At a Glance
Upper airway resistance syndrome (UARS) causes increased breathing effort during sleep, which can cause snoring, sleep interruptions, and excess daytime sleepiness. Common causes of UARS include a small airway and blocked nasal passages, and the condition is diagnosed using a sleep study. UARS treatment options include CPAP therapy, oral appliances, and sometimes surgery.
Upper airway resistance syndrome (UARS) makes it harder to breathe while you sleep and can wake you up through the night. Like obstructive sleep apnea (OSA), UARS causes snoring and daytime sleepiness, but the two conditions also have differences.
When you have symptoms like those above, your doctor may first check for OSA with a sleep study. Based on your results, they can give you a UARS diagnosis and recommend a treatment plan. Below, we’ll explain more about UARS, how it compares to OSA with regards to symptoms and treatment.
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What Is Upper Airway Resistance Syndrome?
Upper airway resistance syndrome is a type of sleep disordered breathing that blocks airflow through your upper airway, causing snoring, wakefulness, and excessive daytime sleepiness. Experts label UARS as a type of OSA, although its symptoms aren’t as severe.
UARS causes respiratory effort-related arousals (RERAs), or increased breathing effort that lasts 10 seconds or more. RERAs can disrupt your sleep, even if they don’t wake you up, but these events typically don’t lower your oxygen levels like they do with OSA.
UARS vs. Sleep Apnea
UARS and OSA both involve trouble breathing caused by soft tissue collapse in and around your upper airway (your throat). They also both cause symptoms like interrupted sleep, loud snoring, and feeling extra sleepy during the day.
But unlike OSA, though, UARS usually doesn’t cause pauses in breathing (apneas) or decreased oxygen levels (hypopneas). UARS also causes fewer sleep disruptions than OSA.
Symptoms of Upper Airway Resistance Syndrome
UARS may cause no symptoms. But if you have symptoms, they usually look similar to signs of OSA. UARS symptoms may include:
- Snoring
- Trouble falling or staying asleep
- Morning headaches
- Heartburn
- Anxiety, depression, and mood changes
- Daytime sleepiness
- Trouble concentrating and brain fog
Causes of Upper Airway Resistance Syndrome
UARS develops when air meets resistance in your upper airway while you breathe during sleep. This resistance can come from the natural shape of your face and throat. If you were born with a narrow throat, for example, air has less space to get through, especially when you relax during sleep.
A blockage in your nasal passages can also play a part in increasing the effort it takes to breathe during sleep. This can happen because of allergies, nasal polyps, or a deviated septum (when the wall dividing your nose in half is uneven).
Risk Factors for UARS
Certain factors increase your risk of developing UARS. For example, people with UARS are typically younger with a lower body mass index (BMI) than those with OSA.
UARS risk factors include:
- Narrow upper airway
- Small mouth or palate (the roof of your mouth)
- Being a light sleeper
- Lower jaw that sits further back
- Frequent nasal congestion or blockage
Diagnosing Upper Airway Resistance Syndrome
To diagnose UARS, you’ll need an overnight sleep study at a sleep clinic. These sleep studies, called polysomnography, record several measurements while you sleep, which helps your doctor give you a diagnosis and plan treatment.
During your sleep study, your doctor will be tracking:
- Apnea-hypopnea index (AHI): How many pauses in breathing and periods of decreased oxygen you have per hour during sleep
- Respiratory effort-related arousals (RERA) score: Periods where you breathe in less air (airflow limitation), making you work harder to breathe, which disrupts your sleep
- Respiratory disturbance index (RDI): The addition of AHI and RERA, which gives another measure of breathing during sleep
- Oxygen saturation: Levels of oxygen in your blood, which tell your doctor if your trouble breathing affects how much oxygen your body gets
- Nasal airflow: Measures air passing through your nose with small plastic tubes in your nostrils (nasal cannula), which can point to upper airway resistance
- Esophageal pressure monitoring: Sometimes used to measure pressure in your esophagus with a small tube
Before your doctor recommends a sleep study, they’ll first ask about your symptoms. Then, if they suspect OSA or UARS, they’ll schedule polysomnography for diagnosis. You may be diagnosed with UARS if you have daytime sleepiness and your sleep study shows these results:
- AHI score of less than five events per hour
- RERA score of five or more events per hour
- Minimum oxygen level of 92%
- Increased airflow resistance for at least 5% of your sleep
Your doctor will discuss your results with you and answer your questions about specific scores.
Treatment for Upper Airway Resistance Syndrome
Treatment for UARS involves many of the same options as OSA. Some experts disagree on the best treatments for UARS, which include continuous positive airway pressure (CPAP) and oral appliances. Your doctor will discuss all your options so you can decide on the best treatment path for your situation.
CPAP Therapy
CPAP therapy uses pressurized air to keep your airways open and help you breathe while you sleep. Some studies have shown that using CPAP for UARS can decrease airway resistance, help you sleep better, and lessen daytime fatigue.
You can choose between several types of CPAP masks and machines for the most comfort and benefit. For example, CPAP masks may cover your nose, nose and mouth, or only your nostrils.
Some experts recommend finding the right CPAP machine setting during a sleep study, rather than using a machine that automatically adjusts throughout the night. This may better manage airway resistance and increase your sleep quality.
Oral Appliances
Oral appliances keep your lower jaw or tongue pulled forward while you sleep, which makes more space for air to get through. Your doctor may recommend an oral appliance if you can’t tolerate your CPAP machine, and they can work well for UARS.
Types of oral appliances for UARS include:
- Mandibular advancement device (MAD): Pulls your lower jaw forward
- Tongue-retaining device (TRD): Uses suction to keep your tongue away from your throat
- Soft palate lifter: Raises the roof of your mouth to create more space
Treating Nasal Obstruction
Opening up your nasal passages can help to decrease breathing effort. If you have allergies, your doctor may recommend medications to improve your symptoms.
For any kind of resistance in your nasal passages, your doctor may also suggest external nasal dilation — stiff strips that stick to the skin of your nose and pull your nostrils outward. Internal nasal dilators go into your nostrils and push them open from the inside.
Sleep Position
Some people notice improved symptoms of UARS by simply changing their sleep position. When you lie on your back during sleep, gravity can pull tissues toward the back of your throat and make your airway smaller. But if you sleep on your side, your throat may stay more open.
Surgery
If the treatments above don’t work for you, your doctor may offer surgery as a treatment option. Surgery for UARS focuses on the area causing a problem with airflow, like your palate (the roof of your mouth). If needed, your doctor will discuss surgical options with you to treat your individual needs.
When to Talk to a Doctor
Call your doctor if you notice symptoms of UARS, feeling extra sleepy during the day or trouble with wakefulness at night. If UARS doesn’t get treated, it can increase your risk of complications like:
- Heart problems
- High blood pressure
- Type 2 diabetes
- Chronic fatigue
- Irritable bowel syndrome
- Depression
Your doctor can help you avoid complications and sleep better with treatment.
Frequently Asked Questions
UARS is a type of obstructive sleep apnea that causes difficulty breathing during sleep, but doesn’t cause pauses in breathing or lower oxygen levels.
For some people, UARS can turn into sleep apnea, because when air can’t get through your throat easily during sleep, your airways can get narrower.
If left untreated, UARS can increase your risk for heart disease, chronic fatigue, digestion issues, hypertension (high blood pressure), obesity, and type 2 diabetes, as well as motor vehicle accidents.
Experts recommend a sleep study done at a sleep clinic to diagnose UARS. Home sleep studies may not catch the specific factors that point to UARS, like respiratory effort-related arousals (RERAs) and decreased airflow when you breathe in.
Medical Disclaimer: This content is for informational purposes and does not constitute medical advice. Please consult a health care provider prior to starting a new treatment or making changes to your treatment plan.
Written by
Abby McCoy, RN, Contributing WriterAbby McCoy is an experienced RN who has worked with adults and pediatric patients encompassing trauma, orthopedics, home care, transplant, and case management. She holds a Bachelor’s of Science in Nursing from St. Louis Univeristy and has practiced nursing all over the world from San Francisco, CA, to Tharaka, Kenya. She now writes health content for trusted health outlets like Everyday Health and Next Avenue.
Reviewed by
Dustin Cotliar, MD, MPH, Medical ReviewerDr. Dustin Cotliar is a board-certified emergency medicine physician with more than eight years of clinical experience across emergency departments and urgent care settings. He earned his medical degree from the State University of New York (SUNY) Downstate College of Medicine and a Master of Public Health from Columbia University.
