Upper Airway Resistance Syndrome (UARS)


Unlike OSA, there are no apneas in UARS. Instead, airway resistance is significant enough to cause short awakenings which disrupt the normal sleep pattern. A patient with UARS is usually not aware of the arousals, but still develop symptoms that affect their quality of life.

  • Excessive daytime fatigue
  • Problems with memory and attention
  • Irritability
  • Problems initiating and maintaining sleep
  • Dry mouth
  • Morning headaches
  • Teeth grinding

It is also important to note that not all patients that have UARS have audible snoring. There may be sufficient anatomical differences within the airway to increase respiratory effort and cause brain “arousals” and “heavy breathing” without loud snoring.


After undergoing a sleep study, some patients do not meet the AHI cutoff receive a diagnosis of OSA. However, as discussed previously, there are other numbers to review on your sleep report:

  • Respiratory Effort-Related Arousals (RERAs): Characterized as a series of breaths where airflow is decreased and respiratory effort is increased. They last at least 10 seconds and lead to awakenings that disturb the normal sleep pattern
  • Respiratory Disturbance Index (RDI): All apneas + hypopneas + RERAs per hour of sleep
  • Lowest Oxygen Saturation: The lowest oxygen concentration in your blood reached during the sleep study

RERAs are particularly important in diagnosing UARS as the arousals themselves cause patients to be symptomatic due to the disrupted sleep pattern.


It is important to emphasize that the absence of OSA does not mean treatment is not required. UARS is considered by sleep physicians to be a “bridge” to more severe disordered sleep, and left untreated, can lead to full blown OSA. Treatment of UARS is similar to treatment of OSA and may include:

  • Lifestyle modifications
  • CPAP
  • Positional changes
  • Dental Sleep Therapy

Dental sleep therapy involves the fabrication of a custom oral appliance. The appliance is worn nightly and works by maintaining the lower jaw in a more forward position. This removes the tongue and other soft tissues from the airway leading to decreased airway resistance, fewer sleep arousals, and improved sleep.

The goal of Carolina Dental Sleep Center is to create an individualized treatment plan that a patient will use, that is effective, and results in the most optimal health. To do this we work closely with other medical providers to determine what therapy is best for you. Patients with UARS are not eligible for CPAP but can, and should, be treated for their condition. Early intervention with dental sleep therapy prevents progression of UARS to OSA. Let us create an oral device just for you and get you on the road to a better night’s sleep and improved quality of life!