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The proposers do not clarify the "distinct" nature of "UARS." Patients with mild sleep apnea/hypopnea syndrome are often thin women. Middle-aged women with insomnia and anxiety are common in sleep clinics, and east Asians common in the Bay Area. The other reported clinical features need to be examined in case-control trials to determine whether they are more common in UARS, but they are certainly not specific.
The pleural pressures reported at event termination are
within the range found in normal subjects (median, 
11 [interquartile range, 8 to 12] cm H2O [1]). While most of their
patients with UARS therefore had no sleep breathing abnormality, some may have had mild, but missed, sleep apnea/hypopnea syndrome. The definitions used for UARS in one of
their articles cannot be checked as it is not yet published. In the
other (2), hypopneas were not defined, but during the time of
recruitment the authors were using thermal sensors plus desaturation for hypopnea identification (3). Thermal sensors are
insensitive to hypopneas and thin, young, well-oxygenated
people do not desaturate with brief apneas or hypopneas, so
hypopneas could have been missed.
The "relative increase in delta sleep" is further proof that these patients do not have increased arousals, despite the proposers' claim of "sleep fragmentation." Both the proposers (4) and we (5) have shown that sleep disruption with arousals that are either visible (4) or not visible (5) on the EEG shows marked decreases in slow-wave sleep. This, along with the normal arousal frequencies and normal Pes at arousal, are convincing evidence that most patients labeled as having UARS have nothing wrong with their breathing during sleep.
Unless and until there is a robust evidence base that the syndrome exists, patients should be treated by firm reassurance, not labeled as having an unsubstantiated illness.
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1. Rees, K., R. N. Klingshott, P. K. Wraith, and N. J. Douglas. Frequency and significance of increased upper airway resistance during sleep. Am. J. Respir. Crit. Care Med. (In press)
2.
Guilleminault, C.,
R. Stoohs,
Y. D. Kim,
R. Chervin,
J. Black, and
A. Clerke.
1995.
Upper airway sleep disordered breathing in women.
Ann.
Intern. Med.
122:
493-501
3.
Guilleminault, C.,
M. Partinen,
M. A. Quera-Salva,
B. Hayes,
W. C. Dement, and
G. Nino-Murcia.
1988.
Determinants of daytime sleepiness
in obstructive sleep apnea.
Chest
94:
32-37
4. Philip, P., R. Stoohs, and C. Guilleminault. 1994. Sleep fragmentation in normals: a model for sleepiness associated with upper airway resistance syndrome. Sleep 17: 242-247 [Medline].
5. Martin, S. E., P. K. Wraith, I. J. Deary, and N. J. Douglas. 1997. The effect of nonvisible sleep fragmentation on daytime function. Am. J. Respir. Crit. Care Med. 155: 1596-1601 [Abstract].
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