Review of Physiology Wikipedia Page:

Is each fact referenced with an appropriate, reliable reference?

Most of the article contains appropriate and reliable references, but there are sentences and facts that lack citations. For example, the paragraph about homeostasis and the interactions between body systems under the Human physiology section and the statement about William Beaumont in the History section do not contain enough citations for the information presented.

Is everything in the article relevant to the article topic? Is there anything that distracted you?

Most of the information in the article is relevant to the topic, but more of the article focused on the history of physiology rather than the science of physiology. Some of the details, particularly in the Women in Physiology section seemed irrelevant and unnecessary. The large amount of content related to history overshadows the important, but lacking, information about the science.

Additionally, the tone of the writing was a bit distracting. In the paragraph about ancient physiology with Hippocrates and Aristotle, some of the language used was too colloquial and grammatically incorrect ("played off of Hippocrates idea"). In this section, the authors seem to express approval of certain discoveries rather than maintain a completely neutral position.

Is the article neutral? Are there any claims, or frames, that appear heavily biased toward a particular position?

The article seems biased in terms of information distribution. The heavy focus on the history of the science suggests that content is more significant than the scientific applications of physiology. Additionally, the writers place a heavy focus on the contributions of women to physiology.

Where does the information come from? Are these neutral sources? If biased, is that bias noted?

Some of the information comes from reputable peer-reviewed journals such as the American Journal of Public Health. Other sources are not as reputable such as that in citation 9 which links to a professor's webpage on ship.edu that lacks any sources of its own. Some of the sources are biased such as that in citation 17 which links to the Jewish Women's Archive and highlights the accomplishments of Ida Henrietta Hyde. This source may embellish facts in order to better represent a successful female scientist who could impact how people perceive their organization and the contributions of Jewish women.

Are there viewpoints that are overrepresented, or underrepresented?

Since the authors focus so heavily on women, they neglect to highlight more recent accomplishments of men in the field. They use too much space writing about how women were excluded from the field when they could instead combine the section on women with the section on history to just write about accomplishments of the individuals over time.

Check a few citations. Do the links work? Is there any close paraphrasing or plagiarism in the article?

I tested six links, all of which worked. The sentence about Barbara McClintock seems to be plagairized from the Wikipedia page about her.

Some citations are poorly formatted. For example, citation 7, which links to Google Books, is merely cited as google.com.

Is any information out of date? Is anything missing that could be added?

The most recent information regarding discoveries in physiology is from 2009. Recent information about breakthroughs in the field such as Yoshinori Ohsumi's recent revelations on autophagy could be included. More information about the science and the different subdivisions of the field should be added.

How does the Wikipedia article compare to the ways we've discussed this topic in class? Does it align? What information might be incorrect or missing?

This article should be considered a "Start class" article. It presents some useful information, but some of the sources are unreliable, and the writers failed to provide a through description about the field as a whole. To better this article, the editors should remove the casual language and overly descriptive transitions, elaborate on recent scientific discoveries, consolidate the history section, and add more information about the various fields within the discipline.

Ideas for Editing: Upper Airway Resistance Syndrome (UARS)

My plans for editing the article include:

- adding citations to content that is lacking them

- adding more details about pathophysiology

- signs and symptoms

- more information about diagnosis using polysomnography

- appearance of the condition in various types of populations

Bibliography:

^[1]

^[2]

De Godoy, Luciana B.M.; Palombini, Luciana O.; Guilleminault, Christian; Poyares, Dalva; Tufik, Sergio; Togeiro, Sonia M. (2015). “Treatment of upper airway resistance syndrome in adults: Where do we stand?”. Sleep Science: 42-48 - via Elsevier.

Kushida, Clete A., ed. (2009). Handbook of Sleep Disorders (Second ed.). New York: Inform Healthcare. pp. 339-347.

Cuelbras, Antonio (1996). Clinical Handbook of Sleep Disorders. New York: Butterworth-Heinemann. pp. 207.

Shneerson, John M., ed. (2005). Sleep Medicine (Second ed.). New York: Blackwell Publishing. pp. 229-237.

Plans for Editing:

My plans for edits are written in bold caps.

Upper airway resistance syndrome or UARS is a sleep disorder characterized by airway resistance to breathing during sleep (REPHRASE; AWKWARD). The primary symptoms include daytime sleepiness and excessive fatigue . ADD TO THIS LEAD. INCLUDE SENTENCES ABOUT DIAGNOSIS, TREATMENT, AND COMPARISON TO OBSTRUCTIVE SLEEP APNEAS.

Diagnosis[edit | edit source]

Polysomnography (sleep study) with the use of a probe to measure Pes (esophageal pressure) is the gold standard diagnostic test for UARS. Apneas and hypopneas are absent or present in low numbers. Multiple snore arousals may be seen, and if an esophageal probe (Pes) is used, progressive elevation of esophageal pressure fluctuations terminating in arousals is noted. UARS can also be diagnosed using a nasal cannula/pressure transducer to measure the inspiratory airflow v. time signal.

ADD MORE ABOUT POLYSOMNOGRAPHY RESORTS

Explanation[edit | edit source]

During sleep the muscles of the airway become relaxed. The relaxation of these muscles in turn reduces the diameter of the airway. Typically, the airway of a person with UARS is already restricted or reduced in size, and this natural relaxation reduces the airway further. Therefore, breathing becomes labored. It can be likened to breathing through a straw.

COMBINE WITH PATHOPHYSIOLOGY SECTION

Pathophysiology[edit | edit source]

Pathophysiology of UARS is similar to obstructive sleep apnea / hypopnea syndrome in that abnormal airway resistance in the upper airway during sleep leads to unwanted physiologic consequences. Increased upper airway resistance in this disorder does not lead to cessation of airflow (apnea) or decrease in airflow (hypopnea), but instead leads to an arousal secondary to increased work of breathing to overcome the resistance. Repeated and multiple arousals (of which the person is usually unaware) result in an abnormal sleep architecture and daytime somnolence (sleepiness). Arousals result in sympathetic activation, and UARS is therefore likely to cause hypertension similar to obstructive sleep apnea syndrome (This has not been verified in large clinical populations because of the relatively small number of people with UARS in the larger epidemiologic studies so far. However, repeated arousals in individuals have clearly been shown to be related to sympathetic activation and elevation in blood pressure).^{[citation needed]. ADD CITATION}

ELABORATE MORE; ELIMINATE EXCESSIVE PARENTHESES.

Clinical presentation[edit | edit source]

People with UARS present with snoring and excessive daytime somnolence. Hypotension is likely to be present. Also, fatigue, cognitive impairment, unrefreshing sleep, frequent awakenings, and chronic pain may be present.

UARS is often misdiagnosed as fibromyalgia or similar disorders. Guilleminault et al. write that up to 75% of adults with sleepwalking have UARS. AWKWARD SENTENCE. EXPLAIN MORE AND REPHRASE.

Treatment[edit | edit source]

Treatment for UARS is essentially the same as that for obstructive sleep apnea. DELETE THIS SENTENCE; HIGHLIGHT SIMILARITIES AND DIFFERENCES TO OSA TREATMENT; ADD SECTION ON TREATMENT IN CHILDREN

Behavioral modification[edit | edit source]

Behavioral modification includes getting at least 7–8 hours of sleep, avoiding sleeping in supine position (on the back), sleeping with head end of bed elevated and avoiding sedatives, alcohol and narcotics.

Positive airway pressure therapy[edit | edit source]

Positive airway pressure therapy is similar to that in obstructive sleep apnea and works by stenting the airway open from the pressure, thus reducing the airway resistance. Reimbursement for the positive airway pressure device (CPAP etc.) may be a concern in certain healthcare models.^{[citation needed]. ELABORATE MORE ON THIS TOPIC; LINK TO CPAP}

Oral appliances[edit | edit source]

Oral appliances to protrude the tongue and mandible (lower jaw) forward have been used to reduce/eliminate sleep apnea/snoring but have uncertain performance in treating excessive daytime sleepiness.

Surgery[edit | edit source]

Various surgical options including uvulopalatopharyngoplasty (UPPP), hyoid suspension, and linguloplasty to increase the dimensions of the upper airway and to reduce the collapsibility of the airway are viable treatment modalities for UARS. One should also be screened for the presence of a hiatal hernia, which may result in abnormal pressure differentials in the esophagus, and in turn, constricted airways during sleep.

Prognosis[edit | edit source]

People with UARS usually respond to treatment with no long term sequelae.^{[[[Wikipedia:Citation needed|citation needed]]] ADD CITATION AND REMOVE SECTION ON PROGNOSIS; COMBINE INTO TREATMENT AND OUTCOMES SECTION.}

References[edit | edit source]

SOME SOURCES LINK TO ERROR PAGES --> FIX AND REMOVE BAD SOURCES; FIND GOOD SOURCES AND CITE

External links[edit | edit source]

UNSURE IF THIS SECTION IS NECESSARY; CONSIDER TAKING INFO FROM THESE TWO SOURCES AND ADDING TO BODY OF WIKI PAGE

Edited Article:

Upper airway resistance syndrome or UARS is a sleep disorder characterized by the narrowing of the airway that can cause disruptions to sleep. The primary symptoms include excessive fatigue and chronic insomnia. UARS can be diagnosed by polysomnography, and can be treated with lifestyle changes, dental devices, or CPAP therapy. UARS is similar to certain types of sleep apneas.

Signs and Symptoms

Symptoms of UARS are similar to those of obstructive sleep apnea, but are usually less severe. Fatigue, daytime sleepiness, unrefreshing sleep, and frequent awakenings during sleep are the most common symptoms.

Many patients experience chronic insomnia that creates both a difficulty falling asleep and staying asleep. As a result, patients typically experience frequent sleep disruptions^[2]. Loud snoring also serves as a possible indicator of the syndrome, but is not a symptom required for diagnosis^[3].

Some patients experience hypotension, which may cause lightheadedness, and patients with UARS are also more likely to experience headaches and irritable bowel syndrome^[2].

Pathophysiology

Upper airway resistance syndrome is caused when the upper airway narrows without closing. Consequently, airflow is either reduced or compensated for through an increase in inspiratory efforts. This increased activity in inspiratory muscles leads to the arousals during sleep which patients may or may not be aware of^[4].

A typical UARS patient is not obese and possesses a triangular face and misaligned jaw, which can result in a smaller amount of space behind the base of the tongue^[3]. Patients may have other anatomical abnormalities that can cause UARS such as deviated septum or nasal valve collapse^[5]. UARS affects equal numbers of males and females^[4]. It is unclear as to whether UARS is merely a phase that occurs between simple snoring and sleep apneas, or whether UARS is a syndrome that describes a deviation from normal upper airway physiology^[4].

Children with UARS may experience symptoms due to minor anomalies of the facial bones or due to enlarged tonsils or adenoids^[6].

Diagnosis

Polysomnograms can be used to help diagnose UARS. Patient who have UARS typically show multiple EEG arousals during the sleep study and little to no polygraphic evidence of obstructive sleep apnea or decreased levels of oxygen. UARS arousals, or respiratory-effort related arousals, typically last for one to three breaths^[5]. These arousals may be due to snoring, but patients do not need to snore in order to have UARS^[3]. Polysomnogram patterns must exhibit no evidence of apneas or hypopneas in order to be lead to a diagnosis of UARS^[4]. Even with polysomnography, diagnosis of UARS may be difficult because of insufficient means of measuring changes in airflow^[4]. This lack of sensitivity in detection may lead to misdiagnosis, as minor undetectable changes in airflow may still be responsible for the arousals^[4]. In order to definitively diagnose UARS, there must be a demonstrated pattern of greater negative esophageal pressures which are then followed by a rapid change to a more positive level with a sleep arousal. This can be confirmed with invasive polysomnography that uses an esophageal balloon transducer and full pneumotachograph^[5].

Based on symptoms, patients are commonly misdiagnosed with chronic fatigue syndrome, fibromyalgia, or a psychiatric disorder such as ADHD^[2].

Management

Behavioral modification

Behavioral modifications include getting at least 7–8 hours of sleep and lifestyle changes to help weight loss to help reduce or eliminate symptoms^[7]. Positional therapy also has helped many patients ease their UARS symptoms. Sleeping on one's side rather than in a supine position or using positional pillows can provide relief, but these modifications may not be sufficient to treat more severe cases^[7]. Avoiding sedatives including alcohol and narcotics can help prevent the relaxation of airway muscles, and thereby reduce the chance of their collapse. Avoiding sedatives may also help to reduce snoring^[7].

Medications

Nasal steroids may be prescribed in order to ease nasal allergies and other obstructive nasal conditions that could cause UARS^[7].

Positive airway pressure therapy

Positive airway pressure therapy is similar to that in obstructive sleep apnea and works by stenting the airway open with pressure, thus reducing the airway resistance. Use of a CPAP mask can help ease the symptoms of UARS. Therapeutic trials have shown that using a CPAP mask with pressure between four and eight centimeters of water can help to reduce the number of arousals and improve sleepiness^[3]. CPAP masks are the most promising treatment for UARS, but effectiveness is reduced by low patient compliance^[8].

Oral appliances

Oral appliances to protrude the tongue and lower jaw forward have been used to reduce sleep apnea and snoring, and hold potential for treating UARS, but this approach remains controversial^[8]. Oral appliances may be a suitable alternative for patients who cannot tolerate CPAP^[7].

Surgery

Various surgical options including uvulopalatopharyngoplasty (UPPP), hyoid suspension, and linguloplasty to increase the dimensions of the upper airway and to reduce the collapsibility of the airway are viable treatment modalities for UARS^[1]. One should also be screened for the presence of a hiatal hernia, which may result in abnormal pressure differentials in the esophagus, and in turn, constricted airways during sleep^[1]. Palatial tissue reduction via radiofrequency ablation has also been successful in treating UARS^[8].

Treatment in children

The primary treatment for children is the removal of enlarged tonsils and adenoids via a tonsillectomy and adenoidectomy. Orthodontic treatment is frequently recommended and CPAP may also be necessary for children with UARS^[6]^[7].

Feedback

Hi, great job so far with the editing of the Upper Airway Resistance Syndrome article. One thing that I would suggest is modifying your sentence about oral appliances where it says, "...and hold promise for treating UARS." The phrase hold promise conveys an opinion about the use of oral appliances for UARS rather than staying neutral. I would get rid of this part of the section and end the sentence at "reduce sleep apnea and snoring" and then keep the new sentence with, "Oral appliances..."

Also, in the Treatment for children section, is there a source that mentions why tonsils are the target factor for UARS? If you can find a source that mentions this, I think it will help provide more evidence on this treatment to readers.

Hope this helps! C.q20n.17 (talk) 16:28, 1 March 2017 (UTC)

Thanks for your feedback, Caroline! I will definitely reword that sentence and pay closer attention to ensure that I take a neutral point of view, and I plan to expand how UARS affects children in both the pathophysiology and treatment section. -Kristina

^ ^a ^b ^c de Godoy, Luciana B.M.; Palombini, Luciana O.; Guilleminault, Christian; Poyares, Dalva; Tufik, Sergio; Togeiro, Sonia M. (2015). "Treatment of upper airway resistance syndrome in adults: Where do we stand?". Sleep Science: 42–48 – via Elsevier.
^ ^a ^b ^c ^d Kushida, Clete A., ed. (2009). Handbook of Sleep Disorders (Second ed.). New York: Inform Healthcare. pp. 339–347.
^ ^a ^b ^c ^d Cuelbras, Antonio (1996). Clinical Handbook of Sleep Disorders. New York: Butterworth-Heinemann. pp. 207.
^ ^a ^b ^c ^d ^e ^f Shneerson, John M., ed. (2005). Sleep Medicine (Second ed.). New York: Blackwell Publishing. pp. 229-237.
^ ^a ^b ^c Garcha, Puneet S.; Aboussouan, Loutfi S.; Minai, Omar (January 2013). "Sleep-Disordered Breathing". Cleveland Clinic Disease Management. Retrieved 15 March 2017.
^ ^a ^b Guilleminault, Christian and Khramtsov, Andrei. (December 2001). “Upper airway resistance syndrome in children”. Seminars in Pediatric Neurology: 207-215 - via Elsevier.
^ ^a ^b ^c ^d ^e ^f "Upper Airway Resistance Syndrome (UARS)". Stanford Medicine. Retrieved February 28, 2017.
^ ^a ^b ^c Exar EN, Collop NA (Apr 1999). "The upper airway resistance syndrome". Chest. 115 (4): 1127–39. doi:10.1378/chest.115.4.1127.

[:5-1] Godoy, Luciana B.M.; Palombini, Luciana O.; Guilleminault, Christian; Poyares, Dalva; Tufik, Sergio; Togeiro, Sonia M. (2015). "Treatment of upper airway resistance syndrome in adults: Where do we stand?". Sleep Science: 42–48 – via Elsevier.

[:0-2] Kushida, Clete A., ed. (2009). Handbook of Sleep Disorders (Second ed.). New York: Inform Healthcare. pp. 339–347.

[:1-3] Cuelbras, Antonio (1996). Clinical Handbook of Sleep Disorders. New York: Butterworth-Heinemann. pp. 207.

[:2-4] ^ ^a ^b ^c ^d ^e ^f Shneerson, John M., ed. (2005). Sleep Medicine (Second ed.). New York: Blackwell Publishing. pp. 229-237.

[:7-5] Garcha, Puneet S.; Aboussouan, Loutfi S.; Minai, Omar (January 2013). "Sleep-Disordered Breathing". Cleveland Clinic Disease Management. Retrieved 15 March 2017.

[:6-6] Guilleminault, Christian and Khramtsov, Andrei. (December 2001). “Upper airway resistance syndrome in children”. Seminars in Pediatric Neurology: 207-215 - via Elsevier.

[:3-7] ^ ^a ^b ^c ^d ^e ^f "Upper Airway Resistance Syndrome (UARS)". Stanford Medicine. Retrieved February 28, 2017.

[:4-8] Exar EN, Collop NA (Apr 1999). "The upper airway resistance syndrome". Chest. 115 (4): 1127–39. doi:10.1378/chest.115.4.1127.

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