Treatment options for UARS include lifestyle changes, Continous Positive Airway Pressure (CPAP), oral appliance therapy and surgery. All patients with UARS should be counseled about the potential benefits of therapy and the risks of going without therapy. Obesity is a modifiable risk factor associated with OSAS so weight loss should be recommended to all overweight or obese. However, patients with UARS are often not obese, so this recommendation has less value in them. As in the treatment of OSAS, within conservative measures are recommended sleep hygiene and avoiding the supine position. Just like in OSA is advisable to multidisciplinary treatment.
Continous positive airway pressure (CPAP) is the treatment of choice for SAHS patients. CPAP was the gold standard for UARS. Initial studies described a good response to CPAP treatment which was considered to be a diagnostic criteria for the syndrome (Messner & Pelayo 2000; Guerrero 2001; Guilleminault 2006). As in mild to moderate OSAS, CPAP compliance and adherence are low. Regarding CPAP titration, it is recommend a similar protocol that for OSAS. After reaching the optimal CPAP, the esophageal peak pressure at the end of inspiration must be higher than-7 cm H2O or the RERA index <10. If this is not achievable, CPAP may be applied at an empirical pressure level of between 8 and 10 cm of
H2O (Kristo 2009). CPAP ususally improves symptomatology and parasomnias. Some reports exist of worsening after CPAP treatment.
No studies exist about the usefulness of positional treatment or electrical stimulation of the muscles of the upper airway in patients with UARS. With respect to drug treatment, as with OSAS, the evidence on the usefulness of pharmacological treatment in UARS is scarce. Given the poor adherence to CPAP treatment, oral devices may be a good alternative for UARS, although little research has been published (Loube 1998; Guerrero 2001; Yoshida 2002; Rose 2000). Predictable efficacy of oral appliances treatments has yet to be demonstrated.
Surgical option include laser-assisted uvulopalatoplasty,uvulectomy, snoreplasty injection, radiofrequency submucosal needle therapy and somnoplasty (Newman1996; Powell 1998; Newman 2002; Pirelli 2004). Existing data on treatment of UARS are scarce, which together with the difficulty of diagnosis makes it a priority disease research in the future.
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