Upper Airway Resistance Syndrome (UARS): a common underlying cause for all "chronic complex illnesses"? (ME/CFS, fibro, GWI, etc.)

But there is no agreed marker for PEM (2 day CPET proposed in past) no agreed identifying symptom (certain delay now promoted as key but that is just assertion). It is a disputable term as to what is entailed and sb who gets it after 14 hrs may be different from sb who gets it after7 or 24 in key aspects or not. We don't know. We don't know and defining PEM as unique by a specific descriptive feature e.g 24hr + delay is cart before horse if that means to deny commonalities with earlier onset post exertional malaises. 24 + PEM it may be researched separataely as e.g." Biomarkers in PEM with 24 hr + onset" but without any foregome conclusion re. the nature of those with earlier onset, though there must be some differences. presumably, but not necessarily key ones.
 
richie said:
But there is no agreed marker for PEM (2 day CPET proposed in past) no agreed identifying symptom (certain delay now promoted as key but that is just assertion). It is a disputable term as to what is entailed and sb who gets it after 14 hrs may be different from sb who gets it after7 or 24 in key aspects or not. We don't know. We don't know and defining PEM as unique by a specific descriptive feature e.g 24hr + delay is cart before horse if that means to deny commonalities with earlier onset post exertional malaises. 24 + PEM it may be researched separataely as e.g." Biomarkers in PEM with 24 hr + onset" but without any foregome conclusion re. the nature of those with earlier onset, though there must be some differences. presumably, but not necessarily key ones.
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I don’t think I’ve said anything about PEM needing a delay of 24 hours. I think I’ve only linked the factsheet that says «PEM usually starts hours or a day or two after it is triggered and can last for hours, days, weeks or longer.» And said something similar about how PEM is often/usually delayed.

If I’ve said something else, I’ll go back and edit it because that wasn’t my intention.
 
Utsikt said:
I don’t think I’ve said anything about PEM needing a delay of 24 hours. I think I’ve only linked the factsheet that says «PEM usually starts hours or a day or two after it is triggered and can last for hours, days, weeks or longer.» And said something similar about how PEM is often/usually delayed.

If I’ve said something else, I’ll go back and edit it because that wasn’t my intention.
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No worries I was just commenting generally on the uncertainties of PEM (or trying to). Sorry for any misunderstanding.
 
Snow Leopard said:
Here is the thing, I don't consider daytime sleepiness to be a core symptom of ME/CFS.
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It's not a core symptom of ME/CFS, but some patients do experience excessive daytime sleepiness (and many patients experience excessive sleeping, like you said, of course). I had daytime sleepiness in addition to fatigue earlier on in my illness and the sleepiness went away.

Both sleepiness and fatigue are well recognized to be associated with UARS/OSAS; some people with these disorders complain of one more than the other. Other people with UARS/OSAS appear to have other complaints like insomnia as their primary complaint (chronic insomnia patients with excessive daytime sleepiness and other OSA signs & symptoms [obesity, witnessed apneas, etc.] were excluded in that study and 40/40 left were still diagnosed with OSA/UARS [90% OSA - the prevalence of OSA in the general population is ~20%]. Many experienced remission from chronic insomnia with PAP therapy). UARS/OSAS being able to cause chronic insomnia may not seem logical (aren't these patients supposed to be tired/sleepy?), but it fits with the stress response paradigm of sleep-disordered breathing: the brain reacting to sleep-disordered breathing as a stressor results in a state of somatic arousal -> chronic insomnia (I think it fits with the "tired but wired" feeling many of us know so well).

And I think the study and case reports I've cited support that for yet others, fibromyalgia/body pain may the dominant complaint. It seems the symptoms and combination of symptoms varies highly in different individuals with UARS/OSAS.
Snow Leopard said:
So the question would be, do we see this pattern in UARS patients?
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There is no universal pattern of how UARS (or OSAS) patients presents.

As I think I think I've convincingly argued above, a person with UARS/OSAS can present with sleepiness without insomnia, or insomnia without sleepiness, e.g.

No one knows if UARS could cause symptoms like PEM because no one has ever taken a group of people who meet strict criteria for ME/CFS, evaluated them for UARS, and treated those who may have it to see the effect on ME/CFS symptoms like PEM.
 
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Peter T said:
When, I think by @Trish, it was suggested you might want to consider creating some new threads, that was in relation to the specific studies you cited as supporting evidence, for example the Fibromyalgia study, so we could discuss the merits and implications of that study independently of any discussion of the idea that UARS has a causal role in a number of conditions.
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Yes, I do want to do this at some point, the idea of it just sounds really exhausting at the moment, especially as I have already spent 10s of hours compiling it all into threads on Bluesky/etc. (but I know that's not an accessible option for people).
Peter T said:
I think this might help with establishing what we can say about sleep related breathing issues in the various conditions in separate threads, an important issue in its own right, then examine in more detail the proposed unifying theory in this thread. @nataliezzz, you are obviously deeply engrossed in all the detail which you want to share, but by presenting it all at once it becomes overwhelming and the thread becomes very difficult to follow as different issues are being discussed simultaneously.
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Yes, agreed.
 
nataliezzz said:
Yes, I do want to do this at some point, the idea of it just sounds really exhausting at the moment, especially as I have already spent 10s of hours compiling it all into threads on Bluesky/etc. (but I know that's not an accessible option for people).
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No need to do everything at once. If there's a study that's central to the hypothesis, you can make a thread for just that one to start. Normally we don't add any color commentary in the first post either, just the abstract, so you don't have to add comments immediately either. Maybe others will make comments that you can later reply to if you want.
 
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