AHI and RERA seem inversely correlated

[RPDM]

Hi all

Let me start by thanking all the persistent and faithful contributors to this forum. By studying the Q&As i have gained more insight in sleep disorders than reading book or medical journal.
Also a big thank you to Mark and the subsequent developers of SleepyHead / OSCAR

now for my topic...
I did a sleep study a while back with a very unsatisfying result. AHI was 0.2, but 18 "unexplained transient arousals" and 4 RERA over a period of 420 minutes of sleep.
7% in stage 1, 85% in stage 2 and 8% in REM sleep. The unexplained arousals bug me....
After review of the study results I left the doc's office with a prescription for a sleep medication to achieve N3 (restorative) sleep.
I am not a fan of chemicals to solve issues and it would also not solve my snoring. I was able to obtain a APAP (Dreamstation).

I have the following observations after about 2 months of use:
- I feel soooo much better in the morning
- My wife has reported the absence of mood swings (on my part)
- Snoring is absent about 75% of nights
- When my AHI goes down, typically my RERA goes up and snoring occurs, though much milder than before.


i'd like your (the persistent and faithful contributors) insight in:
1. Since RERA are not "officially qualified" from a diagnostics perspective, but described as "obstruction not meeting the criteria of Apnea or Hypoapnea".
Is it reasonable to assume that a RERA event is just an Apnea or hypoapnea waiting to happen... (this is where RDI comes in?)
I can fully relate to a post (on Apneaboard) by Sleeprider on UARS,
(hope it is appropriate to post a link to apneaboard, as the link to the original article is no longer available: [http://www.apneaboard.com/forums/Thread ... Sleepyhead])


2. When I look at the pressure curve, it seems to correlate with the REM sleep periods of a 'normal' hypnogram (Thanks Pugsy for that pointer). But what other than the correlation and the decision for APAP instead of CPAP does it tell me?

Thanks!

[zonker]

bump

[DreamDiver]

Hi all

Let me start by thanking all the persistent and faithful contributors to this forum. By studying the Q&As i have gained more insight in sleep disorders than reading book or medical journal.
Also a big thank you to Mark and the subsequent developers of SleepyHead / OSCAR

now for my topic...
I did a sleep study a while back with a very unsatisfying result. AHI was 0.2, but 18 "unexplained transient arousals" and 4 RERA over a period of 420 minutes of sleep.
7% in stage 1, 85% in stage 2 and 8% in REM sleep. The unexplained arousals bug me....
After review of the study results I left the doc's office with a prescription for a sleep medication to achieve N3 (restorative) sleep.
I am not a fan of chemicals to solve issues and it would also not solve my snoring. I was able to obtain a APAP (Dreamstation).

I have the following observations after about 2 months of use:
- I feel soooo much better in the morning
- My wife has reported the absence of mood swings (on my part)
- Snoring is absent about 75% of nights
- When my AHI goes down, typically my RERA goes up and snoring occurs, though much milder than before.


i'd like your (the persistent and faithful contributors) insight in:
1. Since RERA are not "officially qualified" from a diagnostics perspective, but described as "obstruction not meeting the criteria of Apnea or Hypoapnea".
Is it reasonable to assume that a RERA event is just an Apnea or hypoapnea waiting to happen... (this is where RDI comes in?)
I can fully relate to a post (on Apneaboard) by Sleeprider on UARS,
(hope it is appropriate to post a link to apneaboard, as the link to the original article is no longer available: [http://www.apneaboard.com/forums/Thread ... Sleepyhead])


2. When I look at the pressure curve, it seems to correlate with the REM sleep periods of a 'normal' hypnogram (Thanks Pugsy for that pointer). But what other than the correlation and the decision for APAP instead of CPAP does it tell me?

Thanks!

When I get a RERA (rarely) it's often in the middle of a flow limitation, like there's snot blocking my sinuses temporarily and I need to swallow or sniff to unblock it. It may take little or no time, and so may not even affect oxygen levels. Swallow, briefly almost wake up, maybe turn over... That seems to be marked as a RERA for me. It's recorded because it is a form of arousal -- something we're trying to avoid, even if it's not always related to a duration with full-on obstruction and the possible resulting oxygen desaturation. Of course we don't have psg sensors hooked up to do the actual RERA for confirmation, but the machine makers probably have studies of what constitutes a flagworthy flow rate and various other flags like flow limitation that usually accompany psg-flagged RERA's in a full-on polysomnograph and assume those flags are worthy of marking as a RERA even if they aren't confirmed by measuring accompanying psg activity. As the post from ApneaBoard suggests, RERA's aren't yet fully standardized, or weren't in 2016. That may have changed since then. Others will let us know.

A hypopnea is more like an "almost apnea." It has a duration, and is basically shallow breathing, so shallow it's remarkable because it can lead to oxygen desaturation, similar to obstructive or central apnea. In my graphs, hypops look are almost indistinguishable from regular breathing until I expand the both axes of the graph. There's a sort of "shelving" to the left of the inspiration peak where you can see FOT waves just roughing up the shelf. The breathing period may retard slightly as well. You are in fact breathing, just shallowly, so there is no full obstruction in the wave form. O2 levels may drop.

I can't comment on REM sleep, and am looking forward to Pugsy or LSAT inspiring us there. Posting links from ApneaBoard is fine. Many of us are also on that forum as well.

Well that's my understanding. If I'm wrong, I am quite sure there are better-versed members who will correct me!

Welcome!

Chris