Sleep: Definition, Concept, New Area for Physical Therapy

Upper Airway Resistance Syndrome : An Underdiagnosed Sleep-related Breathing Disorder

“…The findings revealed that the use of an oral appliance was beneficial in reducing fragmentation of sleep, as well as subjective and objective daytime sleepiness 16. In UARS patients, OA treatment has been demonstrated to lower negative esophageal pressure, reduce the awakening index, raise percentage of sleep efficiency and minimum saturation of oxygen, in addition to decrease subjective EDS and snoring 17.…”

“…Polysomnography (PSG) findings in UARS are described as: a. The presence of RERA events, which are currently defined by The American Academy of Sleep Medicine (AASM) as a sequence of breaths with increased respiratory effort identified by the flattening of the airflow curve of the nasal pressure cannula, which leads to awakening/arousal and does not meet the criterion for hypopnea and apnea.RERAs have a 10-second duration 17. …”

“…Oral AppliancesUARS patients have a narrow and small area of the posterior airway behind the tongue's base. Oral appliances shift the mandible and tongue forward to widen the oropharyngeal airway and relieve obstruction in the oropharynx 3,17. Oral appliance therapy (OAT), particularly Mandibular Advancement Devices (MAD), which kept the mandible protruding during sleep (expanding the retro-glossal space), has been demonstrated to be helpful.Patients with UARS are suitable candidates for the OAT (MAD) because their threshold for arousal is lower and their muscle's responsiveness is better, resulting in lower pharyngeal collapsibility (lower Pcrit) 22.…”

“…complications. Exhaustion, sleeplessness, and depressive mood are common sleep and daytime symptoms in untreated UARS, and they frequently get worse over time 17. Some of UARS patients tend to report light-headedness and fainting following abrupt standing 9.…”