2), and the mean esophageal pressure recording during polysomnography was -36.7 (+/- 16.2) cm H2O. The Epworth sleepiness scale was used to quantify EDS. The preoperative score of 12.0 (+/- 6.6) decreased to 3.4 (+/- 1.9) (P = .001) after surgical treatment. A variety of procedures, all including some type of palatal surgery, were performed. No treatment complications occurred. The recognition of UARS and an understanding of the mechanisms responsible for the progressive development of obstructive sleep apnea syndrome may facilitate the prompt identification and treatment of such patients. The pathophysiology of UARS and a preliminary report of its surgical treatment are discussed.