H. CALHOUNKARENMDB. KUPPERSMITHRONALDMD
I commend Messner for her clear and concise evaluation of a generally controversial topic to many practitioners across various specialties, most notably, otorhinolaryngology–head and neck surgery and pediatrics. I agree with almost everything Messner stated. I wish only to elaborate on a few points that I think are important to stress and perhaps add a few questions of my own that would perhaps make a good research project for an aspiring pediatric otolaryngologist.
I think an important point Messner makes is that, of the studies that have been done, the majority were performed prior to the recognition of the UARS and most of the parameters that we use to diagnose UARS were not measured or examined. This in no way demeans the work of these authors because, at that time, UARS had not been described. However, I believe that there is a notable group of patients in the adult and especially the pediatric population who have this disorder and yet the results of PSG do not indicate OSAS. Our greatest degree of frustration in dealing with these patients is not so much in making the diagnosis but in the lack of opportunity to treat patients for the problem because they cannot obtain coverage for treatment from the insurance companies. Most insurance companies have not kept abreast of or accepted the findings in recent literature. We have found, at least in our area, that many of the insurance companies do not recognize UARS as a clinical entity and will provide no coverage for patients with this disorder. I think that one obstacle in making the diagnosis of UARS is the need for an esophageal pressure monitoring for the study. This is often a difficult thing for adults to tolerate and I fear that it would be an exercise in frustration to get most children to cooperate with placement and maintenance of an esophageal pressure probe during sleep.
Coleman JA. The Diagnosis of OSAS and UARS in Children: Trying to Relieve the Frustration. Arch Otolaryngol Head Neck Surg. 1999;125(3):356-357. doi:10.1001/archotol.125.3.356