From the Guidelines
Upper airway syndrome should be diagnosed and treated as obstructive sleep apnea (OSA) given the shared pathophysiology and response to treatment, as stated by the American Academy of Sleep Medicine in 2018 1. The diagnosis of upper airway syndrome, also known as upper airway resistance syndrome (UARS), is characterized by increased resistance in the upper airway during sleep, leading to sleep fragmentation and daytime symptoms. According to the AASM International Classification of Sleep Disorders (ICSD-3), patients who exclusively have respiratory effort-related arousals (RERAs) are now subsumed under the heading of OSA given the shared pathophysiology and response to treatment 1. Key features of upper airway syndrome include:
- Repeated episodes of increased respiratory effort due to airway narrowing
- Sleep fragmentation and daytime symptoms such as excessive daytime sleepiness, fatigue, morning headaches, and mood disturbances
- Increased risk of progressing to obstructive sleep apnea if left untreated Treatment options for upper airway syndrome, now considered as part of the OSA spectrum, may include:
- Lifestyle modifications such as weight loss, avoiding alcohol and sedatives before bedtime, and sleeping on one's side rather than back
- Continuous positive airway pressure (CPAP) therapy, potentially starting at lower pressures than those used for sleep apnea
- Oral appliances that reposition the jaw forward to prevent the tongue and soft tissues from collapsing into the airway Given the updated classification and understanding of upper airway syndrome as part of the OSA spectrum, diagnosis and treatment should follow the guidelines for OSA, as outlined by the American Academy of Sleep Medicine 1.
From the Research
Definition and Characteristics of Upper Airway Syndrome
- Upper airway resistance syndrome (UARS) is a sleep disorder characterized by incomplete obstruction of the airway during sleep, leading to increased respiratory efforts and frequent arousals despite normal oxygen saturations 2.
- UARS is a form of non-hypoxic sleep-disordered breathing, which means that it does not involve significant drops in oxygen levels in the blood 3.
- The syndrome is often underdiagnosed, and its symptoms can be similar to those of obstructive sleep apnea syndrome (OSAS), but with some key differences 4, 5.
Diagnosis and Treatment of Upper Airway Syndrome
- Diagnosis of UARS typically involves a sleep study, such as polysomnography, to assess respiratory effort and arousals during sleep 6, 2.
- Treatment of UARS often involves the use of nasal continuous positive airway pressure (CPAP) devices, which can help to keep the airway open during sleep 4.
- However, some patients may not receive treatment due to lack of insurance coverage or other factors, which can lead to worsening of symptoms over time 6.
Symptoms and Consequences of Upper Airway Syndrome
- Common symptoms of UARS include daytime fatigue, insomnia, and depressive mood, which can significantly impact quality of life 5, 6.
- If left untreated, UARS can lead to increased risk of cardiovascular and metabolic comorbidities, as well as worsening of symptoms over time 6, 3.
- Early recognition and treatment of UARS are crucial to preventing long-term consequences and improving patient outcomes 2, 3.