Skip to main content
SpringerLink
Log in

Upper Airway Resistance Syndrome

  • Chapter
  • First Online:
Complex Sleep Breathing Disorders

Abstract

The upper airway resistance syndrome describes a constellation of symptoms, namely, fatigue and excessive daytime sleepiness, attributable to polysomnographic findings of prolonged inspiratory flow limitation and repeated arousals from sleep due to increased upper airway resistive events that do not meet the criteria for apneas or hypopneas. While now subsumed under the diagnosis of obstructive sleep apnea as a clinical entity, the term remains in use in the sleep medicine community necessitating that practitioners of sleep medicine be familiar with it. This chapter uses a representative case to discuss the history, epidemiology, polysomnographic findings, and treatment approach for this often misunderstood syndrome.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 59.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 79.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Abbreviations

AASM:

American Academy of Sleep Medicine

AHI:

Apnea-hypopnea index

CPAP:

Continuous positive airway pressure

EEG:

Electroencephalogram

ESS:

Epworth Sleepiness Scale

ICSD-3:

International Classification of Sleep Disorders – Third Edition

IFL:

Inspiratory flow limitation

MAD:

Mandibular advancement device

NC/PT:

Nasal cannula/pressure transducer

OCST:

Out-of-center sleep test

OSA:

Obstructive sleep apnea

Pcrit:

Pharyngeal critical pressure

PSG:

Polysomnography

REM:

Rapid eye movement

RERA:

Respiratory effort-related arousal

UARS:

Upper airway resistance syndrome

References

  1. Guilleminault C, Stoohs R, Clerk A, Cetel M, Maistros P. A cause of excessive daytime sleepiness: the upper airway resistance syndrome. Chest. 1993;104:781–7.

    Article  CAS  Google Scholar 

  2. Farré R, Montserrat JM, Rotger M, Ballester E, Navajas D. Accuracy of thermistors and thermocouples as flow-measuring devices for detecting hypopneas. Eur Resp J. 1998;11:179–82.

    Article  Google Scholar 

  3. Exar EN, Collop NA. The upper airway resistance syndrome. Chest. 1999;115:1127–39.

    Article  CAS  Google Scholar 

  4. Montserrat JM, Farré R, Ballester E, Felez A, Pastó M, Navajas D. Evaluation of nasal prongs for estimating nasal flow. Am J Respir Crit Care Med. 1997;155:211–5.

    Article  CAS  Google Scholar 

  5. Hosselet JJ, Norman RG, Ayappa I, Rapoport DM. Detection of flow limitation with a nasal cannula/pressure transducer system. Am J Respir Crit Care Med. 1998;157:1461–7.

    Article  CAS  Google Scholar 

  6. Mooney AM, Abounasr KK, Rapoport DM, Ayappa I. Relative prolongation of inspiratory time predicts high versus low resistance categorization of hypopneas. J Clin Sleep Med. 2012;8:177–85.

    Article  Google Scholar 

  7. Ayappa I, Norman RG, Krieger AC, Rosen A, O’Malley RL, Rapoport DM. Non-invasive detection of respiratory effort-related arousals (RERAs) by a nasal cannula/pressure transducer system. Sleep. 2000;23:763–71.

    Article  CAS  Google Scholar 

  8. de Godoy LB, Palombini LO, Guilleminault C, Poyares D, Tufik S, Togeiro SM. Treatment of upper airway resistance syndrome in adults: where do we stand? Sleep Sci. 2015;8:42–8.

    Article  Google Scholar 

  9. Guilleminault C, De Los Reyes V. Upper-airway resistance syndrome. Handb Clin Neurol. 2011;98:401–9.

    Article  Google Scholar 

  10. American Academy of Sleep Medicine. International classification of sleep disorders. 3rd ed. Darien: American Academy of Sleep Medicine; 2014. p. 53–62.

    Google Scholar 

  11. Stoohs R, Gold AR. Snoring and pathologic upper airway resistance syndromes. In: Kryger MH, Roth T, Dement WC, editors. Principles and practice of sleep medicine. 6th ed. Philadelphia: Elsevier; 2017. p. 1088–101.

    Chapter  Google Scholar 

  12. Guilleminault C, Black JE, Palombini L, Ohayon M. A clinical investigation of obstructive sleep apnea syndrome (OSAS) and upper airway resistance syndrome (UARS) patients. Sleep Med. 2000;1:51–6.

    Article  CAS  Google Scholar 

  13. Kristo DA, Lettieri CJ, Andrada T, Taylor Y, Eliasson A. Silent upper airway resistance syndrome; prevalence in a mixed military population. Chest. 2005;127:1654–7.

    Article  Google Scholar 

  14. Palombini LO, Tufik S, Rapoport DM, Ayappa IA, Guilleminault C, de Godoy LB, Castro LS, Bittencourt L. Inspiratory flow limitation in a normal population of adults in São Paulo, Brazil. Sleep. 2013;36:1663–8.

    Article  Google Scholar 

  15. Gold AR, Dipalo F, Gold MS, O’Hearn D. The symptoms and signs of upper airway resistance syndrome; a link to the functional somatic syndromes. Chest. 2003;123:87–95.

    Article  Google Scholar 

  16. Pepin JL, Guillot M, Tamisier R, Levy P. The upper airway resistance syndrome. Respiration. 2012;83:559–66.

    Article  CAS  Google Scholar 

  17. Stoohs RA, Knaack L, Blum HC, Janicki J, Hohenhorst W. Differences in clinical features of upper airway resistance syndrome, primary snoring, and obstructive sleep apnea/hypopnea syndrome. Sleep Med. 2008;9:121–8.

    Article  Google Scholar 

  18. de Godoy LB, Palombini LO, Haddad FL, Rapoport DM, Vidigal TA, Klichouvicz PC, Tufik S, Togeiro SM. New insights on the pathophysiology of inspiratory flow limitation during sleep. Lung. 2015;193:387–92.

    Article  Google Scholar 

  19. Calero G, Farre R, Ballester E, Hernandez L, Daniel N, Canal JM. Physiological consequences of prolonged periods of flow limitation in patients with sleep apnea hypopnea syndrome. Respir Med. 2006;100:813–7.

    Article  Google Scholar 

  20. Guilleminault C, Stoohs R, Shiomi T, Kushida C, Schnittger I. Upper airway resistance syndrome, nocturnal blood pressure monitoring, and borderline hypertension. Chest. 1996;109:901–8.

    Article  CAS  Google Scholar 

  21. Gold AR, Marcus CL, Dipalo F, Gold MS. Upper airway collapsibility during sleep in upper airway resistance syndrome. Chest. 2002;121:1531–40.

    Article  Google Scholar 

  22. de Godoy LB, Luz GP, Palombini LO, Silva LO, Hoshino W, Guimaraes TM, Tufik S, Bittencourt L, Togeiro SM. Upper airway resistance syndrome patients have worse sleep quality compared to mild obstructive sleep apnea. PLoS One. 2016;11:1–12.

    Article  Google Scholar 

  23. Guilleminault C, Kirisogly C, Poyares D, Palombini L, Leger D, Farid-Moayer M, Ohayon MM. Upper airway resistance syndrome: a long-term outcome study. J Psychiatry Res. 2006;40:273–9.

    Article  Google Scholar 

  24. Godoy LB, Palombini L, Poyares D, et al. Long-term oral appliance therapy improves daytime function and mood in upper airway resistance syndrome patients. Sleep. 2017;4(12):zsx175.

    Google Scholar 

  25. Montserrat JM, Badia JR. Upper airway resistance syndrome. Sleep Med Rev. 1999;3:5–21.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, New York, NY, USA

    Robert Hiensch & David M. Rapoport

Authors
  1. Robert Hiensch
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. David M. Rapoport
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Pulmonary, Critical Care and Sleep Medicine, Yale University, New Haven, CT, USA

    Christine Won

Rights and permissions

Reprints and permissions

Copyright information

© 2021 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Hiensch, R., Rapoport, D.M. (2021). Upper Airway Resistance Syndrome. In: Won, C. (eds) Complex Sleep Breathing Disorders. Springer, Cham. https://doi.org/10.1007/978-3-030-57942-5_9

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-57942-5_9

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-57941-8

  • Online ISBN: 978-3-030-57942-5

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation