Normal RERA index?

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jcbr
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Normal RERA index?

Post by jcbr » Wed Jul 31, 2013 2:47 pm

I had a sleep study done, and I never had any apneas. But I did have a lot of non-apnea RERAs throughout the entire night. The report they gave me said my RERA index was "42%". But when I search around for other people reporting a RERA index, I seem to see a lot of non-% type single digit numbers. So what does a normal RERA index look like for: someone with no problems, someone with non-apnea problems, and someone with apnea problems? Does the fact that I had no apnea events, but a ton of non-apnea RERAs throw off the calculation? Or is my number being reported differently?

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Pugsy
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Re: Normal RERA index?

Post by Pugsy » Wed Jul 31, 2013 4:11 pm

I have never seen a index for RERAs and what they might indicate.

You might start researching UARS Upper Airway Resistance Syndrome as high RERAs might indicate UARS diagnosis.

My PR S1 machine flags RERAs but I don't know just how accurate it is without EEG data but they say they get real close.
We are never told what is a good number per hour or a bad number per hour though. It's sort of a gray area and this is where clinical correlation with symptoms is going to be important.

If your doctor does lean towards UARS...cpap is still the treatment but it is much harder to evaluate on paper because you don't have the normal Obstructive apneas to count. So it's a lot harder to measure and you have to go more on subjective "how do you feel" type of stuff. If you do try cpap...I would suggest getting the Respironics PR System One machine that collects RERA data so you can at least monitor RERAs. Respironics is the only brand that flags them right now...and even though we don't know how exactly accurate it might be...it's better than nothing.
When I have a lot of RERAs on my reports it usually means I had a very restless night...poor sleep quality in general..maybe more awakenings than normal...butt dragging the next day.

If you do decided to try cpap...make sure you get a full data PR System One machine...model number 450 or higher or the RERAs (and the other stuff the machine gathers) isn't even available because the lower model number machine won't gather anything but hours of use.

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robysue
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Re: Normal RERA index?

Post by robysue » Wed Jul 31, 2013 4:22 pm

jcbr,

I've never seen a % after a RERA index number in all the reports I've looked at here. Maybe you could scan a copy of your report and post it after deleting the personal information?

At any rate, RERA stands for "respiratory effort related arousal," An elevated RERA index with a normal AHI is typically given a diagnosis of UARS (Upper airway resistance syndrome). UARS is one form of Sleep Disordered Breathing (SDB); obstructive sleep apnea (OSA) is another. Some docs think that UARS and OSA represent different parts on the same continuum. Others believe that UARS may be a (slightly) different syndrome altogether. Regardless of the relationship between UARS and OSA, the "gold standard" for both UARS and OSA is PAP therapy.


The difference between a RERA and a hypopnea is the degree of airway collapse:

A hypopnea is scored on a sleep study when the airway has collapsed to the point where there is a substantial decrease in the volume of the air moving in/out of the lungs that lasts at least 10 seconds and either a corresponding O2 desaturation or an arousal in the EEG at the end of the event or both.

A RERA is scored on a sleep study when the airway is just beginning to collapse, there is evidence of increasing effort to breath, and it ends in an arousal in the EEG followed by normal breathing. (There's often a "recovery breath" right after the arousal.)

Basically you can think of a RERA as a "hypopnea wannabe": In a RERA, the amount of air moving into/out of the lungs may only decrease very slightly instead of the 30-50% reduction needed to score a hypopnea. The length of the RERA may not be long enough to be scored as a hypopnea. In essence, the EEG arousal at the end of the RERA indicates that you are arousing yourself before the distressed breathing reaches the point where it can be scored as an apnea.

The RERA index equals (# of RERAs scored during the night)/(Total sleep time during the night). For example, if you had a total of 95 RERAs during the study and you were asleep for 4.75 hours of the test, your RERA index would be computed as follows:

RERA index = 95/4.75 = 21.1

And this would indicate that on average you experienced about 21 RERAs in each hour of sleep. In other words, you had a RERA about every three minutes on average. But I have no idea what your test result saying you have a RERA index of 42% means because of that silly % sign. Can you look at the test results and see if you can determine your total sleep time (TST)? It's usually measured in minutes not hours. Can you look at the test results and see if you can determine the total number of RERAs scored during the test? If you can give me that information, then I might be able to figure out what that 42% means.

From what I've seen, the RERA index is treated much the same way as the AHI index is.

If the RERA index > 30 that indicates you're having a RERA on average every two minutes you are asleep. And that would loosely be considered a "severe" category of SDB. If the RERA index is this high, a trial of CPAP is very likely to recommended.

If the RERA index is between 15 and 30, that would loosely fall into the category of "moderate" SDB and a trial of CPAP would probably be recommended.

If the RERA index is between 5 and 15, that would loosely fall into the category of "mild" SDB. Whether a trial of CPAP would be recommended would depend on the reported daytime symptoms of the patient and somewhat on the doctor.

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Gabe
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Re: Normal RERA index?

Post by Gabe » Thu Aug 01, 2013 12:13 pm

Image

#1..Is this the number of times that RERAs occurred during the whole night? I noticed that my RERAs are lower when my AHI is high.

#2Can anyone tell me what the numbers in total leak mean? Is this leakage per centage? Is this a normal rate? Thanks. Gabe

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Pugsy
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Re: Normal RERA index?

Post by Pugsy » Thu Aug 01, 2013 12:21 pm

Gabe wrote:#1..Is this the number of times that RERAs occurred during the whole night?
It's an hourly average. To figure out how many you had over the entire night you would multiply that hourly average by the number of hours you slept.
Gabe wrote: #2Can anyone tell me what the numbers in total leak mean? Is this leakage per centage? Is this a normal rate?
Total leak is not a % number. It's a liters per minute number. Total leak with the Respironics machines will include both the masks expected vent rate plus any excess leaks.

Your leak numbers are great. The worst it ever got to was 47 L/min and large leak territory for you and your machine is up around 90 L/min...so you were well below that for the entire night..never even got close.
Excellent leak numbers.

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KillingMe
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Re: Normal RERA index?

Post by KillingMe » Thu Jul 02, 2015 4:34 pm

Gabe wrote:Image

#1..Is this the number of times that RERAs occurred during the whole night? I noticed that my RERAs are lower when my AHI is high.

#2Can anyone tell me what the numbers in total leak mean? Is this leakage per centage? Is this a normal rate? Thanks. Gabe

My machine does not show RERAs in Sleepyhead.

Where did you get one like this?

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cancun
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Re: Normal RERA index?

Post by cancun » Thu Jul 02, 2015 4:56 pm

KillingMe wrote:
Gabe wrote:Image

#1..Is this the number of times that RERAs occurred during the whole night? I noticed that my RERAs are lower when my AHI is high.

#2Can anyone tell me what the numbers in total leak mean? Is this leakage per centage? Is this a normal rate? Thanks. Gabe

My machine does not show RERAs in Sleepyhead.

Where did you get one like this?
All I see is some red piece of machinery

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