Upper Airway Resistance Syndrome
Recognizing Upper Airway Resistance Syndrome (UARS for short) is not easy. That’s why there are many undiagnosed cases.
Unlike obstructive sleep apnea, where breathing pauses are the defining symptom, UARS shows itself more “quietly,” which is why it is also known as the “silent syndrome.” While sleep apnea can be diagnosed well in specialized clinics, UARS is often missed in standard screenings.
How you can still recognize UARS and which treatment can provide lasting relief is explained on this page.
Detecting UARS
“Upper Airway Resistance Syndrome is often overlooked because classic breathing pauses do not occur. Still, nighttime breathing is persistently strained and sleep is heavily fragmented. Anyone who is chronically exhausted despite adequate sleep duration should also consider UARS and seek a specialized evaluation.”
Prof. H. Sailer
What you should know about Upper Airway Resistance Syndrome (UARS)
What is the Upper Airway Resistance Syndrome (UARS)?
Upper Airway Resistance Syndrome is a sleep-related breathing disorder in which the upper airways narrow during sleep without pronounced breathing pauses or relevant drops in oxygen. Affected patients show altered breathing patterns and increased respiratory effort, because the body must work harder against the elevated airway resistance.
What causes UARS?
In people with UARS, a retruded chin and a relatively small lower jaw (or a long facial shape) often stand out visually. These narrow points in the throat can promote the development of UARS. But that alone is not enough to diagnose it. A digital 3D X-ray provides real clarity. It often shows narrow, frequently long upper airways, with a visible constriction. In that sense, the physiognomic presentation is similar to obstructive sleep apnea. But there is one crucial difference: muscle tone is sufficiently high, so a collapse of the upper airways does not occur in UARS patients.
Which patients are most commonly affected by UARS?
While obstructive sleep apnea (OSA) primarily affects men and becomes more common with age, this is not the case with UARS. Studies suggest around 3.1% of the population has UARS, with women affected more often (4.4%) than men (1.5%). Especially notable: it is not uncommon for children and adolescents to have UARS.
In general, Upper Airway Resistance Syndrome (UARS) can affect people of any age. However, children, adolescents, and women are particularly common among UARS patients.
How is UARS diagnosed?
Diagnosis is made in a clinic or by a specialist in two ways: first, in a sleep lab. There, many arousal reactions typically appear, but hardly any apneas or oxygen drops. In addition, a 3D X-ray (CBCT) of the jaw and airway structures can be taken to make anatomical narrowings visible.
Are UARS and ADHD similar?
Because some UARS complaints overlap with those of attention deficit/hyperactivity disorder, UARS is occasionally mistaken for ADHD, especially in children and adolescents. Targeted sleep-medicine testing, however, allows a clear diagnosis.
Is UARS dangerous?
If left untreated, UARS can significantly reduce quality of life and, in the long term, contribute to the development of obstructive sleep apnea. Chronic sleep deprivation and nightly strain also increase the risk of reduced performance, psychological complaints, and cardiovascular problems.
Can UARS be cured?
UARS can be cured. Symptom-based therapies such as CPAP or dental splints work only as long as they are used. A lasting solution is surgical advancement of the upper and lower jaw (e.g., bimaxillary rotational advancement) or Surgically Assisted Rapid Palatal Expansion (SARPE), provided anatomical narrowings are the main cause.
When should you seek medical advice for UARS?
UARS may be present when persistent daytime sleepiness, concentration problems, or restless sleep occur, especially if symptoms come with noticeable jaw features or school performance problems (in children). In these cases, a sleep-medicine evaluation is advisable.
What is the difference between Upper Airway Resistance Syndrome (UARS) and sleep apnea?
Unlike other sleep-related breathing disorders such as obstructive sleep apnea (OSA), Upper Airway Resistance Syndrome typically does not involve complete breathing pauses. However, both conditions share similar anatomical causes, most importantly, characteristically narrowed upper airways. The Apnea–Hypopnea Index (AHI) is usually low in UARS, which is why diagnosis often relies on the RERA index (Respiratory Effort–Related Arousals). A hallmark of UARS is that oxygen saturation during sleep usually remains stable. The simplest way to put it is: “the body wakes you up before an obstruction occurs.”
Symptoms of Upper Airway Resistance Syndrome compared to sleep apnea
Many people with Upper Airway Resistance Syndrome (UARS) do not fit the “typical” sleep apnea profile, which is why (wrongly) no UARS diagnosis is made. Fatal. Because the impact of UARS symptoms on quality of life should not be underestimated. Untreated UARS can lead to serious problems such as depression, high blood pressure, or heart issues.
People affected by UARS often show pronounced daytime fatigue, concentration and attention problems, learning difficulties, inner restlessness, reduced physical performance, and unusually restless sleep. Especially in children and adolescents, these symptoms not rarely lead to an incorrect ADHD diagnosis.
Upper Airway Resistance Syndrome (UARS), like obstructive sleep apnea (OSA), can affect people of any age. But unlike sleep apnea, which mainly affects older people and men, UARS primarily affects children and adolescents.
Surgical treatment of Upper Airway Resistance Syndrome
Treatment for Upper Airway Resistance Syndrome depends on the patient’s individual anatomical situation. As a rule, we recommend surgical treatment, because it makes lifelong use of aids unnecessary.
Recommended procedures include “Bimaxillary Rotational Advancement.” By repositioning the jaws, the tongue, palate, and palatal arches are moved forward, permanently widening the airways.
Many patients report noticeably more restorative sleep after UARS surgery and tangible improvements in everyday life. Fewer arousals during the night have a positive effect on the entire body: daytime sleepiness decreases, performance improves, and overall well-being rises significantly. Comorbidities such as high blood pressure can also normalize after surgery in many cases—sometimes even without further medication.