Prolonged partial upper airway obstruction during sleep – an underdiagnosed phenotype of sleep-disordered breathing

Abstract

Obstructive sleep apnea syndrome (OSAS) is a well-recognized disorder conventionally diagnosed with an elevated apnea–hypopnea index. Prolonged partial upper airway obstruction is a common phenotype of sleep-disordered breathing (SDB), which however is still largely underreported. The major reasons for this are that cyclic breathing pattern coupled with arousals and arterial oxyhemoglobin saturation are easy to detect and considered more important than prolonged episodes of increased respiratory effort with increased levels of carbon dioxide in the absence of cycling breathing pattern and repetitive arousals. There is also a growing body of evidence that prolonged partial obstruction is a clinically significant form of SDB, which is associated with symptoms and co-morbidities which may partially differ from those associated with OSAS. Partial upper airway obstruction is most prevalent in women, and it is treatable with the nasal continuous positive pressure device with good adherence to therapy. This review describes the characteristics of prolonged partial upper airway obstruction during sleep in terms of diagnostics, pathophysiology, clinical presentation, and comorbidity to improve recognition of this phenotype and its timely and appropriate treatment.

Among middle-aged adults, snoring predicted hypertension independently of sleep apnoea

“…Sixthly, the arousal index was not statistically associated with the presence or absence of apnoea, or snoring, or the combination of them. Finally, the study did not allow for the possibility that some patients had undiagnosed upper airway resistance syndrome (UARS), 37 which requires oesophageal pressure monitoring for diagnosis. The treatment of UARS is challenging and the application of nasal continuous positive airway pressure, the mainstay of treatment, has limited effectiveness.…”

Opportunities for Early Outpatient Diagnostics of Obstructive Sleep Disordered Breathing

“…Ряд круп-ных, контролируемых, проспективных исследова-ний показал увеличение частоты ССЗ в 2-3 раза при ИАГ >15 эпизодов и в 5-6 раз -при ИАГ >30 эпизо-дов [8]. Значимость СОАС с медицинской и соци-альной точки зрения не вызывает сомнений, однако большинство его случаев не определяется [10]. Воз-можно, это объясняется несоответствием между распространенностью НДС и пониманием врачами и населением их негативного влияния на здоровье; недостатком времени, особенно у врачей первич-ного звена; акцентированием внимания на послед-ствиях апноэ сна: острое нарушение мозгового кро-вообращения, артериальная гипертония (АГ), хро-ническая сердечная недостаточность, а не на состоянии здоровья человека и недостаточной доступностью диагностических методов.…”

Prolonged partial obstruction during sleep is a NREM phenomenon

“…Prolonged partial obstruction is often considered to be a milder form of SDB than OSA, even if the patients may have severe symptoms, such as fatigue, depressive symptoms, morning headache and decreased quality of life (Anttalainen et al, 2016). Our study cannot address why some patients have PPO.…”

“…In addition, the AHI diminishes in deep sleep (Ratnavadivel et al, 2009). However, the usefulness of the AHI alone to quantify SDB has been criticised because long periods of prolonged partial obstruction without apnoea or hypopnea are common in SDB patients (Anttalainen et al, 2016, Tenhunen et al, 2013.…”