Üst Solunum Yolu Rezistansı Sendromu (UARS)
Özet
Üst Solunum Yolu Rezistansı Sendromu (UARS), apne veya hipopneye yol açmadan üst solunum yollarında direnç artışı ve intratorasik basınç yükselmesiyle karakterize, sık tekrarlayan arousallara ve gündüz aşırı uyku haline neden olan klinik bir tablodur. İlk olarak 1982'de çocuklarda tanımlanan sendrom, obez olmayan bireylerde de görülmesi ve her iki cinsiyeti eşit etkilemesiyle Obstrüktif Uyku Apne Sendromu'ndan (OSAS) ayrılır. UARS vakalarında kronik uykusuzluk, yorgunluk, sabah baş ağrıları ve irritabl bağırsak sendromu gibi somatik belirtiler yaygındır ancak her hastada horlama görülmez. Patofizyolojik açıdan UARS, OSAS'ın aksine üst hava yolunda lokal nörojenik lezyonlar barındırmaz; refleksler ve duyusal girdiler korunduğu için hastalar solunum değişikliklerine daha hızlı yanıt vererek uyanırlar. Tanısı ancak polisomnografi (PSG) ve altın standart kabul edilen özofagus basıncı (PES) ölçümü ile doğrulanabilmektedir. Tedavisinde sürekli pozitif hava yolu basıncı (CPAP) birinci basamak olarak kullanılsa da hastaların uyum zorluğu nedeniyle dental cihazlar, kognitif davranışçı terapiler ile burun konka radyofrekansı, septoplasti ve ortodontik çene genişletme gibi anatomik nedenleri hedefleyen cerrahi yaklaşımlar öncelikli olarak tercih edilmektedir.
Upper Airway Resistance Syndrome (UARS) is a clinical condition characterized by increased upper airway resistance and elevated intrathoracic pressure without causing apnea or hypopnea, resulting in frequent arousals and excessive daytime sleepiness. First identified in children in 1982, UARS differs from Obstructive Sleep Apnea Syndrome (OSAS) as it affects non-obese individuals and shows equal gender distribution. Common symptoms include chronic insomnia, fatigue, morning headaches, and irritable bowel syndrome, whereas regular snoring is not present in all cases. Pathophysiologically, UARS patients do not exhibit the local neurogenic lesions found in OSAS; since upper airway reflexes and sensory inputs remain intact, they respond more rapidly to respiratory variations through micro-arousals. Diagnosis is confirmed via polysomnography (PSG), with esophageal pressure (PES) measurement remaining the gold standard. Although continuous positive airway pressure (CPAP) is used as first-line therapy, poor patient compliance often necessitates alternative treatments, including oral appliances, cognitive behavioral therapy, and surgical or orthodontic interventions such as turbinate radiofrequency ablation, septoplasty, and maxillary expansion targeting the underlying anatomical narrowness.
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