Abstract
Purpose of Review
It is well accepted that obstructive sleep apnea (OSA) is not merely a simplistic anatomical imbalance of a small box (jaw) versus the over-crowding of tissue contents (namely the tonsils, tongue, palate, and lateral pharyngeal walls) within this container. Most sleep specialists agree that there is a strong complex neuro-physiological interconnected web of neurological and proprioceptor mechanism ongoing in this sleep disorder, perhaps simplified phenotypically as the PALM scale (Pcrit, arousal threshold, loop gain, and muscle responsiveness). What determines which patient would sleep through a prolonged and profound apneic event with a high arousal threshold and low muscle responsiveness versus another patient who would be easily aroused (low arousal threshold) and have frequent sleep fragmentations, no one has the answer.
Recent Findings
It has been shown that there is a complex relationship and physiological feedback mechanisms in the pathophysiology of upper airway collapse, cortical arousals, and teeth clenching in order to maintain airway patency.
Summary
We are fairly clear that upper airway resistance syndrome (UARS) is the non-hypoxic sleep-disordered breathing that is closely related to cortical arousals, sleep fragmentation, psycho-somatic issues, excessive daytime sleepiness, neckaches, headaches, bruxism, and almost invariably nasal congestion.
Similar content being viewed by others
References
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
• Eckert DJ, White DP, Jordan AS, Malhotra A, Wellman A. Defining phenotypic causes of obstructive sleep apnea. Identification of novel therapeutic targets. Am J Respir Crit Care Med. 2013;188(8):996–1004 Findings from this article illustrate the balance between the critical pharyngeal pressure, arousal threshold, loop gain, and muscle responsiveness in a patient with sleep disordered breathing.
Guilleminault C, Stoohs R, Clerk A, Cetel M, Maistro P. A cause of excessive daytime sleepiness. The upper airway resistance syndrome. Chest. 1993;104:781–7.
Sleep-related breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clinical research. The report of an American Academy of Sleep Medicine Task Force. Sleep. 1999;22:667–89.
•• Tay DKL, Pang KP. Clinical phenotype of South-East Asian temporomandibular disorder patients with upper airway resistance syndrome. J Oral Rehabil. 2018;45(1):25–33 Findings in this article describe the pathophysiology of teeth grinding and upper airway collapse, that the airway collapse occurs first, with a concomitant cortical arousal and subsequent teeth grinding in order to keep the upper airway patent.
Stoohs RA, Knaack L, Blum HC, Janicki J, Hohenhorst W. Differences in clinical features of upper airway resistance syndrome, primary snoring, and obstructive sleep apnea/hypopnea syndrome. Sleep Med. 2008;9:121–8.
Gold AR, Dipalo F, Gold MS, O’Hearn D. The symptoms and signs of upper airway resistance syndrome: a link to the functional somatic syndromes. Chest. 2003;123:87–95.
Guilleminault C, Chowdhuri S. Upper airway resistance syndrome is a distinct syndrome. Am J Respir Crit Care Med. 2000b;161:1412–3.
Guilleminault C, Kirisoglu C, Poyares D, Palombini L, Leger D, Farid-Moayer M, et al. Upper airway resistance syndrome: a long-term outcome study. J Psychiatr Res. 2006;40:273–9.
Guilleminault C, Li K, Chen NH, Poyares D. Two-point palatal discrimination in patients with upper airway resistance syndrome, obstructive sleep apnea synddrome, and normal control subjects. Chest. 2002;122:866–70.
Tamisier R, Pepin JL, Wuyam B, Smith R, Argod J, Levy P. Characterization of pharyngeal resistance during sleep in a spectrum of sleep-disordered breathing. J Appl Physiol. 2000;89:120–30.
Ozbek MM, Miyamoto K, Lowe AA, Fleetham JA. Natural head posture, upper airway morphology and obstructive sleep apnoea severity in adults. Eur J Orthod. 1998;20:133–43.
Solow B, Ovesen J, Nielsen PW, Wildschiodtz G, Tallgren A. Head posture in obstructive sleep apnoea. Eur J Orthod. 1993;15:107–14.
Makofsky H. The effect of head posture on muscle contact position: the sliding cranium theory. Cranio. 1989;7(4):286–92.
Young JW, McDonald JP. An investigation into the relationship between the severity of obstructive sleep apnoea/hypopnoea syndrome and the vertical position of the hyoid bone. Surgeon. 2004;2:145–51.
Watanabe T, Isono S, Tanaka A, et al. Contribution of body habitus and craniofacial characteristics to segmental closing pressures of the passive pharynx in patients with sleep-disordered breathing. Am J Respir Crit Care Med. 2002;165:260–5.
Chi L, Comyn FL, Mitra N, Reilly MP, Wan F, Maislin G, et al. Identification of craniofacial risk factors for obstructive sleep apnoea using three-dimensional MRI. Eur Respir J. 2011;38:348–58.
Pang KP, Woodson BT. Current concepts in evaluation and surgical panning in OSA. In: Pang KP, Woodson BT, Rotenberg B, editors. Textbook of advanced surgical technique in snoring and obstructive sleep apnea. 1st ed: Plural Publishing; 2013. This chapter describes the importance of the nasal airway in the success rate of upper airway surgery.
Popovic RM, White DP. Upper airway muscle activity in normal women: influence of hormonal status. J Appl Physiol. 1998;84(3):1055–62.
Isono S, Tanaka A, Tagaito Y, Ishikawa T, Nishino T. authors. Influences of head positions and bite opening on collapsibility of the passive pharynx. J Appl Physiol. 2004;97:339–46.
Simmons HC, Gibbs SJ. Anterior repositioning appliance therapy for TMJ disorders: specific symptoms relieved and relationship to disc status on MRI. Cranio. 2005;23(2):89–99.
Raphael KG, Sirois DA, Janal MN, et al. Sleep bruxism and myofascial temporomandibular disorders: a laboratory-based polysomnographic investigation. J Am Dent Assoc. 2012;143:1223–31.
Maixner, et al. Potential autonomic risk factors for chronic TMD: descriptive data and empirically identified domains from the OPPERA case-control study. J Pain. 12(11):T75–91.
Guilleminault C, Black JE, Palombini L. High (or abnormal) upper airway resistance (in French). Rev Mal Respir. 1999;16:173–80.
Stohler CS. Taking stock: from chasing occlusal contacts to vulnerability alleles. Orthod Craniofacial Res. 2004;7:157–61.
Lam B, Ooi CG, Peh WC, Lauder I, Tsang KW, Lam WK, et al. Computed tomographic evaluation of the role of craniofacial and upper airway morphology in obstructive sleep apnea in Chinese. Respir Med. 2004;98(4):301–7.
Zeng B, Ng AT, Qian J, Petocz P, Darendaliler A, Cistulli PA. Influence of nasal resistance on oral appliance treatment outcome in obstructive sleep apnea. Sleep. 2008;31(4):543–7.
Isono S, Tanaka A, Tagaito Y, Ishikawa T, Nishino T. Influences of head positions and bite opening on collapsibility of the passive pharynx. J Appl Physiol. 2004;97:339–46.
Carra MC, Huynh NT, El-Khatib H, et al. Sleep bruxism, snoring, and headaches in adolescents: short-term effects of a mandibular advancement appliance. Sleep Med. 2013;14:656–61.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of Interest
The authors declare that they have no conflict of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Additional information
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
This article is part of the Topical Collection on SLEEP MEDICINE: Sleep Apnea
Rights and permissions
About this article
Cite this article
Pang, K.P., Pang, E.B. Upper Airway Resistance Syndrome: a Combined ENT and Dental Approach. Curr Otorhinolaryngol Rep 9, 254–259 (2021). https://doi.org/10.1007/s40136-021-00354-6
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s40136-021-00354-6