• Sleep Medicine and Psychophysiology
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• v.3 no.2
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• pp.32-42
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• 1996

Objectives : Upper airway resistance syndrome(UARS) is a sleep-related breathing disorder characterized by abnormal negative intrathoracic pressure during sleep. Abnormally increased negative intrathoracic pressure results in microarousal and sleep fragmentation which underlay UARS-associated complaints of daytime fatigue and sleepiness. Although daytime dysfunction in patients with UARS is comparable to that of sleep apnea syndrome, UARS has been relatively unnoticed in clinical setting. That is why UARS is apt to be excluded in diagnosing of sleep-related breathing disorders since its respiratory disturbance index and arterial oxygen saturation are within normal limits. The current study presents a summary of clinical and polysomnographic characteristics found in patients with UARS. The present study aims (1) to explore characteristics of patients diagnosed with UARS, (2) to characterize the polysomnographic findings of UARS patients, and (3) to enhance the understanding of UARS through those clinical and laboratory characteristics. Methods : This was a retrospective study of 20 UARS patients (male 15, female 5) and 30 obstructive sleep apnea (OSA) patients (male 21, female 9) at the Stanford Sleep Disorders Clinic. We diagnosed patients as having UARS when they met critenia, RDI < 5 characteristic findings of an elevated esophageal pressure($<-10\;cmH_2O$), frequent arousals secondary to an elevated esophageal pressure, and symptoms of daytime fatigue and sleepiness. We used polysomnographic value, which is standardized by Williams et al(1974), as normal control. Statiotical test were done with student t-tests. Results : (1) Mean age of UARS was $41.0\;{\pm}\;14.8$ years and OSA was $50.9\;{\pm}\;12.0$ years. UARS subject was significantly younger than OSA subject (p<0.05). (2) The total score of Epworth Sleepiness Scale (ESS) was UARS $9.7\;{\pm}\;6.3$ and OSAS $11.2\;{\pm}\;6.3$. There was no significant difference between two groups. (3) The mean body mass index was UARS $28.1\;{\pm}\;5.7\;kg/m^2$ and OSAS $32.9\;{\pm}\;7.0\;kg/m^2$. UARS had significantly lower meen body man index than OSAS subjects (p<0.05). (4) The polysomnographic parameters of UARS were not significantly different from those of OSA except RDI(p<0.001), $SaO_2$ (p<0.001) and slow wave sleep latency (p<0.05). (5) Compared with normal control, Total sleep time in UARS subjects was significantly shorter (p<0.001), sleep efficiency index was significantly lower (p<0.001), total awakening percentage was significantly higher (p<0.001), and sleep stage 1 (p<0.001) were significantly higher. (6) OSA patients showed poor sleep quality and distinct abnormal sleep architectures compared with normal control. Conclusions : Conclusions from the above results are as follows : (1) UARS patients were younger and had lower body mass index when umpared with OSA patients. (2) The quality of sleep and sleep architectures of the UARS and OSA patients are significantly different from those of normal control. (3) ESS scores and awakening frequencies of UARS are similar with those of OSA, suggesting that daytime dysfunction of UARS patients may be comparable to those of OSA patients. (4) The RDI and the $SaO_2$ which are important indicators in diagnosing sleep-related breathing disorders, of UARS subjects are close to normal value. (5) According to the the above results, we unclude that despite the absence of $SaO_2$ drops and the absence of an elevated number of apnea and hypopnea, subjects developed clinical complaints which were associated with laborious breathing, elevated Pes nadir, and frequently snoring. (6) Accordingly, we suggest including LIARS in the differential diagnosis list when sleep related breathing disorder is suspected clinically and overnight polysomnographic findings except snoring and frequent microarousal are within normal limits.

• Journal of Life Science
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• v.12 no.6
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• pp.700-707
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• 2002

To study the characteristics of organic and nutrient removal by Bacillus species at high COD concentration of influent, three lab-scale batch reactors(R1, R2, R3), each of which has different substrate composition, were operated. More than 95% of $NH_4^+$-N and $COD_{cr}$, concentrations were removed under an aerobic condition, and their removal efficiencies were found to be 22.6 and 90.5%(R1), 23.9 and 65.8%(R2), 30.2 and 86.4%(R3), respectively. The removal efficiency of $NH_4^+$-N was high when an enough amount of $NO_3^{-}$-N was supplied, and that of $COD_{cr}$. was low when a high concentration of initial $NO_2^{-}$-N was added. The amount of carbon utilized in denitrification was a little. In all reactors,$NO_3^{-}$-N was removed under an anoxic condition, but in the R3 reactor, 10% of $NO_3^{-}$-N could be removed even undo, an aerobic condition. The removal efficiencies of TN and TP were 41.8 and 49.5%(R1), 40.1 and 35.8%(R2), 47.0 and 57.6%(R3), respectively. Alkalinities destructed under an aerobic condition for each reactor were 4.96, 5.41 and 3.93 mg/L (as $CaCO_3$) per each gram of $NH_4^+$-N oxidized, respectively, while 3.06, 3.17 and 2.60 mg/L (as $CaCO_3$) of alkalinities were produced for each gram of ,$NO_3^{-}$-N reduced to $N_2$. The SOUR were found to be 38.5, 52.7 and 42.0 mg $O_2$/g MLSS/hr, which indicated that Bacillus sp. had a higher cell activity than activated sludge. The OLR and sludge production were estimated to be 0.69 and 0.28(Rl), 0.77 and 0.20(R2), 0.61 kg COD/$m^3$/day and 0.25 kg MLSS/kg COD(R3), respectively. From the N-balance, the highest percentage(40.9%) of nitrogen lost to $N_2$ was obtained in the R3 reactor. From all the results, the possibility of aerobic denitrification Bacillus sp. has been shown and the B3 process seemed to have two advantages: a little amount of carbon was required in denitrification and not much amount of alkalinity was destructed under an aerobic condition.