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UARS Treatment

UARS (Upper Airway Resistance Syndrome) is a sleep-related breathing disorder that is characterized by increased resistance in the upper airway during sleep. UARS involves a milder narrowing of the airway, which still leads to disrupted sleep and symptoms of sleep disorders. Patients suffering from UARS can suffer from metabolic and cardiovascular consequences.

UARS Symptoms and Risk Factors

Airflow via the upper airway, particularly through the nose, is restricted or resistant in UARS. In UARS, a decrease in nasal airflow will be 50% which leads to frequent awakening during sleep.

  1. Daytime Fatigue and Sleepiness: People may experience daytime fatigue even after getting enough hours of sleep.
  2. Unrefreshing Sleep: A person sleeps for a normal amount of time but still doesn’t feel rested.
  3. Frequent Nighttime Awakenings: The person may wake up multiple times during the night.
  4. Difficulty Falling Asleep or Staying Asleep: Some people with UARS struggle with initiating or maintaining sleep.
  5. Snoring: people with UARS may snore lightly.
  6. Morning Headaches: Frequent headaches upon waking, likely due to poor sleep quality.
  7. Dry Mouth or Sore Throat in the Morning: Caused by mouth breathing during sleep.
  8. Cognitive Impairments: Difficulty in concentrating, memory issues, and brain fog are common due to poor sleep quality.
  9. Mood Disturbances: Anxiety, depression, irritability, and mood swings may result from chronic sleep deprivation.
  10. Frequent Urination at Night: A person may wake up multiple times to urinate during the night.
  11. Breathing Difficulty During Sleep: This can include signs such as gasping, choking, or a sensation of resistance when breathing in.

Risk Factors for UARS:

  1. Anatomy of the Upper Airway: Narrow airways, a small jaw, deviated septum, or enlarged tonsils and adenoids increase the risk of airway resistance.
  2. Allergies or Nasal Congestion: Chronic nasal blockage or allergies can increase airway resistance.
  3. Family History: A family history of sleep-disordered breathing can increase the likelihood of developing UARS.
  4. Poor Sleep Habits: Irregular sleep schedules or poor sleep hygiene can exacerbate symptoms.

if UARS left untreated, can lead to several short-term and long-term consequences like daytime sleepiness and fatigue, memory Issues, difficulty concentrating, mood disturbances, increased blood pressure (Hypertension), reduced quality of life, hormonal imbalances, metabolic disorders, increased risk of accidents, social and relationship strain, compromised immune system, impact on physical health, reduced physical performance, development of obstructive sleep apnea(OSA).

Connection Between UARS and Sleep Apnea

Sleep apnea is a common sleep disorder in which a person’s breathing repeatedly stops and starts during sleep. OSA is the most common form of sleep apnea. Upper airway resistance syndrome (UARS) is closely related to sleep apnea, but there are key differences between the two. Both conditions involve issues with breathing during sleep, but UARS is often considered a milder form of sleep-disordered breathing compared to obstructive sleep apnea (OSA).

Here’s how UARS is connected to sleep apnea:

Unlike with sleep apnea, the airway does not entirely collapse in UARS. Rather, breathing becomes difficult but not completely blocked due to an increase in resistance in the upper airway (nose and neck). As opposed to OSA, which is characterized by a total cessation of breathing (apnea), this results in numerous arousals during sleep. Due to frequent sleep interruptions caused by their body sensing the greater effort required to breathe, people with UARS wake up a lot. Even while these arousals are generally unnoticeable to the person, they always keep them from getting deep, healing sleep. The brain awakens the person up to resume breathing following an apneic episode in sleep apnea.

Researchers tell that UARS may be an early stage of sleep-disordered breathing that can eventually progress into full-blown obstructive sleep apnea over time if left untreated. UARS is harder to diagnose than sleep apnea because it often does not cause significant drops in blood oxygen levels or long pauses in breathing. Specialized sleep studies are often required to measure subtle changes in breathing effort and detect UARS.

Clinical Evaluation

The clinical evaluation of Upper Airway Resistance Syndrome (UARS) involves a comprehensive assessment of symptoms, medical history, physical examination, and sleep studies.A thorough history is crucial in identifying possible UARS. Airway orthodontist will inquire about the symptoms, will do physical examination to identify anatomical factors that could contribute to upper airway resistance, and will suggest to do CBCT scan and a Sleep study.

Clinical evaluation steps include

  • History and Symptom Evaluation: Daytime fatigue, insomnia, non-restorative sleep, snoring.
  • Physical Examination: Check for anatomical airway abnormalities (e.g., small jaw, crowded oral cavity).
  • CBCT scan: This scan shows details of bones and soft tissues which provide accurate measurements including the jaw size and shape, airway obstruction, nasal septum deviation, turbinates hypertrophy, enlarged adenoids, and airway volume.
  • Sleep Study: Focus on detecting respiratory effort-related arousals (RERAs) and flow limitations.

Suggested Treatment Plan

An Airway orthodontist plays a key role in airway management as 90% of airway obstruction occurs behind the maxilla & mandible in the region of the soft palate & tongue. Suggested plan for UARS treatment include

MSE (Maxillary skeletal expander) And RME (Rapid maxillary Expander)

An airway-focused orthodontist can reduce the air flow resistance by expanding the upper jaw with MSE in adults and RME Children which increases nasal volume and makes sleep better. MSE widens the nasal cavity and nasal floor. It decreases the resistance to airflow through the nose and improves nasal breathing. MSE expands the upper arch & creates more space for the tongue to occupy & helps the tongue to move forward & opens up the lower pharyngeal airway space. Since the bone density of children (below 11 years) is less we can expand the maxilla very easily with a simple RME appliance that increases nasal volume.

Advantages:

  1. Significant improvement in nasal airflow, often reducing snoring and symptoms of UARS or OSA.
  2. More effective and stable expansion compared to traditional dental-only expansion methods.

FAQ

How is UARS diagnosed?

UARS is typically diagnosed through a sleep study and CBCT Scan. Upper Airway Resistance syndrome treatment will check the breathing patterns, airflow resistance, and disruptions during sleep . sleep study and CBCT Scan help to determine the presence of UARS.

While both UARS and sleep apnea involve airway obstruction during sleep, sleep apnea is characterized by complete pauses in breathing (apneas), whereas UARS involves partial airway blockages that increase breathing resistance without full airway collapse.

Dental sleep medicine can help manage UARS with oral appliances like MSE and RME , opening the airway to reduce resistance and improve sleep quality. These devices are often effective for mild to moderate cases of UARS.

No. Snoring occurs when there’s partial airway obstruction, but UARS is specifically characterized by increased airway resistance leading to frequent awakenings and disturbed sleep, often without the complete blockage seen in sleep apnea.