Primary Snoring and Upper Airway Resistance Syndrome
Pp. 18-20 (3)
Kannan Ramar and Eric J. Olson
Snoring is the sound of soft tissues vibrating within the upper throat during sleep. The vibration is a result of turbulent air flow through the throat as it narrows during sleep. Snoring is very common in adults and may occur alone or be a feature of other conditions characterized by greater throat narrowing during sleep, namely upper airway resistance syndrome (UARS) and obstructive sleep apnea syndrome (OSA). UARS is marked by daytime sleepiness and/or fatigue in the context of frequent respiratory-effort related arousals (RERAs). RERAs are episodic arousals that follow periods of more intense breathing effort as resistance to airflow in the throat increases. Once the throat is very narrow, hypopneas (partial reduction in airflow) and apneas (complete cessation of airflow) occur, and these events comprise OSA. Whether UARS is an entity distinct from OSA remains still debated.
Risk factors for snoring and UARS are similar and include obesity, nasal congestion, alcohol and drug consumption before bed, and abnormalities of the bony and soft tissue structures of the head and neck. Snoring can be a nuisance, but generally does not produce daytime sequelae, while UARS may lead to daytime fatigue and sleepiness. Treatment options for snoring and UARS include risk factor modifications, nasal-directed therapies, oral appliances, upper airway surgery, while continuous positive airway pressure (CPAP) is an additional option for UARS.
Assistant Professor of Medicine, Mayo College of Medicine, Consultant Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA.