Sleep and daytime sleepiness in upper airway resistance syndrome compared to obstructive sleep apnoea syndrome

Abstract

Sleep and daytime sleepiness in upper airway resistance syndrome compared to obstructive sleep apnoea syndrome. C. Guilleminault, Y. Do Kim, S. Chowdhuri, M. Horita, M. Ohayon, C. Kushida. #ERS Journals Ltd 2001. ABSTRACT: This study has investigated differences in the nocturnal sleep and daytime sleepiness among patients with obstructive sleep apnoea syndrome (OSAS), upper airway resistance (UARS), sleep hypopnoea syndrome, and normal control subjects, using sleep scoring and spectral activity analysis of the electroencephalogram (EEG).Twelve nonobese males with UARS aged 30 -60 yrs were recruited. These subjects were strictly matched for age and body mass index with twelve OSAS patients, 12 sleep hypopnoea syndrome patients, and 12 normal controls, all male. Daytime sleepiness was evaluated using the Epworth Sleepiness Scale (ESS) and the Multiple Sleep Latency Test (MSLT). The macrostructure of sleep was determined using international criteria and spectral analysis of the sleep EEG was obtained from a central lead.The sleep macrostructure of OSAS and UARS patients was significantly different from that of controls. These patients were also sleepier during the daytime than controls. Complaints of tiredness and daytime sleepiness, ESS and MSLT scores were similar in the different patient groups. Mild dysmorphia was present in all three patient groups. However, nocturnal sleep was significantly different among the different groups. OSAS patients had significantly more awake time during sleep than the UARS patients. The spectral activity of the total sleep time of the patient groups also differed significantly from that of controls. When the sleep spectral activity of UARS and OSAS patients were compared, OSAS patients had less slow wave sleep activity than UARS patients. UARS patients had a significantly higher absolute power in the 7 -9 Hz bandwidth than OSAS patients. The absolute delta power over the different sleep cycles was also different between controls and patients, and between UARS and OSAS patients.There are clear differences in the macrostructure and spectral activity of sleep between upper airway resistance and obstructive sleep apnoea syndrome patients, demonstrated by differences in the cortical activity recorded in the central lead during sleep. Despite these nocturnal sleep differences, the tests of subjective daytime sleepiness are not significantly different.

Upper Airway Resistance Syndrome - A Twenty-Five Years Experience

“…The development of slow wave sleep is also abnormal, with persistence of a large number of "power delta" at the end of sleep cycles. Both abnormalities may explain the symptoms of daytime sleepiness, insomnia and fatigue in patients with UARS (Guilleminault 2001a). Black et als found that visually undetectable EEG alterations may occur during breathing disturbances in the absence of arousal (Black 2000).…”

“…Hypersomnolence is the principal daytime manifestation of sleep disordered breathing. Excessive sleepiness resulting from increased breathing effort and sleep disruption is the guide symptom of UARS patients (Guilleminault 1993(Guilleminault , 2001a. Drowsiness related to general exhaustion has a negative impact on quality of life.…”

“…Patients with UARS present an increase in the number of cyclic alternating patterns, with a decreased phase 1 and an increased phase A2 and A3 (Guilleminault 2005c) In recent years, polysomnography has revealed that UARS patients present nonREM-sleep instability. Alpha-delta sleep is characterized by an intrusion of alpha EEG waves into slow delta waves during deep sleep, which also occurs in insomnia and non-refreshing sleep (Guilleminault 2001a).…”

The search for the Holy Grail and the upper airway resistance syndrome. New data are welcome

“…The paper by Guilleminault et al [10] requires some comments. They recruited 12 patients with UARS who are described as representative of the general UARS patient.…”

“…In this issue of the European Respiratory Journal, Guilleminault et al [10] present data on spectral analysis of sleep and sleep architecture in matched groups of normal subjects and patients with UARS, sleep apnoea syndrome (SAS) and sleep hypopnoea syndrome (SHS). They contend that according to the data, SAHS and UARS patients have different brain activity during sleep and cannot therefore be considered as similar.…”