Introduction: Upper airway resistance syndrome (UARS) is an underrecognized form of sleep-disordered breathing that predominantly affects young, non-obese individuals, particularly women. Unlike obstructive sleep apnea (OSA), UARS occurs in the absence of significant hypoxemia, yet it produces substantial impairment in quality of life and is frequently misdiagnosed as a psychiatric or functional disorder. Pathophysiology: Upper airway resistance syndrome is characterized by increased upper airway resistance leading to progressive respiratory effort and repetitive microarousals (RERAs). A hallmark feature is a low arousal threshold, whereby patients awaken in response to minimal increases in intrathoracic pressure before oxygen desaturation occurs. This sensory-motor dysfunction results in severe sleep fragmentation, neuroendocrine dysregulation, and autonomic imbalance, despite preserved oxygenation. Diagnosis: Clinical suspicion is essential, as conventional apnea–hypopnea indices are typically normal. Definitive diagnosis requires polysomnography (PSG) with detection of airflow limitation and RERAs. Esophageal manometry remains the gold standard for quantifying respiratory effort, although nasal pressure transducers provide a reliable, non-invasive alternative in routine practice. Treatment: Continuous positive airway pressure (CPAP) is the most effective therapy, significantly reducing microarousals and improving daytime symptoms, though adherence may be challenging. Mandibular advancement devices (MADs) and targeted upper airway surgery represent effective alternatives in selected patients. Management of comorbid insomnia and allergic airway disease is crucial. Discussion: Upper airway resistance syndrome is a distinct clinical entity rather than a mild variant of OSA. Early recognition and personalized, multidisciplinary treatment are essential to prevent progression to OSA and to reduce cardiometabolic risk, particularly resistant hypertension. Greater awareness of UARS may profoundly improve patient outcomes and redefine current paradigms in sleep medicine.

Introduction: Restless legs syndrome (RLS) is a highly prevalent condition in the general population, although it is rarely diagnosed. For this reason, its clinical presentation continues to have multiple aspects that are confusing or contradictory. Methods: A total of 40 patients diagnosed with RLS were included in this cross-sectional study. They were questioned about the clinical characteristics of their condition. Frequency analysis was applied to the collected data. Results: Of the 40 patients, 23 were male and 17 were female. Their ages ranged from 17 to 64 years. All presented with a combination of symptoms, and most clearly progressive symptoms. The most common symptoms were insomnia and a burning sensation in the feet. Without treatment, the frequency of symptom onset ranged from 1 to 7 days per week. Discussion: Restless legs syndrome is a common sleep disease, although it is not usually diagnosed early. It is a progressive disorder that can significantly affect the quality of life of those who suffer from it.

Introduction:Despite significant advancements in sleep medicine, its integration into formal medical education remains uneven. While structured programs exist in some regions, a standardized framework for postgraduate education is notably lacking in Latin America. This study assesses the availability of sleep medicine training programs, how specialists gain expertise, and the current clinical practice across the region. Methods:A descriptive, cross-sectional survey was conducted among Latin American sleep medicine specialists via a WhatsApp group of 443 professionals. The questionnaire covered formal education programs, training locations, and public and private healthcare coverage for sleep disorder treatments. Descriptive statistical analysis was performed. Results:Seventy-four physicians from 11 Latin American countries participated. Only four countries-Mexico, Brazil, Argentina, and Chile-had formal postgraduate programs, leading many specialists to seek training abroad. Mexico was the most cited destination for further education. Public healthcare coverage varied: five countries provided sleep surgeries, while others did not, and CPAP device access was inconsistent. Private insurance generally did not cover sleep disorder treatments, including DISE, which was only covered in Argentina and Colombia with mixed responses. Discussion:Significant disparities exist in sleep medicine education and healthcare access in Latin America. The lack of structured training limits local expertise development and increases reliance on international education. Raising awareness is a crucial step toward improving education and ensuring broader access to standardized sleep disorder care. Continued research is necessary to bridge existing gaps and enhance opportunities for specialized sleep medicine care.

Introduction: Sleep-disordered breathing (SDB) is a prevalent condition characterized by upper airway collapse during sleep. Precise identification of the anatomical site of obstruction is essential to tailor therapy, particularly for noncontinuous positive airway pressure treatment modalities. This study proposes and evaluates the protrusion maneuver (PM) as a simple, noninvasive clinical tool to assess tongue involvement in pharyngeal obstruction. Methods: A prospective, nonrandomized concordance study was conducted with 100 patients with snoring and/or obstructive sleep apnea syndrome (OSAS). Each patient underwent the PM, which was independently assessed by three blinded clinicians. The maneuver involved comparing the patient’s snoring pattern with and without mandibular protrusion. Interobserver agreement was analyzed using Kappa (κ) statistics. Results: Of the 100 patients, 78 were males and 22 were females. The overall interobserver agreement for the PM was high (κ = 0.834; 95% CI: 0.738–0.930; p < 0.001). Agreement was similarly strong across individual patterns. Discussion: The PM mimics the mechanical action of mandibular advancement devices (MADs) by advancing the mandible and displacing the tongue anteriorly, thereby assessing retroglossal obstruction. The high interobserver concordance supports its reliability. Protrusion maneuver is rapid, equipment-free, and suitable for routine clinical settings. Conclusions: The PM is a reproducible, cost-effective, and clinically useful tool for identifying tongue-related pharyngeal obstruction in patients with SDB. It may aid in selecting candidates for MADs or targeted surgical interventions, and should be integrated into standard clinical evaluation protocols alongside polysomnography and physical examination.

Introduction: Obstructive sleep apnea syndrome (OSAS) is a common condition that has been associated to a number of metabolic, cardiovascular and cognitive consequences. Its diagnosis relies on a polysomnographic or polygraphic study, but clinical findings remain as an important part of the diagnostic process. Nocturia is a common symptom that may indicate severe OSAS, but it is often forgotten in the initial evaluation of these kind of patients. Positive airway pressure (CPAP) is known to reduce nocturia, but the roll of surgery is not clear about it. Material and Methods: A case series is presented. We compare 2 groups of male adults with severe OSAS, the first group treated with CPAP for 3 months, while group 2 underwent a multilevel surgical management. Apnea-hypopnea index (AHI) and the nocturia events number (NEN) were assessed before and after the treatment. Frequencies, descriptive statistics and a related sample Student's t-test were performed for statistical analysis. Results: 97 male patients were included, age ranged from 29 to 71 years old. In group 1, treated with CPAP, AHI mean was 54.59 and nocturia mean 4.53 before treatment. With CPAP, the AHI mean was 6.63 and NEN mean 0.51. In group 2, AHI mean before surgery was 40.02, NEN mean 3.78, and after the surgical management AHI mean was 7.74 and NEN mean 0.7. Student's t-test in groups 1 and 2 showed a p=0.000. Conclusions: AHI and NEN were clearly related in both groups, and the improvement of NEN and AHI were consistent in both groups, the CPAP and the surgical treatment. The presence of a NEN value of 4-5 may be an indicator of severe OSAS and should always be clinically evaluated.

Obstructive Sleep Apnea Syndrome (OSAS) is a consequence of a reduced area at the upper respiratory tract that leads to obstruction and cessation of airflow, causing oxygen desaturation and fragmentation of the sleep architecture. Between 60 and 70% of patients with OSAS are obese.

Introducción: Es muy importante establecer el sitio de obstrucción en la vía aérea, en pacientes con sospecha de apnea obstructiva del sueño (AOS); la obstrucción ocurre mientras dormimos, por lo tanto ¿la evaluación en posición supina debería dar una mejor información del estado de la vía aérea? Establecer la correlación y diferencias entre la evaluación en posición supina y sentado, mediante el examen físico y endoscópico. Métodos: Cohorte longitudinal, observacional, prospectiva, analítica y prolectiva. Se evaluaron 63 pacientes con sospecha de AOS mediante: posición de la lengua según Friedman, maniobra de Müller y evaluación endoscópica de la vía aérea en posición supina y sentado. Se evaluó la correlación y diferencias entre cada grupo. Resultados: No hay diferencia significativa entre la posición supina y sentado tanto en la evaluación física y endoscópica de la vía aérea, sin ser modificado por sexo o IMC. Se encontró un coeficiente de correlación > 0,8 con p=<0,001 entre la evaluación sentado y en supino. Conclusiones: No hay diferencia entre la evaluación de la vía aérea en posición supino y sentado, pero con una correlación significativa de los hallazgos de estos dos grupos, por esta razón no es necesario evaluar la vía aérea en posición supina.

Introducción: El síndrome de apnea obstructiva del sueño (SAOS) ha aumentado su incidencia en los últimos años, con repercusiones importantes en la salud, su tratamiento debe ser elaborado por un equipo multidisciplinario según las necesidades de cada paciente. Los dispositivos de avance mandibular pueden ser una herramienta útil y no invasiva. Objetivo: Evaluar el efecto que tienen los dispositivos de avance mandibular (DAM) en pacientes con SAOS de intensidad severo, en quienes presentan como único sitio de obstrucción la base de lengua y son candidatos para utilizar el dispositivo. Diseño: Estudio cuasi-experimental no controlado de antes y después. Materiales y Métodos: Se incluyeron 30 pacientes con diagnóstico de SAOS de intensidad severo, con único sitio de obstrucción en la base de lengua, que fueran candidatos al uso dedispositivos de avance mandibular, también se realizó polisomnografía de nochedividida de control, comparándose índice de apnea hipopnea (IAH) e índice de ronquido (IR) antes y después del tratamiento. Resultados: En el estudio polisomnográfico de noche dividida de control, se encontró diferencia significativa p<0,001 al comparar el índice de apnea hipopnea e índice de ronquido antes y después de usar el dispositivos de avance mandibular. Discusión: Los dispositivos de avance mandibular pueden ser una herramienta considerada en el manejo del SAOS con cualquier grado de intensidad, siempre y cuando el sitio de obstrucción sea evaluado adecuadamente mediante un grupo multidisciplinario, donde se individualice a cada paciente.

Introducción: El Síndrome de Apnea Obstructiva del Sueño (SAOS) es uno de los trastornos de sueño más frecuentes, asociada con el riesgo cardiovascular. En la actualidad se ha descrito el uso de esclerosantes en el manejo del ronquido simple, no en la apnea del sueño leve. Objetivo: Evaluar la eficacia de este procedimiento para los pacientes con SAOS de intensidad leve con sitio exclusivo de obstrucción en paladar blando. Diseño: Estudio cuasi-experimental no controlado de antes y después. Métodos: Se incluyeron 11 pacientes con SAOS leve, con sitio de obstrucción exclusivo en paladar blando. Se realizó polisomnografía basal y de control a los 6 meses del tratamiento. Se usó tetradecil sulfato de sodio 3%, submucoso en paladar blando 1ml. en la línea media y 0.5 ml paramedial. Se evaluó el índice de ronquido, de apnea/hipopnea (IAH), saturación de oxígeno y despertares. Discusión: Aunqueel número de pacientes es muy pequeño, este es el único antecedente del uso de esclerosantes en el tratamiento de apnea del sueño leve, siendo un procedimiento rápido, económico y poco molesto. Se observó mejoría en los parámetros evaluados exceptuando los despertares. Conclusiones: La inyección de esclerosantes podría ser un tratamiento de elección en pacientes con SAOS leve que cumplan con los criterios de obstrucción ya nombrados.

INTRODUCTION:Mandibular advancement device (MAD) may represent a feasible choice in the treatment of obstructive sleep apnea-hypopnea syndrome (OSAHS), in well selected patients. OBJECTIVE:The aim of this study is to assess the efficacy of MAD in patients with OSAHS, using split night polysomnography (SNP). METHOD:We performed an auto controlled clinical trial to assess the efficacy of MAD in 30 patients with snoring and OSAHS. Clinical evaluation was made every 2 weeks to adjust treatment and observe changes in clinical symptoms. Three-months after placement of the MAD, a SNP was performed, using the MAD in the second half of the night, in order to compare the respiratory results. RESULTS:SNP show significant changes with use of MAD (p<0.05) such as: Decrease in Snore index (from 159.95 to 32.46/h) and in Apnea-hypopnea index (AHI, from 22.45 to 4.63/h), increase in oxygen saturation (SaO2, from 89.98% to 91.39%) and somnolence improvement, using the Epworth Sleepiness Scale (from 14.4 to 4.6 points). CONCLUSION:Our data supports that the use of MAD is an alternative in the management of OSAHS, in well selected patients, used in a multidisciplinary fashion, and evaluated using a SNP.

Background: Obstructive sleep apnea syndrome is a common disease in general population and somnoplasty is an effective treatment. The use of local anesthesia and sedation may provide an increased tolerability during procedure and better results.