Images in Clinical Medicine

Upper-Airway Resistance Syndrome

M. Safwan Badr, M.D., and Brian R. Zahn, B.S.

N Engl J Med 2000; 342:1408May 11, 2000

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Figure 1 A 42-year-old woman was evaluated because of excessive daytime sleepiness and habitual heavy snoring. A nocturnal polysomnogram revealed no evidence of obstructive or central sleep apnea, but it did show frequent periods of snoring and augmented negative esophageal pressure that was indicative of a high level of upper-airway resistance. Typically, these periods were terminated by transient arousal from sleep. The repeated arousals caused sleep fragmentation and, hence, daytime sleepiness. The combination of habitual heavy snoring, increased upper-airway resistance, sleep fragmentation, and daytime sleepiness is referred to as the upper-airway resistance syndrome, which is considered part of the continuum of sleep-disordered breathing. The patient was treated with nasal continuous positive airway pressure, which reduced upper-airway resistance and eliminated snoring, sleep fragmentation, and daytime sleepiness.

M. Safwan Badr, M.D.
Brian R. Zahn, B.S.
Veterans Affairs Medical Center, Detroit, MI 48201-1932