A 40-year-old woman came to our clinic complaining of fatigue with some daytime sleepiness. She was slightly overweight and her husband reported that she snores on occasion. She had a complete physical with labs through her primary-care provider, and nothing was found to be abnormal. The woman was taking no medications and was referred to our office to rule out obstructive sleep apnea (OSA).
The polysomnogram showed an apnea/hypopnea index of 1.5 (less than 5 is considered normal and not consistent with OSA). However, she was found to have a high number of arousals during sleep. These arousals are called respiratory effort related arousals (RERAs). A RERA is an arousal following a period of high respiratory effort that does not meet the criteria for OSA. This is often seen in a syndrome called upper airway resistance syndrome (UARS).
With UARS, often fatigue and daytime sleepiness are the chief complaint. Snoring is common, but not all who have the syndrome snore. The arousals that occur during sleep cause unrefreshing sleep. UARS may be a separate syndrome but part of a spectrum between simple snoring and OSA. Subtle changes in respiration followed by arousals in the brain may be the only clue.
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Other symptoms of UARS can include dry mouth on awakening, morning headaches, daytime sleepiness, hypertension, or symptoms of insomnia. Of course, such other illnesses as depression, narcolepsy, and seizure disorder should be ruled out.
Treatment options can include CPAP therapy, dental appliances, and uvulopalatopharyngoplasty. Weight loss is also recommended and may cure the problem in some patients.
Many sleep professionals believe that UARS will eventually lead to OSA, so the recognition of the symptoms and treatment is important. Consider UARS in your patients who complain of unrefreshing sleep and fatigue. Early treatment can help prevent serious disease.
Sharon M. O’Brien, MPAS, PA-C, works at Presbyterian Sleep Health in Charlotte, N.C. Her main interest is helping patients understand the importance of sleep hygiene and the impact of sleep on health.
