Physical Examination

Orthostatic hypotension has been reported in 25% of patients with UARS (58) contrasting with the frequent finding of arterial hypertension in patients with OSA (59). It has been hypothesized that nonhypoxic resistive respiration may alter parasympathetic control during sleep. Therefore, questions regarding this sign should be addressed in the history of the patients and blood pressure measurement should be included.

An oropharyngeal examination should be part of any clinical investigation in patients being evaluated for an SRBD. Allergy-related enlargement of the inferior nasal turbinates should be assessed (60). This finding is supported by our own data where patients with UARS presented with a higher frequency of seasonal allergies (40%) compared to all other groups (49).

At inspection, patients with OSA often tend to present with a crowded oral cavity primarily due to excess soft tissue, especially when patients are overweight or obese. A significant reason for this finding can also be attributed to a short intermolar distance, and overlapping teeth. Whether this holds true for patients with UARS still needs to be investigated. Questions about the effectiveness of nasal breathing are important since poor nasal ventilation precipitates mouth breathing. This is especially important in children where chronic mouth breathing may alter craniofacial growth.

Early reports about UARS have emphasized that patients with UARS are generally not considered obese (2). In our UARS population the mean body mass index (BMI) is 26.1 ± 4.1 kg/m2 versus 29.3 ± 5.3 kg/m2 in the OSA patients. Other investigations have reported a BMI < 25 kg/m2 for UARS patients (2,22). Of note, female UARS patients (25.2 kg/m2) appear to be significantly less overweight than male UARS patients (26.4 kg/m2). A similar gender-related BMI differential is seen in the OSA patients (49).

With respect to age, Gold et al. (52) reported that patients with UARS are younger than patients presenting with moderate and severe OSA. In their sample of 22 patients with UARS the mean age was 47.5 years. This is consistent with our data showing an age differential of -6.7 years for patients with UARS compared to OSA. Patients with UARS in our sample have a mean age of 44.9 ± 12.1 years compared to 51.7 ± 11.6 years in patients with OSA. Whether this finding may act in favor of the hypothesis that UARS may represent an early stage of OSA will have to be addressed by long-term, prospective studies. A 2006 study indicated that of 94 patients with untreated UARS only five progressed to OSA (55). The mean change in AHI between initial diagnosis and follow-up was nonsignificant. However, they did progress significantly in terms of their clinical symptoms (insomnia, fatigue, and depressive mood) (55) four years after the initial diagnosis.

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