Upper airway resistance syndrome (UARS): often missed

The short answer

In this syndrome the throat narrows during sleep without closing: breathing takes more effort and the brain wakes up for a moment, again and again, without you noticing. Oxygen does not drop and the apnea index is normal, which is why it often goes unnoticed: the person wakes up tired, sleeps poorly or has headaches, and is told the sleep study is fine. Remember this: a normal home sleep test does not rule it out.

What upper airway resistance syndrome is

Upper airway resistance syndrome (UARS; in Spanish also SRVAS or SARVAS) is a sleep breathing disorder in which the airway narrows without closing. Each narrowing forces a harder breath, and after one to three of those breaths the brain wakes for a few seconds to reopen the airway. It was described in 1993 in 15 people who had been labelled as having unexplained sleepiness; in them, CPAP made the sleepiness and the brief awakenings disappear [1].

These brief awakenings are called RERAs (respiratory effort-related arousals). The American Academy of Sleep Medicine counts them together with apneas and hypopneas in the respiratory disturbance index (RDI), and recommends treating patients with symptoms when that index reaches 5 per hour [4]. Honestly, it is a debated condition: the international classification does not treat it as a separate disease but as a subgroup of obstructive sleep apnea [2], and some authors still discuss its criteria, or even whether it exists as a syndrome [3].

Why it goes unnoticed

The usual figures come out normal. By definition the apnea index is below 5 and oxygen does not drop significantly [3]. A report that only looks at those two figures says «normal».
Home tests do not see it. Most home devices cannot record the brief awakenings, so the AASM advises an in-laboratory polysomnography when the risk is high and the home test is negative [4]; its guideline recommends the same when a single home test is negative, inconclusive or technically poor [5].
It depends on how the study is scored. With the rule that counts a hypopnea when there is a 3% oxygen drop or an awakening, most of these events become hypopneas; with the 4% rule they are left as RERAs, and if the laboratory does not score them, they vanish from the report [6].
The profile does not fit the stereotype. It is more frequent in young adult women [3]; women with this kind of breathing disorder and a low index were younger, slimmer and had thinner necks than those with apnea [7]. And snoring may be absent: in the first series it was present in 10 of 15 people [1].
The symptoms point elsewhere. Insomnia, headaches or irritable bowel are more common the lower the apnea index, and resemble the so-called functional somatic syndromes [8]; in women, sleepiness is often mistaken for tiredness [2]. In a classic study of women with sleep breathing disorders, diagnosis took on average almost 10 years from the first symptoms [7].

Symptoms

Tiredness and unrefreshing sleep are often more noticeable than sleepiness. In a study of 115 people, those with this syndrome had worse sleep quality and more fatigue than people with mild apnea [9], and their quality of life was as affected as that of people with apnea [10].

Waking up tired even after enough hours of sleep.
Daytime sleepiness: in people with an apnea index under 15, more airflow limitation during sleep was linked to twice the risk of excessive sleepiness [11].
Insomnia, especially difficulty falling asleep, and waking up during the night [8].
Morning headaches, poor concentration and low mood [8][9].
Irritable bowel [8].
Low blood pressure or dizziness on standing up: in a single-centre study it affected about one in five patients [12].
Snoring, but not always [1].

Who has it

The only population study available, in São Paulo, found it in 3.1% of adults: 4.4% of women and 1.5% of men [3]. It has no Spanish data yet, and the figure changes with the criteria used. The anatomy matters: in people with mild breathing disorders and a lot of airflow limitation, an abnormal nose made it 3.2 times more likely, bulky side walls of the throat 4.2 times and mouth breathing 2.7 times [13]. A narrow palate or a small, set-back jaw also narrow the airway; you can read more in nose, snoring and apnea and adult palatal expansion.

«My sleep study was normal and I am still tired»

It is one of the most common situations. Before accepting that «there is nothing», it is worth checking three things in your report, preferably with a specialist:

Was it done at home or in a laboratory? A home test does not record sleep or brief awakenings; if the suspicion remains, a polysomnography is recommended [5]. Compare both in home sleep test or polysomnography.
Does it mention RERAs or an RDI, and which hypopnea rule (3% or 4%)? Without that, this syndrome cannot be assessed [6]. The indices are explained in AHI, ODI and CT90.
Does it measure airflow limitation? Some limitation is normal: 95% of healthy people have it for less than 30% of their sleep [14]. Much more than that points to resistance in the airway.

How it is diagnosed

Consultation and ENT examination: nose, palate, tongue, jaw and bite, looking for what narrows the airway.
In-laboratory polysomnography: it records the brain (to see the brief awakenings) and the shape of the airflow; RERAs should be scored and the RDI reported [4].
Sleep endoscopy (DISE), in selected cases: before deciding on a treatment, it shows where the airway narrows during a medication-induced sleep. In 54 people with an apnea index under 5, most had narrowing at several levels (83%), most often at the soft palate [15]. More in sleep endoscopy.

Diagnostic criteria: could it be UARS?

There is no validated questionnaire for this syndrome, and the American Academy of Sleep Medicine advises against diagnosing sleep apnea with questionnaires [5]. What does help is knowing what should raise the suspicion and what the sleep study has to show to confirm it. The exact criteria vary from one research group to another, and none is validated or agreed by consensus [9][3].

It may be UARS if…

To guide you: none of these signs is enough on its own.

You wake up tired or feel sleepy during the day even after enough hours of sleep; in this syndrome tiredness often weighs more than sleepiness [9][10].
Your sleep is unrefreshing: you wake up often or find it hard to fall asleep [8][31].
You snore… or not: only about half do (48.8%), and in one series 9.1% did not snore at all [10][29].
Your partner rarely sees you stop breathing: only 17.5% reported pauses, compared with 44% in apnea [10].
You do not fit the typical apnea profile: younger and slimmer, and more often a woman (51.6% women, compared with 13.2% in apnea) [10][7].
Your nose is blocked, you breathe through your mouth or wake up with a dry mouth: nasal problems were 15.6 times more frequent than in healthy people [30][13].
You also have headaches, irritable bowel, low mood or anxiety [8][9].
Other causes of tiredness have already been ruled out: thyroid, anaemia or low iron, depression or medicines [23].

It is probably not UARS if…

You snore but wake up rested and feel well during the day: that is simple snoring (apnea index under 5 and no daytime symptoms) [32].
Your sleep study shows an apnea index (AHI) of 5 or more per hour with symptoms: that is already called obstructive sleep apnea [5].
The report shows RERAs but you have no symptoms: 3.8% of the general population has 5 or more per hour without any harm [28].

In-laboratory polysomnography confirms it if…

What is looked at	Usual criterion
The test	In-laboratory polysomnography that records the brain (EEG). A normal home sleep test does not rule it out, because it does not see the brief awakenings [5][33].
Apneas and hypopneas (AHI)	Under 5 per hour [9][3].
Breathing effort	At least one of: an RDI (apneas, hypopneas and RERAs) above 5 per hour; 5 or more RERAs per hour; or airflow limitation during more than 30% of sleep (some groups use lower thresholds) [9][10][14][3].
Oxygen	Lowest saturation of 92% or more [3][10].
Daytime symptoms	Tiredness or sleepiness (for example, an Epworth score of 10 or more, or a high fatigue score) [9].

Two warnings. The official classification (ICSD-3) does not consider it a separate disease: it includes it in obstructive sleep apnea when the RDI reaches 5 per hour with symptoms [4][5]. And depending on the rule the laboratory uses to count hypopneas (3% or 4%), the same night can appear in the report as «mild apnea» or as RERAs [6].

Simple snoring, UARS and apnea: the differences

	Simple snoring	UARS	Sleep apnea
What happens	The throat vibrates	The throat narrows, breathing takes effort and the brain wakes briefly	The throat closes partly or fully, breathing stops or drops
Apnea index (AHI)	Normal	Normal (under 5 per hour)	5 or more per hour
Oxygen	Normal	Normal or almost	Drops repeatedly
How you feel	Usually fine	Tired, unrefreshing sleep, insomnia	Sleepiness, tiredness
Test that detects it	—	In-lab polysomnography	Home test or polysomnography

More on the two ends of the spectrum in snoring or sleep apnea.

Is it linked to chronic fatigue, fibromyalgia, menopause, burnout or stress?

This is where most is written, and where caution is most needed. What exists are associations in small studies, not proof that the syndrome causes these conditions.

Fibromyalgia

In 28 women with fibromyalgia, 27 had a sleep breathing disorder, almost all of this mild type; in the 14 treated with CPAP, symptoms improved by 23% to 47%, but there was no comparison group [16]. It is worth ruling it out if there is also snoring or unrefreshing sleep; it is not a treatment for fibromyalgia.

Chronic fatigue (ME/CFS)

A systematic review of 20 studies found inconsistent sleep results and small samples [17]. A sleep study can uncover a treatable disorder, but there is no proof that this syndrome causes chronic fatigue.

Menopause

After menopause, partial obstruction of the airway was ten times more common than apnea (17.7% versus 1.6%), and oestrogens did not correct it [18]. In postmenopausal women with insomnia and this syndrome, treating breathing improved daytime tiredness more than behavioural therapy, which worked better for falling asleep [19]. Hot flushes also wake women up, so both need telling apart; see sleep apnea and menopause.

Burnout and stress

No study links burnout with this syndrome. Burnout itself breaks up sleep: young people with high burnout scores had more awakenings (12 versus 8 per hour) [20]. In a placebo-controlled trial in patients with the syndrome, an oral appliance reduced stress symptoms after a year and a half [21]. A promising line, not an explanation of burnout.

Anxiety and depression

In the same placebo-controlled trial, the oral appliance reduced the severity of depressive symptoms [22]. Treating breathing does not replace psychological or psychiatric care. More in sleep apnea and mental health.

Irritable bowel and headache

Both are more frequent in patients with this syndrome than in those with more severe apnea [8]. It is an association, not a cause; there are no specific studies on migraine.

Not all tiredness is UARS

Tiredness is the main or secondary reason for 10% to 20% of visits to the family doctor. The most common causes of persistent tiredness are sleep and sleep breathing disorders, depression (18.5%) and psychosocial stress; anaemia and other organic causes are rare (4.3%) [23]. That is why it is worth starting with a history, an examination and simple blood tests, and ruling out:

Too few hours of sleep or irregular schedules.
Obstructive sleep apnea (symptoms).
Insomnia, alone or with apnea (COMISA).
Depression, anxiety and stress.
Anaemia or low iron: in women with ferritin below 50, iron reduced tiredness more than placebo (47.7% versus 28.8%) [24].
Thyroid problems.
Restless legs or periodic limb movements.
Narcolepsy or idiopathic hypersomnia.
Medicines that cause drowsiness.
Daytime sleepiness from other causes (causes of daytime sleepiness).

Treatment: what helps and what is still unproven

The evidence is limited and comes from few groups: a 2015 review found almost only case series, and not a single CPAP trial in this syndrome [34]. This is what there is, from most to least solid:

Mandibular advancement device

It is the only treatment with a placebo-controlled trial: 30 patients for a year and a half. The RDI, RERAs, airflow limitation and awakenings went down, and sleep quality, morning attention and depressive symptoms improved [22]; stress also fell, although memory and attention tests did not change [21]. To be honest, sleepiness and tiredness did not improve more than with the placebo [21]. It was worn about 6 hours a night and side effects were mild, such as tooth or jaw discomfort [21]. An earlier study of 32 patients, without a comparison group, also saw sleepiness improve [37]. Whether it will work for you can be checked beforehand: DISE before the appliance.

CPAP

There is no CPAP trial in this syndrome, only small series [34]. In the first one, with 15 patients, the time it took them to fall asleep during the day (multiple sleep latency test) rose from 5.1 to 13.5 minutes and the brief awakenings fell from 31 to 8 per hour [1]. In another small series, 5 of 6 patients with borderline blood pressure had it normalised after a month [36]. Low pressures are usually enough, around 7 cmH₂O [35]. The problem is keeping it up: the 2015 review describes low adherence [34], and after four and a half years none of 94 patients was using it (in most, their US insurer had refused to cover it) [27]. If it is hard for you, read CPAP alternatives.

Surgery

The only systematic review (2021) found 3 studies with 49 people: surgery improved sleepiness (the Epworth score fell by about 6 points on average; from 11.0 to 7.0 in its own series) but did not change the sleep study indices [25]. It is chosen according to where the airway narrows:

Nose (septoplasty, turbinates): there are no series of septoplasty alone in this syndrome. In postmenopausal women with insomnia and UARS, treating breathing, with CPAP or with radiofrequency of the turbinates, improved daytime tiredness more than behavioural therapy [19]. Nasal strips and dilators did not work: in a trial with 18 patients they changed neither the brief awakenings nor sleepiness [39].
Palate: in 9 patients operated on the palate, the Epworth score fell from 12.0 to 3.4, with no complications [38].
Jaws (maxillomandibular advancement, palatal expansion): there are no studies in adults with this syndrome. The closest is mild apnea: in 18 patients who had jaw (orthognathic) surgery, the apnea index fell from 7.7 to 5.0 and half were cured at one year [40].
Hypoglossal nerve stimulation: no studies in this syndrome.

Myofunctional therapy

It helps in apnea, but there is no evidence for this syndrome in particular [26]. More in myofunctional therapy.

Sleeping pills

In 8 men, a sleeping pill (zopiclone) improved sleep and daytime sleepiness, but not breathing or the brief awakenings [41]. It does not treat the cause.

Without treatment, in 94 patients followed for four and a half years, complaints of tiredness, insomnia and low mood increased, and the use of sleeping pills rose from 11.7% to 61.7%; only 5 progressed to apnea [27].

And a counterweight, to avoid alarm: in the general population, 3.8% have 5 or more RERAs per hour without any associated harm [28]. A figure in the report is not a disease on its own: what matters is whether there are symptoms.

When to see a specialist

You wake up tired most days despite sleeping enough, and the usual tests are normal.
You snore, breathe through your mouth or have a blocked nose at night.
You feel sleepy while driving (sleep apnea and driving).
You are a woman with tiredness, insomnia or headaches that nobody has explained (sleep apnea in women).

If you are tired and nobody has found why, looking at how you breathe while you sleep is worth it.

See the specialist Sleep assessment

Frequently asked questions

What is UARS?

Upper airway resistance syndrome (also called SRVAS in Spanish): during sleep the throat narrows without fully closing, breathing takes more effort and the brain wakes up for a moment, many times a night, without the person remembering it. Oxygen usually does not drop and the apnea index comes out normal.

Can you be tired all day without having sleep apnea?

Yes. There are many causes: too few hours of sleep, depression, anxiety, stress, anaemia or low iron, thyroid problems, medicines and other sleep disorders. One of them, little known, is this syndrome. It is worth an orderly assessment, starting with your family doctor.

My home sleep test was normal but I am still tired. Could it be UARS?

It could. Most home tests do not record sleep or the brief awakenings, which are exactly what defines this syndrome. If the suspicion remains, the American Academy of Sleep Medicine recommends an in-laboratory polysomnography.

Is UARS the same as sleep apnea?

They are related. Official classifications treat it as a form of obstructive sleep apnea, not a separate disease, and some experts still debate whether it is a syndrome of its own. What sets it apart is that the airway does not fully close and oxygen does not drop, but sleep is broken up all the same.

What are the RERAs in my sleep report?

Respiratory effort-related arousals: breathing becomes harder for a few seconds and the brain wakes briefly to open the airway. They are added to apneas and hypopneas in the RDI. Depending on the scoring rule the laboratory uses, many of them are counted as hypopneas instead.

Is it more common in women?

In the only population study available (São Paulo), yes: 4.4% of women versus 1.5% of men, especially young adults. Older series found no difference between sexes, so it is not exclusive to women.

Is it linked to fibromyalgia, anxiety or stress?

An association has been described in small studies, and in a placebo-controlled trial an oral appliance reduced stress and depression symptoms. But it has not been shown to cause those conditions, and treating breathing does not replace their own treatment.

How do I know if I might have UARS?

Suspect it if you wake up tired or sleepy even after enough sleep, your sleep is unrefreshing, you breathe poorly through your nose or sleep with your mouth open, and other causes of tiredness have been ruled out; it can happen even if you do not snore. Only an in-laboratory polysomnography confirms it: an apnea index under 5, but with arousals from breathing effort (RERAs) or airflow limitation, no significant oxygen drops, and daytime symptoms. There is no validated questionnaire to diagnose it.

Can it be treated? Does CPAP or an oral appliance help?

There are options, with limited evidence: the mandibular advancement device is the only one with a placebo-controlled trial (30 patients), and it improved breathing, brief awakenings, mood and stress, although not tiredness more than the placebo; CPAP worked in small series, at low pressures, but is hard to keep using; and surgery improved sleepiness in small studies. What suits each person depends on where their airway narrows.

References

Guilleminault C, Stoohs R, Clerk A, Cetel M, Maistros P. A cause of excessive daytime sleepiness. The upper airway resistance syndrome. Chest. 1993;104(3):781-7. PMID 8365289 (trabajo fundacional). doi.org/10.1378/chest.104.3.781
Pépin JL, Guillot M, Tamisier R, Lévy P. The upper airway resistance syndrome. Respiration. 2012;83(6):559-66. PMID 22377755. doi.org/10.1159/000335839
Tufik SB, Pires GN, Palombini L, Andersen ML, Tufik S. Prevalence of upper airway resistance syndrome in the São Paulo Epidemiologic Sleep Study. Sleep Med. 2022;91:43-50. PMID 35255282. doi.org/10.1016/j.sleep.2022.02.004
Malhotra RK, Kirsch DB, Kristo DA, et al. Polysomnography for Obstructive Sleep Apnea Should Include Arousal-Based Scoring: An American Academy of Sleep Medicine Position Statement. J Clin Sleep Med. 2018;14(7):1245-1247. PMID 29991439. doi.org/10.5664/jcsm.7234
Kapur VK, Auckley DH, Chowdhuri S, et al. Clinical Practice Guideline for Diagnostic Testing for Adult Obstructive Sleep Apnea: An American Academy of Sleep Medicine Clinical Practice Guideline. J Clin Sleep Med. 2017;13(3):479-504. PMID 28162150. doi.org/10.5664/jcsm.6506
Tu X, Morgenthaler TI, Baughn J, Herold DL, Lipford MC. Are scoring respiratory effort-related arousals worth the effort? A study comparing outcomes between 4% vs 3% hypopnea scoring rules. Sleep Med. 2024;124:396-403. PMID 39395262. doi.org/10.1016/j.sleep.2024.09.037
Guilleminault C, Stoohs R, Kim YD, Chervin R, Black J, Clerk A. Upper airway sleep-disordered breathing in women. Ann Intern Med. 1995;122(7):493-501. PMID 7872583 (trabajo fundacional). doi.org/10.7326/0003-4819-122-7-199504010-00003
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(1):87-95. PMID 12527607. doi.org/10.1378/chest.123.1.87
de Godoy LBM, Luz GP, Palombini LO, et al. Upper Airway Resistance Syndrome Patients Have Worse Sleep Quality Compared to Mild Obstructive Sleep Apnea. PLoS One. 2016;11(5):e0156244. PMID 27228081. doi.org/10.1371/journal.pone.0156244
Vizcarra-Escobar D, Duque KR, Barbagelata-Agüero F, Vizcarra JA. Quality of life in upper airway resistance syndrome. J Clin Sleep Med. 2022;18(5):1263-1270. PMID 34931609. doi.org/10.5664/jcsm.9838
Mann DL, Staykov E, Georgeson T, et al. Flow Limitation Is Associated with Excessive Daytime Sleepiness in Individuals without Moderate or Severe Obstructive Sleep Apnea. Ann Am Thorac Soc. 2024;21(8):1186-1193. PMID 38530665. doi.org/10.1513/AnnalsATS.202308-710OC
Guilleminault C, Faul JL, Stoohs R. Sleep-disordered breathing and hypotension. Am J Respir Crit Care Med. 2001;164(7):1242-7. PMID 11673217. doi.org/10.1164/ajrccm.164.7.2011036
de Godoy LBM, Palombini LO, Martinho Haddad FL, et al. New insights on the pathophysiology of inspiratory flow limitation during sleep. Lung. 2015;193(3):387-92. PMID 25827757. doi.org/10.1007/s00408-015-9714-x
Palombini LO, Tufik S, Rapoport DM, et al. Inspiratory flow limitation in a normal population of adults in São Paulo, Brazil. Sleep. 2013;36(11):1663-8. PMID 24179299. doi.org/10.5665/sleep.3122
Spinowitz S, Kim M, Park SY. Patterns of Upper Airway Obstruction on Drug-Induced Sleep Endoscopy in Patients with Sleep-Disordered Breathing with AHI <5. OTO Open. 2017;1(3). PMID 30480190. doi.org/10.1177/2473974X17721483
Gold AR, Dipalo F, Gold MS, Broderick J. Inspiratory airflow dynamics during sleep in women with fibromyalgia. Sleep. 2004;27(3):459-66. PMID 15164899. doi.org/10.1093/sleep/27.3.459
Maksoud R, Eaton-Fitch N, Matula M, et al. Systematic Review of Sleep Characteristics in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome. Healthcare (Basel). 2021;9(5):568. PMID 34065013. doi.org/10.3390/healthcare9050568
Polo-Kantola P, Rauhala E, Helenius H, Erkkola R, Irjala K, Polo O. Breathing during sleep in menopause: a randomized, controlled, crossover trial with estrogen therapy. Obstet Gynecol. 2003;102(1):68-75. PMID 12850609. doi.org/10.1016/s0029-7844(03)00374-0
Guilleminault C, Palombini L, Poyares D, Chowdhuri S. Chronic insomnia, premenopausal women and sleep disordered breathing: part 2. Comparison of nondrug treatment trials in normal breathing and UARS post menopausal women complaining of chronic insomnia. J Psychosom Res. 2002;53(1):617-23. PMID 12127180. doi.org/10.1016/s0022-3999(02)00463-4
Söderström M, Ekstedt M, Akerstedt T, Nilsson J, Axelsson J. Sleep and sleepiness in young individuals with high burnout scores. Sleep. 2004;27(7):1369-77. PMID 15586790. doi.org/10.1093/sleep/27.7.1369
de Godoy LBM, Sousa KMM, Palombini LO, et al. Long term oral appliance therapy decreases stress symptoms in patients with upper airway resistance syndrome. J Clin Sleep Med. 2020;16(11):1857-1862. PMID 32686643. doi.org/10.5664/jcsm.8698
Godoy LBM, Palombini L, Poyares D, et al. Long-Term Oral Appliance Therapy Improves Daytime Function and Mood in Upper Airway Resistance Syndrome Patients. Sleep. 2017;40(12). PMID 29045745. doi.org/10.1093/sleep/zsx175
Maisel P, Baum E, Donner-Banzhoff N. Fatigue as the Chief Complaint—Epidemiology, Causes, Diagnosis, and Treatment. Dtsch Arztebl Int. 2021;118(33-34):566-576. PMID 34196270. doi.org/10.3238/arztebl.m2021.0192
Vaucher P, Druais PL, Waldvogel S, Favrat B. Effect of iron supplementation on fatigue in nonanemic menstruating women with low ferritin: a randomized controlled trial. CMAJ. 2012;184(11):1247-54. PMID 22777991. doi.org/10.1503/cmaj.110950
Kshirsagar RS, Harless L, Liang J, Durr M. The efficacy of surgery for upper airway resistance syndrome: A systematic review, meta-analysis and case series. Am J Otolaryngol. 2021;42(5):103011. PMID 33831820. doi.org/10.1016/j.amjoto.2021.103011
Carrasco-Llatas M, O’Connor-Reina C, Calvo-Henríquez C. The Role of Myofunctional Therapy in Treating Sleep-Disordered Breathing: A State-of-the-Art Review. Int J Environ Res Public Health. 2021;18(14):7291. PMID 34299742. doi.org/10.3390/ijerph18147291
Guilleminault C, Kirisoglu C, Poyares D, et al. Upper airway resistance syndrome: a long-term outcome study. J Psychiatr Res. 2006;40(3):273-9. PMID 16473570. doi.org/10.1016/j.jpsychires.2005.03.007
Ogna A, Tobback N, Andries D, et al. Prevalence and Clinical Significance of Respiratory Effort-Related Arousals in the General Population. J Clin Sleep Med. 2018;14(8):1339-1345. PMID 30092888. doi.org/10.5664/jcsm.7268
Kristo DA, Lettieri CJ, Andrada T, Taylor Y, Eliasson AH. Silent upper airway resistance syndrome: prevalence in a mixed military population. Chest. 2005;127(5):1654-7. PMID 15888842. doi.org/10.1378/chest.127.5.1654
de Oliveira PWB, Gregorio LL, Silva RS, Bittencourt LRA, Tufik S, Gregório LC. Orofacial-cervical alterations in individuals with upper airway resistance syndrome. Braz J Otorhinolaryngol. 2016;82(4):377-84. PMID 26671020. doi.org/10.1016/j.bjorl.2015.05.015
Gold AR, Gold MS, Harris KW, Espeleta VJ, Amin MM, Broderick JE. Hypersomnolence, insomnia and the pathophysiology of upper airway resistance syndrome. Sleep Med. 2008;9(6):675-83. PMID 18024168. doi.org/10.1016/j.sleep.2007.08.013
Chang JL, Goldberg AN, Alt JA, et al. International Consensus Statement on Obstructive Sleep Apnea. Int Forum Allergy Rhinol. 2023;13(7):1061-1482. PMID 36068685. doi.org/10.1002/alr.23079
Palombini LO, Assis M, Drager LF, et al. 2024 Position Statement on the Use of Different Diagnostic Methods for Sleep Disorders in Adults – Brazilian Sleep Association. Sleep Sci. 2024;17(4):e476-e492. PMID 39698173. doi.org/10.1055/s-0044-1800887
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(1):42-8. PMID 26483942 (revisión). doi.org/10.1016/j.slsci.2015.03.001
Gold AR, Marcus CL, Dipalo F, Gold MS. Upper airway collapsibility during sleep in upper airway resistance syndrome. Chest. 2002;121(5):1531-40. PMID 12006440. doi.org/10.1378/chest.121.5.1531
Guilleminault C, Stoohs R, Shiomi T, Kushida C, Schnittger I. Upper airway resistance syndrome, nocturnal blood pressure monitoring, and borderline hypertension. Chest. 1996;109(4):901-8. PMID 8635368. doi.org/10.1378/chest.109.4.901
Yoshida K. Oral device therapy for the upper airway resistance syndrome patient. J Prosthet Dent. 2002;87(4):427-30. PMID 12011859. doi.org/10.1067/mpr.2002.123228
Newman JP, Clerk AA, Moore M, Utley DS, Terris DJ. Recognition and surgical management of the upper airway resistance syndrome. Laryngoscope. 1996;106(9 Pt 1):1089-93. PMID 8822711. doi.org/10.1097/00005537-199609000-00009
Bahammam AS, Tate R, Manfreda J, Kryger MH. Upper airway resistance syndrome: effect of nasal dilation, sleep stage, and sleep position. Sleep. 1999;22(5):592-8. PMID 10450594. pubmed.ncbi.nlm.nih.gov/10450594/
Valls-Ontañón A, Giralt-Hernando M, Zamora-Almeida G, Anitua E, Mazarro-Campos A, Hernández-Alfaro F. Does orthognathic surgery have an incidentally beneficial effect on mild or asymptomatic sleep apnoea? Int J Oral Maxillofac Surg. 2023;52(12):1255-1261. PMID 37211459. doi.org/10.1016/j.ijom.2023.04.004
Lofaso F, Goldenberg F, Thebault C, Janus C, Harf A. Effect of zopiclone on sleep, night-time ventilation, and daytime vigilance in upper airway resistance syndrome. Eur Respir J. 1997;10(11):2573-7. PMID 9426097. doi.org/10.1183/09031936.97.10112572

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Upper airway resistance syndrome (UARS): the great unknown of sleep