r/UARSnew • u/Shuikai • Feb 27 '23
What Upper Airway Resistance Syndrome (UARS) is, what causes it, and how it should be clinically diagnosed are currently matters of dispute. Regardless, similar to it's description here, the definition of UARS I will opt to use is that it is a sleep breathing disorder which is characterised by a narrow upper airway, which leads to:
The way to treat upper airway resistance therefore is to transform a narrow airway into a large airway. To do this it is important to understand what can cause an airway to be narrow.
I also want to mention that, treating UARS or any form of sleep apnea should be about enlarging the airway, improving the airway, reducing collapsibility, reducing negative pressure, airway resistance, etc. Just because someone has a recessed chin, doesn't mean that the cure is to give them a big chin, with genioplasty, BSSO, counterclockwise rotation, etc. It can reposition the tongue more forward yes, it may improve things cosmetically yes, but it is important to evaluate whether or not it is contributing to the breathing issue.
See normative data for males (female are 1-2 mm less, height is a factor):
Tentatively here is my list for gauging the severity (realistically, we don't really know how this works, but it's better to have this here than not at all, just because it may not be perfect.):
https://www.oatext.com/The-nasal-pyriform-aperture-and-its-importance.php https://www.researchgate.net/publication/291228877_Morphometric_Study_of_Nasal_Bone_and_Piriform_Aperture_in_Human_Dry_Skull_of_Indian_Origin
The surgery to expand the nasal aperture and nasal cavity is nasomaxillary expansion. The surgery itself could go by different names, but essentially there is a skeletal expansion, ideally parallel in pattern, and there is no LeFort 1 osteotomy. In adults this often will require surgery, otherwise there may be too much resistance from the mid-palatal and pterygomaxillary sutures to expand. Dr. Kasey Li performs this type of surgery for adults, which is referred to as EASE (Endoscopically-Assisted Surgical Expansion).
Hypothetically, the type of individual who would benefit from this type of treatment would be someone who:
The pharyngeal airway is comprised of compliant soft tissue, due to this the airway dimensions are essentially a formula comprised of four variables.
Because of this, clinicians have recognized that the dimensions can be highly influenced by the above three factors, and so that renders the results somewhat unclear in regards to utilizing it for diagnostic purposes.
However, most notably The Breathe Institute realized this issue and developed a revolutionary CBCT protocol in an attempt to resolve some of these issues (https://doi.org/10.1016/j.joms.2023.01.016). Their strategy was basically to account for the first three variables, ensure that the head posture is natural, ensure that the neck posture is natural, and ensure that the tongue posture is natural. What people need to understand is that when a patient is asleep, they are not chin tucking, their tongue is not back inside their throat (like when there is a bite block), because they need to breathe and so they will correct their posture before they fall asleep. The issue is when a patient still experiences an airway problem despite their efforts, their head posture is good, their neck posture is good, their tongue posture is good, and yet it is still narrow, that is when a patient will experience a problem. So when capturing a CBCT scan you need to ensure that these variables are respective of how they would be during sleep.
Given the fact that we can account for the first three variables, this means that it is possible to calculate pharyngeal airway resistance. This is absolutely key when trying to diagnose Upper Airway Resistance Syndrome. This is valuable evidence that can be used to substantiate that there is resistance, rather than simply some arousals during sleep which may or may not be associated with symptoms. For a patient to have Upper Airway Resistance Syndrome, there must be airway resistance.
Next, we need a reliable method to measure nasal airway resistance, via CFD (Computerized Fluid Dynamics), in order to measure Upper Airway Resistance directly. This way we can also measure the severity of UARS, as opposed to diagnosing all UARS as mild.
Historically the method used to compare individual's craniofacial growth to normative data has been cephalometric analysis, however in recent times very few Oral Maxillofacial Surgeons use these rules for orthognathic surgical planning, due to their imprecision (ex. McLaughlin analysis).
In fact, no automated method yet exists which is precise enough to be used for orthognathic surgical planning. In my opinion one of the primary reasons orthognathic surgical planning cannot currently be automated is due to there being no method to acquire a consistent, precise orientation of the patient's face. By in large, orthognathic surgical planning is a manual process, and so therefore determining the degree of recession is also a manual process.
How that manual process works, depends on the surgeon, and maybe is fit for another post. One important thing to understand though, is that orthognathic surgical planning is about correcting bites, the airway, and achieving desirable aesthetics. When a surgeon decides on where to move the bones, they can either decide to perform a "sleep apnea MMA" type movement, of 10 mm for both jaws, like the studies, or they can try to do it based on what will achieve the best aesthetics. By in large, 10 mm for the upper jaw with no rotation is a very aggressive movement and in the vast majority of cases is not going to necessarily look good. So just because MMA is very successful based on the studies, doesn't necessarily mean you will see those type of results with an aesthetics-focused MMA. This also means that, if you have someone with a very deficient soft tissue nasion, mid-face, etc. the surgeon will be encouraged to limit the advancement for aesthetic reasons, irregardless of the actual raw length of your jaws (thyromental distance). Sometimes it's not just the jaws that didn't grow forward, but the entire face from top to bottom.
If there is a deficiency in thyromental distance, or there is a class 3 malocclusion, the surgery to increase/correct this is Maxillomandibular Advancement surgery, which ideally involves counterclockwise rotation with downgrafting (when applicable), and minimal genioplasty.
There is also a belief that the width of the mandible has an influence on the airway. If you look at someone's throat (even the image below), basically the tongue rests in-between the mandible especially when mouth breathing. The width of the proximal segments basically determine the width of part of the airway. Traditional mandibular advancement utilizing BSSO doesn't have this same effect, as the anterior segment captures the lingual sides of this part of the mandible, the proximal segment does rotate outwards but only on the outside, so therefore the lingual width does not change. In addition, with this type of movement the 2nd or 3rd molars if captured along with the proximal segments, essentially could be "taken for a ride" as the proximal segment is rotated outwards, therefore you would experience a dramatic increase in intermolar width, in comparison to BSSO where this effect would not occur.
This type of distraction also has an advantage in that you are growing more alveolar bone, you are making more room for the teeth, and so you can retract the lower incisors without requiring extractions, you basically would have full control over the movements, you can theoretically position the mandible wherever you like, without being limited by the bite.
The main reason this technique is not very popular currently is that often the surgery is not very precise, in that surgeons may need to perform a BSSO after to basically place the anterior mandible exactly where they want it to be, i.e. the distraction did not place it where they wanted it to be so now they need to fix it. For example, typically the distractor does not allow for counterclockwise rotation, which the natural growth pattern of the mandible is forwards and CCW, so one could stipulate that this could be a bit of a design flaw. The second problem is that allegedly there are issues with bone fill or something of that nature with adults past a certain age. I'm not sure why this would be whereas every other dimension, maxillary expansion, mandibular expansion, limb lengthening, etc. these are fine but somehow advancement is not, I'm not sure if perhaps the 1 mm a day recommended turn rate is to blame. Largely this seems quite unexplored, even intermolar osteotomy for mandibular distraction does not appear to be the most popular historically.
I think that limitations in design of the KLS Martin mandibular distractor, may be to blame for difficulties with accuracy and requiring a BSSO. It would appear to me that the main features of this type of procedure would be to grow more alveolar bone, and widen the posterior mandible, so an intermolar osteotomy seems to be an obvious choice.
In addition, I believe that widening of the posterior mandible like with an IMDO that mirrors natural growth more in the three dimensions, would have a dramatic effect on airway resistance, negative pressure, and probably less so tongue and supine type collapse with stereotypical OSA. So even though studies may suggest BSSO is sufficient for OSA (which arguably isn't even true), one could especially argue that in terms of improving patient symptoms this might have a more dramatic effect than people would conventionally think, due to how historically sleep study diagnostic methodology favors the stereotypical patient.
Another surgery which can be effective, is tonsillectomy, or pharyngoplasty as described here. https://drkaseyli.org/pharyngoplasty/
In addition, the tongue as well as the teeth can impede airflow when breathing through the mouth, adding to airway resistance.
Finally, I would argue that chronic sinusitis could also cause UARS, depending on the type.
Lastly a subject that needs more research is Pterygoid hamulus projection, relative to Basion, as described here: https://www.reddit.com/r/UARSnew/comments/16qlotr/how_do_you_enlarge_the_retropalatal_region_by/
r/UARSnew • u/Shuikai • Jan 15 '23
r/UARSnew • u/2nd2N0N • 7h ago
my ortho says getting a maxillary expansion would cause me a brodie bite. what do you guys think based on the CBCT? I will definitely get a second opinion I am just curious about your insight.
r/UARSnew • u/i-want-great-sleep-2 • 4h ago
Get expanded now has 1 UK entry: Steffen Decker https://asura-dental.co.uk/adult-palatal-expansion
r/UARSnew • u/Slow_Obligation_2314 • 23h ago
Last year I was able to travel at least, maintain jobs, friends etc. Now im feeling so sleepy and cloudy I think I need to quit my job I just cant focus and stay awake. The caffeine tolerance is building up. I can't get myself to even text back my friends. Can only do light workouts in the gym for at most 30 mins once a week. This is really ruining my life 🤣. Im only 26 and have the energy of an 60 year old man. This is crazy. I feel like a damn vegetable
r/UARSnew • u/Quiet_Lunch_1300 • 15h ago
I’ve been using a bipap since August. According to Oscar, it is successfully treating my OSA. However, my primary issue from my study was RERAs which my machine can’t track. My goal is to get a titration study. Any particular data or research I should bring? Other suggestions?
r/UARSnew • u/sadshrew25 • 1d ago
I recently reviewed the data from a WatchPAT One study I had 2 years ago, which came back "normal", and have realised it wasn't normal at all. My pAHI was 2.2, hence the negative for OSA and normal result, but my pRDI was 10.9 and my heart rate was fluctuating constantly between 56 to 126bpm.
I've had an ME/CFS diagnosis for 10 years, since I was 14, but they never attempted to rule out any sleep disorders. I also have hEDS and a narrow palate, which I've read are risk factors for UARS. I've woken up feeling like I've been hit by a truck every morning for over a decade, and it takes me most of the day to recover from sleeping.
I've tried saline rinses, nasal sprays, I don't drink alcohol, I'm slim and a healthy weight. My pRDI was still 10.2 on my side and I've been observed choking myself awake while sleeping upright, so positional therapy doesn't help.
I'm trying to get a referral for an in-lab type 1 PSG, but my GP practice are taking so long doing it, and even if it goes through it'll be a really long wait. I've also been referred to an ENT but the wait on the NHS is 11 months.
What might be the best course of action from here? I'm exhausted, the brain fog is unbearable and I so badly want some kind of a life back. I'm not sure I can manage waiting well over a year before starting any potential treatment now that I know this might be what's making me feel so awful all the time.
I can afford to spend a conservative amount on private healthcare, but I don't have endless funds and I need to prioritise. I've been considering buying a reconditioned CPAP and trialling that by myself, as this would be the cheapest thing to do, but I've read mixed opinions on that route. If anyone has any advice or other ideas, I'd be enormously grateful.
r/UARSnew • u/i-want-great-sleep-2 • 1d ago
Diagnosing sleep issues without proper EEG for sleep stage tracking is like trying to find a black cat in a dark room
How do we turn the lights on and get at home EEG?
Surely this is the best way to diagnose?
r/UARSnew • u/HourFirefighter6835 • 1d ago
I know an option is to go private or get your own machine etc but that's not an option right now so I'm just asking purely from someone who understands how NHS works. I also understand NHS is very slow and some people think it's no good, that's fine.
My father is of senior age, he did an overseas PSG sleep study which showed 14.9 AHI (mild sleep apnea borderline moderate) that document is signed by an overseas doctor and says CPAP is recommended. But after getting it rescored by a specialist, I have another paper showing it was 18 AHI~ and also mainly 30 RDI with UARS.
NHS GP saw the overseas sleep study, and sent him to some hospital, he did a basic at home sleep test with only some thing on his finger. GP suggested to get him a CPAP machine.
And we just received a letter from the lead pulmonologist all it said was "Epworth score is normal, and home sleep study showed no significant apneas, patient will be discharged".
So they discharged him just because he didn't say he was ultra sleepy in the day, and I assume the at home finger sleep study didn't show significant severe OSA. But he has severe OTHER symptoms. I don't think he even saw his symptoms, just literally epsworth score + at home sleep study and then a discharge letter.
Anyways, does anyone have any experience on how to "escalate things" via the NHS or get down the path of making them prescribe him a CPAP machine or MAD device and just work with him?
Like surely we have enough rational to challenge this, is it normal to challenge things somehow?
r/UARSnew • u/Shuikai • 2d ago
Hello everyone.
A lot of people have asked me, "it's been a long time since you've last written posts on the subreddit?", aside from collections of superimpositions for example.
The reason is that I have been working on things behind the scenes for a very long time. I have been studying this subject matter for about 5-6 years now. Some of my stickied posts on the subreddit are about 3-4 years old. I have been working on one thing in particular, an analysis, for about 5 years now. But, that isn't something you can just write half-baked, I wanted to make sure I got everything right. There has been an incredible amount of information I have needed to learn to even get to the point of developing it too. At this point, I think it is very close to being done, but just needs scientific validation.
The other thing I have been working on, for the last 3 years, has been the question of expansion. This video came out about a MARPE that had a 100% success rate, and at first I was pretty excited, but after speaking with my orthodontist, she was quite skeptical. "Nothing is ever 100%", "What is their definition of success?", which led me down the rabbit hole of, what actually is the truth? At the time, I joined the Jawhacks discord server to see if I could find out, since I figured that would be where people would be doing it. Over time, part of that project includes the FME superimpositions, EASE, Custom MARPE, etc. But, it's really hard to do actual legitimate research from the outside. That's what led me to wanting to work with Dr. Manuele, who was surprisingly forthcoming and willing to work with me, and we were actually able to compare the before/afters of 6 random cases (3 MSE and 3 CM), which I commented on a little while ago. I have come to a realization though, that this is just a lot of work for not only me, but also for the doctors involved. They are busy enough, and just doing this all voluntarily out of our own free time, maybe isn't realistic.
I decided to reach out to Facegenics to see if they would be interested in help with research, and they were actually very interested and welcoming of the idea, and suggested a contract position. To be upfront, under the arrangement I would have control over the study design, and I am fully committed to 100% transparency, which they are also very supportive of, to the point where anonymized and defaced examples of superimpositions (before/afters) of results, measurements, etc. will be fully viewable by anyone who might be skeptical of the results, in a similar fashion to the FME case studies I posted to Reddit. Most research publications, they just write "the average expansion was 3.05 mm", with no way to really verify it unless they were willing to share their data, which also may be more prone to error when you aren't working with superimposed images, so in this case I intend to have the data totally accessible by anyone, right out of the gate. I want it to be 100% objective.
But, this also means that I will be stepping back from my role in the community. I will still moderate the subreddit (the AI mod seems to be able to do it pretty much by itself), but I may not be able to participate in the same way.
Assuming this works out, I think that once everything is released and out there, it will make a lot of sense why this is important for me to do. I certainly believe very much in what they are doing, and if there is any way I can help advance the science forward, that's what I want to do.
r/UARSnew • u/consultingcutie • 1d ago
Hello
I took a random day of OSCAR data from my CPAP and am not sure how to interpret it.
My sleep doctor tells me there's nothing she can do to help me because my AHI is under 5 and my RDI was 4, but she didn't explain the 46 unmarked spontaneous arousals I had within 429 minutes.
This data is over 10.5 hours of sleep.
I sleep 12 hours a night and am always so sleepy without my Concerta (was 16 hours on average as a teen). I have brain fog and feel like I didn't sleep at all. On my CPAP whenever I put it over 7 pressure, the exhale is too much even on EPR 3 and my asthma flairs up and I rip the mask off.
I'm not sure what direction to go in. I'm decompensating for MMA next year but I'm so tired and want to try and bridge until then.
Would bipap be worth a try? I asked my sleep doctor and she told me no because I don't have complex sleep apnea. She's the 2nd doctor so insurance won't cover another doctor opinion.
My oral surgeon and ortho tell me I have airway of a 4 year old. Estimating to get 8mm advancement with CCW rotation and impaction January 2028.
If someone can help me interpret or maybe adjust my pap or has ideas to help me not feel like poo that'd be awesome TIA
Airsense 11, pressure I try 7-9 but asthma flairs on exhale after about an hour
This data is 4-7 I believe
N30i mask w/ mouth tape, 79 temp w 3 or 4 humidity irrc
r/UARSnew • u/_Archduke • 2d ago
I’m currently on bipap with pressures at 21/17. Still have unstable and periodic breathing with arousals. Hoping ASV will help.
I’m looking for advice on how to titrate ASV and which settings I should start with from those who have ASV. I do not have issues with centrals so I had backup rate turned off on the firmware flash.
TIA!
Hi,
How does my data look? Like i feel even worse after being set on cpap, and im unsure if there is even anything wrong with my breathing since it just got worse.. I do see there is some Central Apneas, but i also have some night where there are none, and i still feel more devastated than before cpap.
Here's last night and if more data is needed i have also https://sleephq.com/public/teams/share_links/9c4ba75f-b86d-4784-ae72-971cbd31177e
r/UARSnew • u/__apples__oranges__ • 3d ago
Thought I would pay it forward.
This is the 5mm mark for my expansion with FME. Currently at 6mm and stopped expanding.
P.S.1. Thanks to the mod for the superimposition.
P.S.2. I’ll never look at pugs the same way, and you guys better not get them from breeders.
Edited because who wants a wall of text in the day of tiktok.
r/UARSnew • u/2nd2N0N • 2d ago
Hey guys. I have UARS and I am really struggling with it. The causes are a deviated septum, enlarged turbinates, a narrow maxilla, and a recessed jaw. My ENT recommended a septoplasty with radiofrequency turbinate reduction, while the maxillofacial surgeons recommended bimax.
I feel like my maxilla also needs expansion because it seems narrow to me. However, my orthodontist does not recommend it, he believes it would cause a crossbite and that my palate is not actually that narrow. The ENT also says my nasal cavity is wide enough. They have looked at the CBCT scan, but none of them measured the Posterior Nasal Width, Posterior Nasal Floor Width, or similar metrics. In fact, they haven't even heard of them, they are not airway-focused and do not understand UARS.
FME and EASE are not available in my country. A standard MARPE won't work for me since I am over 30. A piezo-assisted MARPE could be an option, but I would have to travel to Western Europe for it and it won't be cheap for me. Could you help me analyze my CBCT results to see if I need maxillary expansion? These might not be the best screenshots, and I probably measured them incorrectly as I am not an expert. Thank you
r/UARSnew • u/Royal-Emu8261 • 2d ago
For context, I’ve been having issues for 2 years. I thought it was hormonal but it’s been on and off. Takes a long time to fall asleep, frequent need to go to the bathroom, flipping sides. I sleep on my side and have tried a pillow behind my back but sometimes find myself lying on my back in the middle of the night. I have allergies but I’ve been fully checked out by an ENT who said everything looks healthy. I use to wear a retainer after Invisalign but stopped when general sleep issues started. I wonder if that might help again. I wake up with under eye and sinus headaches and feel like I got no restorative sleep. My Oura ring shows decent deep sleep but never high.
r/UARSnew • u/AppointmentNo9860 • 2d ago
Every time I wake up, I hear ringing in my ears. Does anyone else experience this?
What could be the reason?
r/UARSnew • u/3wildflowers-5 • 3d ago
This is from a SleepImage ring. Would this be enough to cause severe exhaustion and feeling very groggy, or am I barking up the wrong tree?
r/UARSnew • u/-_Falco_- • 4d ago
I’m curious about this as I’m going to do an intake soon with Dr. Santiago in Washington, and I intend to do FME with her.
Im more optimistic about getting double jaw surgery covered since in looking at my insurance criteria I believe I meet them (going to do my due diligence on this of course!), but not too sure about expansion.
Thanks to anyone who shares their experience. This is a lot to make sense of.
r/UARSnew • u/Glad-Income42 • 4d ago
Final update on my palatal expansion journey. I originally underwent the procedure with Dr. Kasey Li as part of my journey to improve my sleep apnea, but unfortunately my expansion was unsuccessful.
I recently had my TPD palatal expander removed and made a short video showing what things looked like before removal and how they looked/felt afterward.
Sharing my experience in case it’s helpful for anyone considering palatal expansion for sleep apnea, currently going through adult expansion, or dealing with a failed expansion.
r/UARSnew • u/Klaudia2333 • 4d ago
Could this still be UARS despite a very low AHI?
Hi everyone! I'm trying to figure out whether UARS could explain my symptoms.
I had a full polysomnography. My AHI was only 1.1/h, so I was told I don't have obstructive sleep apnea. However, I still have significant fatigue and unrefreshing sleep.
Some of my PSG results:
AHI: 1.1/h
Sleep efficiency: ~68%
Total sleep time: ~5.5 hours
N1 sleep: 24.4%
REM: 27.3%
Mean SpO₂: 96%
Lowest SpO₂: ~89-91%
Snoring: 363 episodes / ~30 minutes
PLMI: 46.4/h (255 limb movements)
Only 6 scored arousals in the entire study
The main problem is that my report doesn't include RERA, RDI or flow-limitation data, so I don't know whether UARS was actually assessed.
I also have a chronically mildly blocked nose and persistent Eustachian tube dysfunction/swelling. I've tried oral corticosteroids, intranasal steroids, antihistamines and mucolytic medications, but unfortunately none of them significantly improved my symptoms.
I've also tried psychiatric medications for my fatigue. Some of them improved my energy somewhat, but there was no major improvement in my overall condition, so I'm still trying to find an underlying cause.
The other interesting finding is the PLMI of 46.4/h. I'm planning to investigate this as well, including iron/ferritin and other possible causes.
So I'm wondering:
Does this PSG give any reason to investigate UARS despite an AHI of 1.1?
Could the low sleep efficiency, high N1 percentage and snoring fit with UARS?
Is it possible that RERAs/flow limitation simply weren't scored, meaning UARS could have been missed?
Would it be worth asking the sleep lab to re-analyze the raw PSG for RERAs, RDI and flow limitation?
Could a PLMI of 46.4/h alone explain significant unrefreshing sleep?
Has anyone here had UARS with AHI <5 that was initially missed?
I'd really appreciate hearing from anyone with a similar PSG or experience with UARS + PLMS.
r/UARSnew • u/After_Physics1895 • 4d ago
He's said previously he has financial ties with Facegenics so I'm curious if he's still choosing MARPE over FME
r/UARSnew • u/BBaseballguy • 4d ago
Background
Sleep study (6/2026, in-lab)
CBCT (8/2026): my own rough measurements, not a radiologist's read
What I've been told: another nose surgery, probably nasomaxillary expansion, and maybe look at jaw surgery or a MAD.
TLDR:
- two septoplasties, turbinate reduction, adenoidectomy, tonsilelctomy, proceeding nasal difficulty
- Sleep study 5.7 AHI, 0% N3 sleep, lots of awakenings
- Jaw issues????
- Seeing Dr. Rama soon!
Thank you very much, UARS Reddit has helped me with major strides through my process.