174:. On polysomnograms, a UARS patient will have very few apneas and hypopneas, but many Respiratory effort-related Arousals. Portable Home Sleep Test monitors (HST) are an alternative to sleep-laboratory polysomnography. Some of the HSTs allow for the breathing signals to be viewed within the raw data of the HST study and even a cursory review of these flow signals, will reveal those patients who would likely have upper airway resistance syndrome as well. RERAs are periods of increased respiratory effort lasting for more than ten seconds and ending in arousal. Whether or not an event is classified as a RERA or Hypopnea depends on the definition of Hypopnea used by the sleep technician. The
147:
mucosa allow UARS patients to more effectively detect and respond to flow limitations before apneas and hypopneas can occur. Patients with intact nerves are able to dilate the genioglossus muscle, a key compensatory mechanism utilized in the presence of airway obstruction. What damages the nerves is not definitively known, but it is hypothesized to be caused by the long term effects of gastroesophageal reflux and/or snoring.
312:
283:, and linguloplasty exist. These procedures increase the dimensions of the upper airway and reduce the collapsibility of the airway. 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. Palatal tissue reduction via
146:
Why some patients with airway obstruction present with UARS and not OSA is thought to be caused by alterations in nerves located in the palatal mucosa. UARS patients have largely intact and responsive nerves, while OSA patients show clear impairment and nerve damage. Functioning nerves in the palatal
94:
Symptoms of UARS are similar to those of obstructive sleep apnea, but not inherently overlapping. Fatigue, insomnia, daytime sleepiness, unrefreshing sleep, anxiety, and frequent awakenings during sleep are the most common symptoms. Oxygen desaturation is minimal or absent in UARS, with most having a
236:
can help ease the symptoms of UARS. Therapeutic trials have shown that using a CPAP with pressure between four and eight centimeters of water can help to reduce the number of arousals and improve sleepiness. CPAPs are the most promising treatment for UARS, but effectiveness is reduced by low patient
126:
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
207:
Behavioral modifications include getting at least 7–8 hours of sleep and various lifestyle changes, such as positional therapy. 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
299:
is common in children. Due to the ossification of the median palatine suture, traditional tooth-born expanders cannot achieve maxillary expansion in adults as the mechanical forces instead tip the teeth and dental alveoli. Mini-implant assisted rapid palatal expansion (MARPE) has been recently
834:
Berry, Richard B.; Budhiraja, Rohit; Gottlieb, Daniel J.; Gozal, David; Iber, Conrad; Kapur, Vishesh K.; Marcus, Carole L.; Mehra, Reena; Parthasarathy, Sairam; Quan, Stuart F.; Redline, Susan; Strohl, Kingman P.; Ward, Sally L. Davidson; Tangredi, Michelle M. (15 October 2012).
248:
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. Oral appliances may be a suitable alternative for patients who cannot tolerate CPAP.
928:
Amiri, Shahrokh; AbdollahiFakhim, Shahin; Lotfi, Alireza; Bayazian, Gholamreza; Sohrabpour, Mojtaba; Hemmatjoo, Taghi (August 2015). "Effect of adenotonsillectomy on ADHD symptoms of children with adenotonsillar hypertrophy and sleep disordered breathing".
58:, and difficulty concentrating. UARS can be diagnosed by polysomnograms capable of detecting Respiratory Effort-related Arousals. It can be treated with lifestyle changes, functional orthodontics, surgery, mandibular repositioning devices or
300:
developed as a minimally invasive option for the transverse expansion of the maxilla in adults. This method increases the volume of the nasal cavity and nasopharynx, leading to increased airflow and reduced respiratory arousals during sleep.
178:
currently recognizes two definitions. The scoring of
Respiratory Effort-related Arousals is currently designated as "optional" by the AASM. Thus, many patients who receive sleep studies may receive a negative result, even if they have UARS.
130:
A typical UARS patient is not obese and possesses small jaws, which can result in a smaller amount of space in the nasal airway and behind the base of the tongue. Patients may have other anatomical abnormalities that can cause UARS such as
117:
greater than or equal to 3 millimeters, and a thin soft palatal mucosa with a short uvula. In 88% of the subjects, there is a history of early extraction or absence of wisdom teeth. There is an increased prevalence of UARS in east Asians.
697:
Guilleminault, Christian; Li, Kasey; Chen, Ning-Hung; Poyares, Dalva (September 2002). "Two-Point
Palatal Discrimination in Patients With Upper Airway Resistance Syndrome, Obstructive Sleep Apnea Syndrome, and Normal Control Subjects".
837:"Rules for Scoring Respiratory Events in Sleep: Update of the 2007 AASM Manual for the Scoring of Sleep and Associated Events: Deliberations of the Sleep Apnea Definitions Task Force of the American Academy of Sleep Medicine"
163:(AHI) less than 5, but an RDI greater than or equal to 5. Unlike the Apnea-Hypopnea Index, the Respiratory Disturbance Index includes Respiratory Effort-related Arousals (RDI = AHI + RERA Index). In 2005, the definition of
98:
Many patients experience chronic insomnia that creates both a difficulty falling asleep and staying asleep. As a result, patients typically experience frequent sleep disruptions. Most patients with UARS snore, but not all.
208:
cases. 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.
884:
Huang, Yu-Shu; Chen, Ning-Hung; Li, Hsueh-Yu; Wu, Yu-Yu; Chao, Chia-Chen; Guilleminault, Christian (September 2004). "Sleep disorders in
Taiwanese children with attention deficit/hyperactivity disorder".
190:, or a psychiatric disorder such as ADHD or depression. Studies have found that children with UARS are frequently misdiagnosed with ADHD. One study found UARS or OSA present in up to 56% of children with
224:
If left untreated, UARS can develop into obstructive sleep apnea. Treatments for OSA such as positive airway pressure therapy can be effective at stopping the progression of UARS.
1164:
368:
de
Oliveira, Pedro Wey Barbosa; Gregorio, Luciano Lobato; Silva, Rogério Santos; Bittencourt, Lia Rita Azevedo; Tufik, Sergio; Gregório, Luis Carlos (July 2016).
269:
191:
424:
de Godoy, Luciana B. M.; Palombini, Luciana O.; Guilleminault, Christian; Poyares, Dalva; Tufik, Sergio; Togeiro, Sonia M. (1 January 2015).
991:
785:
de Godoy, Luciana B.M.; Palombini, Luciana O.; Guilleminault, Christian; Poyares, Dalva; Tufik, Sergio; Togeiro, Sonia M. (January 2015).
233:
59:
175:
106:, which may cause lightheadedness, and patients with UARS are also more likely to experience headaches and irritable bowel syndrome.
1080:
Guilleminault, Christian; Khramtsov, Andrei (1 December 2001). "Upper airway resistance syndrome in children: A clinical review".
194:. Studies show that symptoms of ADHD caused by UARS significantly improve or remit with treatment in surgically treated children.
1242:
974:
216:
Nasal steroids may be prescribed in order to ease nasal allergies and other obstructive nasal conditions that could cause UARS.
50:
characterized by the narrowing of the airway that can cause disruptions to sleep. The symptoms include unrefreshing sleep,
265:
156:
1117:"Non-surgical treatment of transverse deficiency in adults using Microimplant-assisted Rapid Palatal Expansion (MARPE)"
1180:"Comparison of dimensions and volume of upper airway before and after mini-implant assisted rapid maxillary expansion"
541:
Guilleminault, Christian; Chowdhuri, Susmita (May 2000). "Upper Airway
Resistance Syndrome Is a Distinct Syndrome".
1237:
276:
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225:
183:
578:"From Obstructive Sleep Apnea Syndrome to Upper Airway Resistance Syndrome: Consistency of Daytime Sleepiness"
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83:
79:
679:
617:
Bao, Gang; Guilleminault, Christian (November 2004). "Upper airway resistance syndrome-one decade later".
132:
479:
Cuelbras, Antonio (1996). Clinical
Handbook of Sleep Disorders. New York: Butterworth-Heinemann. pp. 207.
353:
Shneerson, John M., ed. (2005). Sleep
Medicine (Second ed.). New York: Blackwell Publishing. pp. 229-237.
1158:
182:
Based on symptoms, patients are commonly misdiagnosed with idiopathic insomnia, idiopathic hypersomnia,
1178:
Li, Qiming; Tang, Hongyi; Liu, Xueye; Luo, Qing; Jiang, Zhe; Martin, Domingo; Guo, Jing (1 May 2020).
576:
Guilleminault, Christian; Stoohs, Riccardo; Clerk, Alex; Simmons, Jerald; Labanowski, Michael (1992).
160:
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and works by stenting the airway open with pressure, thus reducing the airway resistance. Use of a
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Orthodontic treatment to expand the volume of the nasal airway, such as nonsurgical Rapid
171:
167:
was changed to include patients with UARS by using RDI to determine sleep apnea severity.
1045:
Exar, Elliott N.; Collop, Nancy A. (April 1999). "The Upper Airway
Resistance Syndrome".
78:
in the late 1980s. The article that described it by name, along with its relationship to
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370:"Orofacial-cervical alterations in individuals with upper airway resistance syndrome"
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787:"Treatment of upper airway resistance syndrome in adults: Where do we stand?"
491:"Treatment of upper airway resistance syndrome in adults: Where do we stand?"
426:"Treatment of upper airway resistance syndrome in adults: Where do we stand?"
66:, although some scientists and doctors believe it to be a distinct disorder.
1093:
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275:
Though less common methods of treatment, various surgical options including
143:, or nasal valve collapse. UARS affects equal numbers of males and females.
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272:(SARPE) are the most effective surgeries for sleep disordered breathing.
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55:
114:
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Garcha, Puneet S.; Aboussouan, Loutfi S.; Minai, Omar (January 2013).
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hypertrophy, a narrow hard palate that reduces nasal volume, enlarged
750:
140:
159:(RDI). A patient is considered to have UARS when they have an
733:
Poothrikovil, Rajesh P.; Al Abri, Mohammed A. (May 2012).
543:
American
Journal of Respiratory and Critical Care Medicine
74:
Upper airway resistance syndrome was first recognized at
264:
Orthognathic surgeries that expands the airway, such as
668:(Second ed.). New York: Inform Healthcare. pp. 339–347.
113:, an abnormally small intermolar distance, an abnormal
1115:
Brunetto DP, Sant'Anna EF, Machado AW, Moon W (2017).
931:
International
Journal of Pediatric Otorhinolaryngology
261:, turbinate reductions, or surgical palate expansion.
735:"Snoring Induced Nerve Lesions in the Upper Airway"
29:
24:
170:The diagnosis of UARS is based on findings on a
1017:"CPAP Machine: How It Works, Reasons, and Uses"
680:"Cleveland Clinic Sleep-Disordered Breathing"
8:
1163:: CS1 maint: multiple names: authors list (
33:UARS, non-hypoxic sleep-disordered breathing
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287:has also been successful in treating UARS.
270:Surgically Assisted Rapid Palatal Expansion
228:therapy is similar to that in obstructive
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975:"Upper Airway Resistance Syndrome (UARS)"
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62:therapy. UARS is considered a variant of
739:Sultan Qaboos University Medical Journal
489:de Godoy, Luciana B.M. (20 March 2015).
374:Brazilian Journal of Otorhinolaryngology
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257:For nasal obstruction, options can be
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95:minimum oxygen saturation >92%.
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841:Journal of Clinical Sleep Medicine
631:10.1097/01.mcp.0000143689.86819.c2
176:American Academy of Sleep Medicine
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899:10.1111/j.1365-2869.2004.00408.x
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220:Positive airway pressure therapy
40:Upper airway resistance syndrome
25:Upper airway resistance syndrome
1082:Seminars in Pediatric Neurology
664:Kushida, Clete A., ed. (2009).
109:Predisposing factors include a
981:. Retrieved February 28, 2017.
1:
1015:Repasky, David (2021-03-03).
266:Maxillomandibular advancement
157:Respiratory Disturbance Index
943:10.1016/j.ijporl.2015.05.015
595:10.1093/sleep/15.suppl_6.S13
155:UARS is diagnosed using the
803:10.1016/j.slsci.2015.03.001
666:Handbook of Sleep Disorders
555:10.1164/ajrccm.161.5.16158a
507:10.1016/j.slsci.2015.03.001
442:10.1016/j.slsci.2015.03.001
387:10.1016/j.bjorl.2015.05.015
111:high and narrow hard palate
82:, was published in 1992 by
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887:Journal of Sleep Research
277:uvulopalatopharyngoplasty
102:Some patients experience
1059:10.1378/chest.115.4.1127
226:Positive airway pressure
184:chronic fatigue syndrome
1243:Breathing abnormalities
1094:10.1053/spen.2001.29045
712:10.1378/chest.122.3.866
285:radiofrequency ablation
203:Behavioral modification
80:obstructive sleep apnea
1184:The Angle Orthodontist
996:stanfordhealthcare.org
684:Virtual Medical School
54:, sleepiness, chronic
1121:Dental Press J Orthod
1196:10.2319/080919-522.1
161:Apnea-Hypopnea Index
291:Maxillary expansion
76:Stanford University
90:Signs and symptoms
979:Stanford Medicine
853:10.5664/jcsm.2172
326:Airway resistance
297:Palatal expansion
127:not be aware of.
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331:Sleep apnea
259:septoplasty
230:sleep apnea
212:Medications
165:sleep apnea
135:, inferior
104:hypotension
64:sleep apnea
30:Other names
1227:Categories
1026:2021-05-11
1001:2021-05-11
337:References
198:Management
1248:Syndromes
268:(MMA) or
151:Diagnosis
137:turbinate
1214:33378437
1151:28444019
1102:11768783
1067:10208219
1021:CPAP.com
951:26066853
915:19828868
907:15339263
871:23066376
821:26483942
769:22548134
720:12226025
647:37248742
639:15510051
563:10806128
525:26483942
460:26483942
406:26671020
304:See also
279:(UPPP),
56:insomnia
1205:8032299
1142:5398849
862:3459210
812:4608900
760:3327562
604:1470801
516:4608900
451:4608900
397:9448996
253:Surgery
141:tonsils
115:overjet
86:et al.
70:History
52:fatigue
46:) is a
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