Upper Airway Resistance Syndrome (UARS): Symptoms and Treatment in the UK

Upper Airway Resistance Syndrome (UARS) is a condition within the spectrum of sleep-disordered breathing. While many people in the UK are familiar with Obstructive Sleep Apnoea (OSA), UARS is a more subtle but equally disruptive condition. It occurs when the flow of air through the nose and throat is restricted during sleep, requiring the brain to work harder to maintain breathing.

In patients with UARS, the airway does not collapse completely (as it does in apnoea), but it narrows significantly. This high 'resistance' to airflow leads to Respiratory Effort-Related Arousals (RERAs). These are brief disruptions in sleep that the patient often doesn't remember, but they prevent the body from entering the restorative phases of deep sleep, leading to chronic exhaustion.

Distinguishing the Two Conditions

While UARS and OSA share similarities—such as snoring and daytime sleepiness—there are fundamental clinical differences recognised by UK sleep specialists:

• Oxygen Saturation: In OSA, oxygen levels in the blood typically drop during breathing pauses. In UARS, oxygen levels often remain relatively stable.
• Breathing Pauses: OSA involves clear cessation of breath (apnoeas). UARS involves increased breathing effort without full cessation.
• Patient Profile: UARS can often affect people who do not fit the typical OSA profile, including younger individuals or those with a lower Body Mass Index (BMI).

The symptoms of UARS can be broad and sometimes overlap with other conditions like Chronic Fatigue Syndrome or Anxiety. Common indicators include:

• Persistent Daytime Sleepiness: Feeling unrefreshed despite getting a full night's sleep.
• Frequent Awakenings: Waking up multiple times a night for no apparent reason.
• Chronic Headaches: Particularly upon waking in the morning.
• Low Blood Pressure (Hypotension): Some studies suggest UARS patients may experience lower blood pressure than those with OSA.
• Cold Hands and Feet: Often associated with the autonomic nervous system's response to breathing effort.
• Nasal Congestion: Chronic blockage that makes nasal breathing difficult.

UARS is primarily caused by physical obstructions or anatomical variations in the upper airway. These can include:

• Nasal Obstructions: A deviated septum, nasal polyps, or enlarged turbinates.
• Jaw Structure: A narrow palate or a receding chin (retrognathia) can reduce space for the tongue.
• Soft Tissue: Large tonsils or a long soft palate can crowd the airway.

The NHS and NICE guidance suggest that lifestyle factors, such as smoking and alcohol consumption, can further relax the throat muscles, exacerbating these physiological issues.

Diagnosis can be challenging because standard home sleep tests may only look for oxygen drops, effectively 'missing' UARS. A full in-lab polysomnography (PSG) is often required to measure the specific pressure changes in the oesophagus or subtle brain wave changes associated with RERAs.

Treatment Pathways

Treatment within the UK health system typically follows a tiered approach:

• Lifestyle Modifications: Weight management (if applicable), smoking cessation, and avoiding sleep on your back.
• Nasal Treatments: Steroid nasal sprays or saline rinses for those with chronic congestion.
• Mandibular Advancement Devices (MAD): Custom-fitted dental splints that hold the lower jaw forward.
• CPAP Therapy: Continuous Positive Airway Pressure can be effective for UARS by keeping the airway open with air pressure.
• Surgery: In specific cases, an ENT specialist may recommend tonsillectomy or septal correction.

If you are struggling with unexplained fatigue or persistent snoring, you may wish to speak to an online doctor in the UK. An online consultation provides a convenient way to discuss your sleep patterns and symptom history with a healthcare professional.

An online GP can perform an initial assessment using tools like the Epworth Sleepiness Scale. If UARS is suspected, they can provide advice on sleep hygiene, prescribe nasal treatments for congestion, or produce a private referral for a sleep specialist or an ENT (Ear, Nose, and Throat) consultant for further diagnostic testing. Seeking help early can prevent the long-term mental and physical strain associated with chronic sleep deprivation.