Why do patients exhibit apneas, others hypopneas or both and others (UARS) respiratory effort-related arousals (RERAs)? It could be related to either abnormal upper airway anatomical properties, the integrity of upper airway defense mechanisms, the chain of events at which arousal from sleep is the last resort, or a combination of all three factors. Upper airway anatomical factors include fat deposition, nasal resistance, tonsillar hypertrophy, and craniofacial abnormalities. Upper airway defense mechanisms translate into neuromuscular function whose net effect can be expressed as upper airway closing pressure (PCRIT). In fact, Schwartz et al. (12) have shown that in normal individuals PCRIT is markedly negative whereas in patients with predominantly apneas and hypopneas during sleep PCRIT is relatively more positive. More recently, Gold et al. (13) have demonstrated that patients with UARS (PCRIT -4.0 cm H2O) present with PCRIT levels, are intermediate between mild-to-moderate OSA (PCRIT -1.6 cm H2O) and normal controls (PCRIT -15.4 cm H2O). PCRIT in patients with UARS is significantly different from asymptomatic primary snorers (PS) shown to have an average PCRIT of -6.5 (14).
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