UARS – “The Silent Syndrome”

Upper Airway Resistance Syndrome

There is a spectrum of sleep-related breathing disorders, ranging from mild snoring at one end to severe complex sleep apnea at the other end. Toward the milder side of this spectrum is Upper Airway Resistance Syndrome (UARS). UARS is more common in women than in men, and it is also more common in people who are slender and normal weight than in those who are overweight or obese. In fact, about half of the people affected by UARS do not even snore!

What is UARS?

UARS is a common breathing disorder that occurs during sleep. It is best described as a partial collapse of the upper airway (primarily in the back of the throat) that causes increased effort of breathing on a frequent and recurring basis. I typically describe it as “similar to breathing through a straw”. Since this occurs throughout the night in affected individuals, it results in frequent awakenings, sleep disruption, unrefreshing sleep, and significant daytime fatigue.

Why doesn’t UARS happen during the day?

It may, but to a milder extent. Since our upper airway muscles are most relaxed during sleep, especially during deeper stages of sleep, that is when UARS occurs most often. That is why people who have sleep-related breathing disorders typically complain of unrefreshing sleep and fatigue – it’s because they’re unable to maintain their deep sleep and get enough deep, restorative sleep.

How is UARS different than sleep apnea?

Sleep apnea occurs as a result of complete, or almost complete, collapse of the upper airway. This means there are periods of time when a person is not moving any air at all (or only a very limited amount of air). This also happens repeatedly throughout the sleep cycle, causing sleep disruption. One of the other major differences in sleep apnea and UARS, is that in sleep apnea a person’s oxygen levels drop significantly more because they’re moving much less air during these breathing pauses/reductions, compared to someone with UARS.

What causes UARS?

The primary causes of UARS and sleep apnea are hereditary factors, especially the anatomy of the jaw and upper airway. The size and shape of the jaw and upper airway is something we inherit from our parents, and that is how sleep-related breathing disorders are inherited. These disorders typically get worse over time, with age. They are also exacerbated by gaining weight, use of alcohol, and smoking tobacco.

Is there treatment available?

Yes, there are several treatments available for UARS. The treatments are similar to what we would recommend for treatment of sleep apnea. First, CPAP is an option for treatment. CPAP is a breathing device used to help keep the airway open during sleep, so you can breathe just like you do when you’re awake. A second option is a dental appliance. Some dental appliances, which work to reposition the lower jaw forward, can also help to manage the problem. These dental appliances are primarily used during sleep. Another option is upper airway surgery. There are various types of surgery available, and it depends on your individual anatomy and issues in the upper airway. Usually, nasal surgery to correct a deviated nasal septum or enlarged turbinates can be helpful. Balloon sinuplasty for chronic sinus congestion may also be helpful. Finally, surgical treatment may also require intervention to the soft palate and/or base of tongue. Of course, if there is significant enlargement of the tonsils, this is also a potential surgical target area.

So I think I have UARS. What’s next?

If you think you may have UARS, or any sleep-related breathing disorder, the best option is to seek out a Sleep Health physician in your area. Ideally, this person can get further history and examine and provide appropriate medical testing to confirm the diagnosis. It should be pointed out that UARS is unable to be picked up on a home sleep test, since they are not sensitive enough to pick up this subtle breathing disorder. Therefore, if you are concerned about UARS, the only way to truly confirm the diagnosis is to perform a formal sleep study in a sleep lab.

But be careful - not all sleep labs are the same!

To prevent wasting your time and money, it’s important you seek out a sleep lab that measures RERA’s (respiratory effort related arousals), which are the primarily type of respiratory event that occur in UARS. Most sleep labs don’t measure these, because it’s more laborious and time-consuming. So most sleep labs are simply evaluating for sleep apnea, and that is how UARS often goes missed or undetected. So again, to save yourself the hassle, please check to make sure your sleep lab measures and evaluates for RERA’s. If they don’t, you may be wasting your time.