Upper Airway Resistance Syndrome Patients Have Worse Sleep Quality Compared to Mild Obstructive Sleep Apnea

Abstract

PurposeTo compare sleep quality and sustained attention of patients with Upper Airway Resistance Syndrome (UARS), mild Obstructive Sleep Apnea (OSA) and normal individuals.MethodsUARS criteria were presence of excessive daytime sleepiness (Epworth Sleepiness Scale—ESS—≥ 10) and/or fatigue (Modified Fatigue Impact Scale—MFIS—≥ 38) associated to Apnea/hypopnea index (AHI) ≤ 5 and Respiratory Disturbance Index (RDI) > 5 events/hour of sleep or more than 30% of total sleep time with flow limitation. Mild OSA was considered if the presence of excessive daytime sleepiness (ESS ≥ 10) and/or fatigue (MFIS ≥ 38) associated to AHI ≥ 5 and ≤ 15 events/hour. “Control group” criteria were AHI < 5 events/hour and RDI ≤ 5 events/hour and ESS ≤ 9, without any sleep, clinical, neurological or psychiatric disorder. 115 individuals (34 UARS and 47 mild OSA patients and 34 individuals in “control group”), adjusted for age, gender, body mass index (BMI) and schooling years, performed sleep questionnaires and sustained attention evaluation. Psychomotor Vigilance Task (PVT) was performed five times (each two hours) from 8 a.m. to 4 p.m.ResultsUARS patients had worse sleep quality (Functional Outcomes of Sleep Questionnaire—FOSQ—and Pittsburgh Sleep Quality Index—PSQI: p < 0.05) and more fatigue than mild OSA patients (p = 0.003) and scored significantly higher in both Beck inventories than “control group” (p < 0.02). UARS patients had more lapses early in the morning (in time 1) compared to the results in the afternoon (time 5) than mild OSA (p = 0.02). Mild OSA patients had more lapses in times 2 than in time 5 compared to “control group” (p = 0.04).ConclusionsUARS patients have a worse sleep quality, more fatigue and a worse early morning sustained attention compared to mild OSA. These last had a worse sustained attention than controls.

Analysis of Attention Subdomains in Obstructive Sleep Apnea Patients

“…Lee et al ( 24 ) with the aid of the psychomotor vigilance task (PVT)) found that reaction time (RT) was related to the quality of life in subjects with OSA. The PVT is a single RT performance test ( 25 ) that is commonly used in sleep research (e.g., ( 26 )). Taken together, the results based on different performance tests remain largely controversial.…”

“…Factor analyses of different CPTs ( 26 – 31 ) yielded four factors that each explained a sizeable portion of variance in test scores. The four test variables that loaded highest on the four attention subdomains are the following: (1) RT loaded on the alertness factor; (2) VRT loaded on the sustained attention factor; (3) OE loaded on the focused attention factor; and (4) CE loaded on the hyperactivity/impulsivity factor.…”

Sleep-disordered breathing in gestational hypertension and preeclampsia: impact on maternal and fetal outcomes

“…114 For example, patients with UARS (defined as a normal AHI but increased RDI) had worse sleep quality and more fatigue than patients with mild OSA (AHI ≥ 5 and ≤ 15 events/hour). 115 There is also evidence that in the absence of apnoeas and hypopnoeas, repetitive increased in BP can occur as a result of increased airway resistance during sleep, and that treatment of UARS can help to control high BP. 116 Gender differences in SDB disease manifestation are thought to exist.…”

Obstructive Sleep Apnea: Beyond Obesity

“…The UARS has clinical presentations similar to OSA but certain diferences are found in OSA and UARS. Many authors have tried to diferentiate these two entities but only could reach to a very thin line of demarcation [37,38]. The fact remains that UARS is commonly seen in nonobese, with body mass index (BMI) ≤25 kg/m 2 [39,40].…”