The Symptoms and Signs of Upper Airway Resistance Syndrome*

A Link to the Functional Somatic Syndromes

Gold, Avram R. MD
Dipalo, Francis DO
Gold, Morris S. DSc
O'Hearn, Daniel MD

*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.

This research was supported by the Division of Pulmonary/Critical Care Medicine of SUNY-Stony Brook and did not receive any extramural support. The authors received no compensation from Novartis Consumer Health in return for their participation in this research.

Manuscript received January 14, 2002; revision accepted July 23, 2002.

Correspondence to: Avram R. Gold, MD (111 D), DVA Medical Center, Northport, NY 11768; e-mail: [email protected]

Chest 123(1):p 87-95, January 2003.

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.