Why does Oscar and SleepHQ hightlight RERA lower than 10 secs?

[Charlieboy UK]

I thought a RERA (Respiratory Effort-Related Arousal) was when you have 'subtler limitations in breathing' of 10 seconds or more... (which can cause significant sleep fragmentation if you have a lot of them in a night) ... but OSCAR and SleepHQ start recording them at under 10 secs... mine are mostly 7 secs, and on this night I only had one over 10 secs. https://sleephq.com/public/76a358e7-790 ... 9be041822c

[Dog Slobber]

No.

Apneas and Hypopneas need to last 10 seconds to be marked.

The length of the disturbed breathing that caused the RERA, isn't really significant. An arousal is an arousal.

[Sleepzilla]

RERA events are typically defined as lasting longer than 10 seconds, similar to apneas and hypopneas. (A quick internet search for "RERA definition" shows this repeatedly, without notable exception.)

Unlike apneas or hypopneas, RERAs are uniquely categorized as OSA-related upper airway breathing disruptions that manifest as the combination of:
1) >10s period of decreased nasal breathing combined with increased respiratory effort, and
2) Absence of significant oxygen desaturation, and
3) Result in brief arousals from sleep, which contribute to sleep fragmentation.

The only way to accurately detect RERAs is via sleep lab polysomnography that monitors respiration, oximetry, and brain activity. (The latter being required to detect the actual arousal.)

Some PAP machine, like the ResMed AirSense series, will imply and flag RERA events by monitoring flow via an algorithm for this purpose. Per the Apnea Board RDI wiki, the premise for ResMed devices is that the "RERA is flagged when increasing flow limitation or flow reduction is followed by an increased respiratory flow rate suggesting an arousal or recovery breathing."

... but OSCAR and SleepHQ start recording them at under 10 secs... mine are mostly 7 secs, and on this night I only had one over 10 secs.

OSCAR and SleepHQ don't record anything. They simply report what the therapy machine has recorded and stored in its memory.

[Charlieboy UK]

RERA events are typically defined as lasting longer than 10 seconds, similar to apneas and hypopneas. (A quick internet search for "RERA definition" shows this repeatedly, without notable exception.)

Unlike apneas or hypopneas, RERAs are uniquely categorized as OSA-related upper airway breathing disruptions that manifest as the combination of:
1) >10s period of decreased nasal breathing combined with increased respiratory effort, and
2) Absence of significant oxygen desaturation, and
3) Result in brief arousals from sleep, which contribute to sleep fragmentation.

The only way to accurately detect RERAs is via sleep lab polysomnography that monitors respiration, oximetry, and brain activity. (The latter being required to detect the actual arousal.)

Some PAP machine, like the ResMed AirSense series, will imply and flag RERA events by monitoring flow via an algorithm for this purpose. Per the Apnea Board RDI wiki, the premise for ResMed devices is that the "RERA is flagged when increasing flow limitation or flow reduction is followed by an increased respiratory flow rate suggesting an arousal or recovery breathing."

... but OSCAR and SleepHQ start recording them at under 10 secs... mine are mostly 7 secs, and on this night I only had one over 10 secs.

OSCAR and SleepHQ don't record anything. They simply report what the therapy machine has recorded and stored in its memory.

I thought they just took the RAW data... but.. whichever way, it does seem to be a bit silly to even show it, if its under 10 secs... it doesn't even seem to really mean much...I guess we can over analyse this stuff.. if AHI is under 5, Sp02 over 95% all night and not getting up in the night, with minimal movement shown when sleeping.. they seem to be the key indicators that PAP is treating you ok.

[Sleepzilla]

I thought they just took the RAW data... but.. whichever way, it does seem to be a bit silly to even show it, if its under 10 secs... it doesn't even seem to really mean much...I guess we can over analyse this stuff.. if AHI is under 5, Sp02 over 95% all night and not getting up in the night, with minimal movement shown when sleeping.. they seem to be the key indicators that PAP is treating you ok.

With respect, I think you're kind of overlooking some key concepts with this line of thinking.

AHI is just a simple metric that summarizes the frequency—not the duration or severity—of apnea and hypopnea events on a per-hour basis. There's no direct correlation between AHI scores and arousals and/or quality of sleep. Put differently: Plenty of people have low AHI scores and still suffer from poor sleep due to myriad other non-apnea related reasons, including RERAs.

RERAs on the other hand, are not factored into AHI calculation and include arousal from sleep as a criteria of their definition. This regardless of their duration. So people with low AHI and still poor sleep quality have much reason to be interested in RERA events... even if they do last less than 10 seconds. (Same for coughing spouses, slamming doors, fireworks, gunshots, barking dogs, and kids driving by with loud exhausts etc.)

[Charlieboy UK]

I thought they just took the RAW data... but.. whichever way, it does seem to be a bit silly to even show it, if its under 10 secs... it doesn't even seem to really mean much...I guess we can over analyse this stuff.. if AHI is under 5, Sp02 over 95% all night and not getting up in the night, with minimal movement shown when sleeping.. they seem to be the key indicators that PAP is treating you ok.

With respect, I think you're kind of overlooking some key concepts with this line of thinking.

AHI is just a simple metric that summarizes the frequency—not the duration or severity—of apnea and hypopnea events on a per-hour basis. There's no direct correlation between AHI scores and arousals and/or quality of sleep. Put differently: Plenty of people have low AHI scores and still suffer from poor sleep due to myriad other non-apnea related reasons, including RERAs.

RERAs on the other hand, are not factored into AHI calculation and include arousal from sleep as a criteria of their definition. This regardless of their duration. So people with low AHI and still poor sleep quality have much reason to be interested in RERA events... even if they do last less than 10 seconds. (Same for coughing spouses, slamming doors, fireworks, gunshots, barking dogs, and kids driving by with loud exhausts etc.)

Well I'm certainly no expert.. I do feel better using my PAP machine, even though I get a number of RERA's...i guess you cant really tell without a proper sleep study, so its more of an indicator to the Doctor, like FL's, eFL, eMO, eS and eSO...of what might be going on... I do think its a bit odd though, when it says for example I have had 8 Hypopnea events.. which should of course mean my Oxygen drops.. but it doesn't, well not below 95% and I use the 02 Ring from Viatom so I know its accurate. Its very complex all this data. Our NHS in the UK only seem to look at AHI and leaks and of course how long you use it for.

[zonker]

Our NHS in the UK only seem to look at AHI and leaks and of course how long you use it for.

believe me, the same is true here in the former land of the free. and then they say an ahi of 5 is fine. here in the forum, we look at an ahi of 2 to be fine.

whether UK or US, doctors pretty much just want to make their boat payments.

/off soapbox

[Nocibur]

I get a number of RERA's...i guess you cant really tell without a proper sleep study

Sure you can. AAMOF, your last SleepHQ upload shows no RERAs. The machine is lying.

[Nocibur]

I get a number of RERA's...i guess you cant really tell without a proper sleep study

Sure you can. AAMOF, your last SleepHQ upload shows no RERAs. The machine is lying.

Just like it lied to you about SoftPAP.

That is one uppity machine. I think you need to KIFA.

[Nocibur]

However, in response to your question:

I thought a RERA (Respiratory Effort-Related Arousal) was when you have 'subtler limitations in breathing' of 10 seconds or more... but...mine are mostly 7 secs...

It appears Lowenstein has elected to tag just the "A" instead of the "RE-R" and "A" together in scoring RERAs.

[Charlieboy UK]

However, in response to your question:

I thought a RERA (Respiratory Effort-Related Arousal) was when you have 'subtler limitations in breathing' of 10 seconds or more... but...mine are mostly 7 secs...

It appears Lowenstein has elected to tag just the "A" instead of the "RE-R" and "A" together in scoring RERAs.

yep it does seem odd, that it is tagging RARA under 10 secs.... I rather like the machine though, the humidifier is really easy to clean, its quiet and easy to change settings etc good old German engineering ...I guess SoftPAP is really meant for higher pressures, as mine is low it didn't really do anything.. apart from causing loads of flow limitations, although they didn't seem to impact AHI etc.

[Nocibur]

...(SoftPAP causes) loads of flow limitations, although they didn't seem to impact AHI etc.

A deep dive would be necessary, but I think there's a good chance SoftPAP simply engineers breaths to make them look like FLs, or it occasionally intervenes prematurely. An expiratory adjunct should have NO influence on inspiration.

[Nocibur]

Or somehow SoftPAP FsU the algorithm somehow. I mean, I'm looking at these

soft.jpg (47.28 KiB) Viewed 1884 times

and thinking

"On what planet are those FLs??"

[Charlieboy UK]

Or somehow SoftPAP FsU the algorithm somehow. I mean, I'm looking at these

soft.jpg

and thinking

"On what planet are those FLs??"

well its interesting that since turning off SofatPAP I have had no FLs...but as you say, they were clearly not real FLs anyway.. I think it might simply be the way OSCAR is built...because my understanding is they just take the raw data, really need to see what Lowenstein software says which I guess my hospital has. I only have the app, which just looks at AHI, leaks, deep sleep and total sleep time. My App said i had an AHI today of 3 but OSCAR says almost 5 and the app said no leaks...guess because they are small.

[Nocibur]

Something else to consider.

These are from your current D/L:

rera1.jpg (62.63 KiB) Viewed 1874 times

rera2.jpg (47.4 KiB) Viewed 1874 times

RERAs need FL reduction to be scored RERAs.

So how did Prisma score RERAs w/o scoring FL?

AAMOF, the areas preceding these RERAs look more FL-y than the FLs scored during SoftPAP!!

Like WTF??