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The Symptoms and Signs of Upper Airway Resistance Syndrome^*

A Link to the Functional Somatic Syndromes

^* From the Division of Pulmonary/Critical Care Medicine (Drs. A.R. Gold, Dipalo, and O’Hearn), SUNY-Stony Brook, School of Medicine, DVA Medical Center, Northport, NY; and Biostatistics and Data Management (Dr. M.S. Gold), Novartis Consumer Health, Summit, NJ.

Correspondence to: Avram R. Gold, MD (111 D), DVA Medical Center, Northport, NY 11768; e-mail: avram.gold{at}med.va.gov

Study objectives: The functional somatic syndromes are associated with a variety of symptoms/signs of uncertain etiology. We determined the prevalence of several of those symptoms/signs in patients with sleep-disordered breathing and examined the relationship between the prevalence of the symptoms/signs and the severity of sleep-disordered breathing.

Design: A descriptive study without intervention.

Setting: A university sleep-disorders center located in a suburban setting.

Patients or participants: Three groups of 25 consecutively collected patients with sleep-disordered breathing. Groups varied in their apnea hypopnea indexes (AHIs) as follows: upper airway resistance syndrome (UARS) [AHI < 10/h), mild-to-moderate obstructive sleep apnea/hypopnea (OSA/H) [AHI 10 to < 40/h), and moderate-to-severe OSA/H (AHI 40/h).

Measurements and results: Patients underwent comprehensive medical histories, physical examinations, and full-night polysomnography. The diagnosis of UARS included quantitative measurement of inspiratory airflow and inspiratory effort with demonstration of inspiratory flow limitation. The percentage of women among the patients with sleep-disordered breathing (p = 0.001) and the prevalence of sleep-onset insomnia (p = 0.04), headaches (p = 0.01), irritable bowel syndrome (p = 0.01), and alpha-delta sleep (p = 0.01) was correlated with decreasing severity of AHI group.

Conclusions: We conclude that patients with UARS, mild-to-moderate OSA/H and moderate-to-severe OSA/H differ in their presenting symptoms/signs. The symptoms/signs of UARS closely resemble those of the functional somatic syndromes.

Key Words: alpha-delta sleep • bruxism • chronic fatigue syndrome • fibromyalgia • functional somatic syndromes • irritable bowel syndrome • sleep-disordered breathing • temporomandibular joint syndrome • upper airway resistance syndrome

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