Hi

I just wanted to get some feedback on my sleep study.  I read through the site's fact and help sheets but I just wanted make sure I had UARS - which i was  diagnosed with by my doctor.  My sleep study is below.  I have been wearing a dental device for the past week and I'm concerned that the device will permanently alter my jaw/bite while not improving the quality of  my sleep.  Thanks in advance for any help.  

Staging Table:        
            Duration    %
Stage REM    22.5    7.4%
Stage 1 Sleep    75    24.7%
Stage 2 Sleep    118.5    39.0%
Stage 3 Sleep    24.5    8.1%
Stage 4 Sleep    63    20.8%

Sleep Efficiency                          65.80%    
Stage REM Latency                       93.50%    
Number of Awakenings                       20.0    
wake time after sleep onset (min)     27.0    
Sleep Onset Latency (min)               131.0    
Total Sleep Time (min)                          303.5    
# of Stage Shifts                                238    

Respiratory Events:            
Apneas                                        1        
Hypopneas                              3        
Apneas + Hypopneas                4        
Duration in Apnea (min)               0.3        
Duration in Hypopnea (min)    1.2        
AHI                                        0.8        
RDI                                       10.3        


Arousal Summary:            
                                     REM    Non -REM    Sleep
Respiratory Arousals          3                  47         50
Limb Movement Arousals      0              14             14
Spontaneous Arousals        4                78               82
Total                                                          146

Per Hour:            
Respiratory Arousals          8                  10          9.9
Limb Movement Arousals      0               3               2.8
Spontaneous Arousals      10.7              16.7             16.2
Total                                                            28.9

Hi,

I'm still learning how to interpret sleep study results. I, too, was dx'd with UARS.

My results differ quite a bit from yours. Did your physician explain why he thinks you have UARS? If so, can you share what he said?

I averaged 31 arousals/hr. I repeatedly made a lot of effort to take a deeper breath, awakened, then immediately re-entered deep sleep. I spent a lot of time in deep sleep and was unaware of the arousals. My airway never fully collapsed.

Is there any chance of verifying the efficacy of your oral device via polysomnography? Was it fitted to your mouth? Did your doc consider CPAP? I think I would prefer an oral device if it is effective, but I believe I have read that ODs can affect your teeth and cause jaw dysfunction. I'll double check next time I look on the PubMed site.

According to those results, you don't have sleep apnea.


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You're right, I don't have sleep apnea. I have UARS. My brain senses (and doesn't like) the increased resistance in my airway and it causes me to make a bigger effort to breathe, at which point I wake up. Although UARS differs quite a bit from OSA, both are treated w/CPAP.

Does UARS cause oxygen desaturation?


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Hi Sunshine,

From what I recall, the doctor thought I had UARS because I had a decent number of arousals per hour (28) which were mostly spontaneous arousals.  I think the spontaneous arousals tipped him off, I think.  I have been wearing the dental device for almost two weeks now and I feel great.  Almost every day for two years, I was fatigued but I have felt great the past 10 days.  My device is fitted for my mouth and while it was expensive, it was definitely worth it for me.  The doctor told me i could try the CPAP or go for a dental device and i decided to try the latter first.  I am concerned about my jaw/bite and need to figure out if my jaw will be permanently be altered -  i might ask my dentist if there is anything i can do.  And i haven't checked the efficiency of my dental device (to see if its the device that is actually causing the improvement) but i might consider it.  let me know if you have any more questions and good luck.

UARS does not cause oxygen desaturation.

This is a good explanation:

The term, "Upper Airway Resistance Syndrome," (UARS) was first coined by Dr. Guilleminault at Stanford in 1993, to signify chronic daytime sleepiness in the absence of actual apneas or hypopneas, but often associated with snoring in turn associated with brief, frequent arousals with an only slightly abnormal breathing pattern. There is no actual cessation of breathing, nor any decrease in oxygen saturation, but with measurement of air flow through the nose and mouth there are signs of decreased flow on breathing in. The arousals and resulting sleep fragmentation are related to increased effort to breathe, detectable with measurement of pressure changes in the esophagus. Just before the arousal, the esophageal pressure starts to decrease, indicating increased effort to maintain the flow of air, which is only slightly reduced.

Guilleminault's original group of 15 UARS patients had fairly high arousal indices of 31/hour, abnormally low percentages of stages 3 and 4 sleep and fairly normal REM sleep. On Multiple Sleep Latency Testing or MSLT there was a significantly reduced sleep latency of only 5.3 minutes, corroborating the patients' reports of increased sleepiness. Treatment with CPAP at low pressures (7) reduced the arousal index to an average of 7.9, all patients ending up in a "normal range" of less than 10, and MSLT results showed improvement to sleep latencies averaging 13.5, with increases in stage 3 and 4 sleep. In other words, despite their lack of real apneas or hypopneas, these patients who merely seemed to require extra effort to maintain their respiratory flow had respiratory-related arousals, symptoms, and CPAP response very similar to sleep apneics.

Hi amshadowat9,

Thanks for your response! If you have experienced such dramatic improvement in the absence of other changes then the oral appliance is likely responsible for your reduced fatigue. I did a quick PubMed search and copied a couple of relevant points below. It sounds like follow-up appts w/your dental specialist are a good idea. You might consider another sleep study if your symptoms begin to worsen. However, your doc should know best, and I'm so encouraged to hear that you're feeling better.

According to a 2006 scientific literature review published in the journal, "Sleep,"
"Minor adverse effects [of oral appliances] were frequent whereas major adverse effects were uncommon. Minor tooth movement and small changes in the occlusion developed in some patients after prolonged use, but the long-term dental significance of this is uncertain."

Another 2006 article in "Sleep" about practice parameters for using oral appliances in OSA (not UARS, specifically) recommended:
"Oral appliances should be fitted by qualified dental personnel who are trained and experienced in the overall care of oral health, the temporomandibular joint, dental occlusion and associated oral structures. Follow-up polysomnography or an attended cardiorespiratory (Type 3) sleep study is needed to verify efficacy, and may be needed when symptoms of OSA worsen or recur. Patients with OSA who are treated with oral appliances should return for follow-up office visits with the dental specialist at regular intervals to monitor patient adherence, evaluate device deterioration or maladjustment, and to evaluate the health of the oral structures and integrity of the occlusion. Regular follow up is also needed to assess the patient for signs and symptoms of worsening OSA."

Sunshine

Thanks SleepySandyG.  I now understand the difference between UARS and OSA.


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Sorry but that is not true. I have UARS and my oxygen decreases to 84% (8.5 times hr in non-rem sleep and 39 times an hr in REM sleep).. The reason it wasn't diagnosed as apnea is obviously because I have hypopnea events and don't actually quit breathing. I was also informed that the only difference in UARS and apnea is that with UARS, you don't quit breathing. But my doctors still seem to consider this to be apnea even though my test results said UARS. Now, what I don't get is why someone would even be diagnosed with UARS if their oxygen level didn't drop with it, there really would be no danger in your breathing slowing then. I just can't see how there would be a significant disturbance, if your oxygen sats is normal.

Thanks for the info Sunshine.

babyblueeyes wrote:

Now, what I don't get is why someone would even be diagnosed with UARS if their oxygen level didn't drop with it, there really would be no danger in your breathing slowing then. I just can't see how there would be a significant disturbance, if your oxygen sats is normal.

Because the body/brain do detect it and arouse and resume "normal" breathing before your O2 drops.  That's my understanding.

I just didn't understand the whole thing as to how a person would have trouble breathing in their sleep without an oxygen drop. Let me re-word that... If the trouble in breathing is not from sleep disordered breathing, then what else would cause it? It's not that I don't think your sleep couldn't be disturbed from it, just don't understand what could cause it.. I usually wake up right when I first fall asleep from a forced inhalation and I know my oxygen isn't dropping at that time.. This happens when my oxygen level drops and when it doesn't.. Also happens when I am just sitting down relaxed. Everytime this happens, is it actually from apnea even when your awake, or when your oxygen doesn't drop or is it just from some abnormalty in your airways or such? Anyone have any thoughts on this?

babyblueeyes: I was just dx'ed with UARS today, my doctor explained the difference to me this way:

With OSA, your airway closes, you stop breathing, a few seconds later your body realizes you have stopped breathing, you arouse so you can start again. With UARS, your airway closes,  but before you actually stop your body realizes you're having trouble breathing, you arouse to take a deeper breath and keep yourself from stopping breathing altogether.  

Or to put it in the simplest terms, UARS means you have an arousal *right before* you would have had an apnea, instead of after.


It's not that you have trouble breathing because of an oxygen drop, it's that your oxygen drops because of a problem breathing. My understanding is that UARS can occur with or without a drop in blood O2, depending on how soon the arousal happens after the airway starts to narrow, but usually without (because usually blood O2 desaturation is considered a hypopnea, which means one has SAHS, not UARS).

So UARS doesn't usually cause the problems that come from lack of oxygen (like high blood pressure and heart problems), but does cause the problems that come with lack of sleep (like fatigue, sleepiness, low glucose tolerance, depressed immune system, etc.) because the arousals are as frequent as they would be with apnea.

Since the physical cause is the same (narrowing of the airway during sleep), both are treated with CPAP. The difference is how (or, more precisely, when) your brain reacts to the narrowing.

My breathing slows and then I have to fight for my breath and my oxygen drops below normal (hypoxemia). Not exactly sure what SAHS is but it was diagnosed as UARS (RDI averaged 130 total). When your airways narrow with apnea, what part of the airway actually narrows? I am aware that your throat collapses, but not aware of your airways narrowing. I have a problem causing this in my turbinate on one side of my nose. So kind of curious about it. My CPAP makes the pain/congestion worse from this condition so I can't even manage to use it much. Thanks...