Scan of my results (what is RERA and UAR?)

[SleepyonMagnoliaSt]

I definitely do NOT have apnea right? Why does it say RERA's and UAR noted? What's that mean?



This is the only information my GP was provided with. But I think I've been barking up the wrong tree and it's time to find out what else could be causing my issues (even though I've had tons of blood work and so much more)

Also why does it say 'Diagnosis: Sleep Apnea' at the top?

[Pugsy]

Google UARS...Upper Airway Resistance Syndrome
http://en.wikipedia.org/wiki/Upper_airw ... e_syndrome

Over simplified it means a lot of little mini reductions in air flow and arousals that are maybe affecting sleep quality (architecture and sleep stages) an thus maybe affecting how you feel during the day.
Treatment is still cpap therapy though...but harder to get insurance on board since they typically want to use the normal AHI standards as a guideline to go by.

RERAs Respiratory Event Related Arousal
Respiratory Event Related Arousal... a sequence of breaths characterized by increasing respiratory effort leading to an arousal from sleep, but which does not meet criteria for an apnea or hypopnea.”

RERA Detection in the Respironics System One data..Respiratory effort-related arousal..defined as an arousal from sleep that follows a 10 second or longer sequence of breaths that are characterized by increasing respiratory effort, but which does not meet criteria for an apenea or hypopnea. Snoring, though usually associated with this condition need not be present. The RERA algorithm monitors for a sequence of breaths that exhibit both a subtle reduction in airflow and progressive flow limitation. If this breath sequence is terminated by a sudden increase in airflow along with the absence of flow limitation, and the event does not meet the conditions for an apnea or hypopnea, a RERA is indicated.

[SleepyonMagnoliaSt]

Google UARS...Upper Airway Resistance Syndrome
http://en.wikipedia.org/wiki/Upper_airw ... e_syndrome

Over simplified it means a lot of little mini reductions in air flow and arousals that are maybe affecting sleep quality (architecture and sleep stages) an thus maybe affecting how you feel during the day.
Treatment is still cpap therapy though...but harder to get insurance on board since they typically want to use the normal AHI standards as a guideline to go by.

RERAs Respiratory Event Related Arousal
Respiratory Event Related Arousal... a sequence of breaths characterized by increasing respiratory effort leading to an arousal from sleep, but which does not meet criteria for an apnea or hypopnea.”

RERA Detection in the Respironics System One data..Respiratory effort-related arousal..defined as an arousal from sleep that follows a 10 second or longer sequence of breaths that are characterized by increasing respiratory effort, but which does not meet criteria for an apenea or hypopnea. Snoring, though usually associated with this condition need not be present. The RERA algorithm monitors for a sequence of breaths that exhibit both a subtle reduction in airflow and progressive flow limitation. If this breath sequence is terminated by a sudden increase in airflow along with the absence of flow limitation, and the event does not meet the conditions for an apnea or hypopnea, a RERA is indicated.

Thanks for the information!

I just realized my study says 'Diagnosis/Indication: Sleep Apnea' at the top. So yeah. Definitely to bring up to the sleep doctor today

[kteague]

I definitely do NOT have apnea right? ... Also why does it say 'Diagnosis: Sleep Apnea' at the top?

I could be off base, but I wouldn't say this report unequivocally proves you don't have sleep apnea. You may not, but with only 17% of your sleep time being supine, and just 28 minutes of REM (which was notably fragmented), I wonder how much time you were in REM while supine. My sleep studies were termed "technically suboptimal" due to that factor, as that is considered a worst case scenario. So, in my opinion, this test may prove you didn't have sleep apnea during the test, but it doesn't say beyond a shdow of a doubt that you don't have sleep apnea. UARS can be quite detrimental to sleep too.

I'm thinking the "Diagnosis: Sleep Anea" on your report is probably the pre-study diagnosis, the reason why they did the study, a suspected diagnosis to justify the study. Someone who does these reports would know better than I - I'm just guessing based on when I used to transcribe surgical reports we had a preo-op diagnosis and a post-op diagnosis.

Since your first conversations about your report were with a nurse in your GP's office, I wouldn't expect her to be very knowledgeable on a specialty report. She may have been better off just saying to ask the doctor.

[Pugsy]

Well the GP is probably going to say the same thing that his nurse said. He very likely told her to convey that fact and thus the referral to someone else. Based on the report as shown...nothing indicates that the typical obstructive sleep apnea diagnosis criteria has been met.
I know that is what we were expecting and actually wanted to see because it gives us a face and a name to fight...something to clearly explain the unwanted symptoms that are present. Something which there is a readily available solution...cpap therapy.
The lack of the typical OSA flagged events doesn't mean that there isn't some other type of sleep disordered breathing issue going on.
It does mean that more detective work probably needs to be done. Maybe UARS is what is going on here. Treatment is still cpap therapy but it is much harder to evaluate because a person has to rely on subjective "how they feel" as opposed to some nice easy to see numbers off of a machine. It's real hard to improve over zero apnea events of any kind and that's most likely what a typical cpap machine report would show....zero events or maybe an occasional random event or awake event getting flagged.
For some people the snoring itself is a sleep quality disturbing factor. Maybe enough to cause the arousals and awakenings and fragmented sleep. Fragmented sleep for any reason will certainly mess with the normal sleep architecture even if OSA is not present.

[SleepyonMagnoliaSt]

Ok I saw my sleep doctor! She said based on my symptoms she wouldn't have given me a sleep study in the first place. Obviously I sleep fine so the problem is quality of sleep.

We're starting Sleep Restriction Therapy. Starting today. I'm supposed to stay awake for 24 hours. All day today, all night tonight, and all day tomorrow. THEN I need to go to sleep at midnight and sleep only until 6 am. That's all I can sleep from now on. It's supposed to increase my quality of sleep? She said that my sleep study obviously was lack of quality because I had been sleeping all day (even though the day of the study I was up from 6 am on with 0 naps)

She also made sure to mention that UARS doesn't exist and I needed to stop reading online.

LOL so I'll start my Sleep Restriction Therapy with staying up until Midnight tomorrow night! Wish me luck!!

[patrick_a]

Good luck... and listen to your sleep doc.

[patrick_a]

I see you You're supposed to stay offline.

[SleepyonMagnoliaSt]

I see you You're supposed to stay offline.

While I don't have apnea my daughter does and will be starting her CPAP therapy as soon as Insurance and the DME and Pulmo work out information.

[SleepingUgly]

First of all, did you ask whether they used the AASM Recommended or Alternative criteria for scoring hypopneas? If Recommended, this study could be worthless if you had hypopneas associated with arousals. If you had enough of those, you do have OSA, even if the lab doesn't "count" it as such ("A rose by any other name...". Secondly, they mention RERAs, so you could have UARS. What's this business where the sleep doc says that UARS doesn't exist?! Hello?? It's not even a controversial diagnosis! Third, as noted by someone else, you hardly got any REM time (and your REM latency was extraordinarily delayed) so who knows what you would have looked like in REM, let alone in REM supine?

IMO, it is NOT clear that you don't have SDB.

If this lab doesn't, why don't you find a lab that uses the AASM Alternative criteria for scoring hypopneas AND scores RERAs, then restrict your sleep to 6 hours a night and go into a sleep study like that? If all that REM-rebound doesn't show SDB with that kind of scoring, THEN you could be more confident you don't have SDB.

The field of Sleep Medicine is a hot mess.

[Todzo]

I definitely do NOT have apnea right? Why does it say RERA's and URA noted? What's that mean?

This is the only information my GP was provided with. But I think I've been barking up the wrong tree and it's time to find out what else could be causing my issues (even though I've had tons of blood work and so much more)

Also why does it say 'Diagnosis: Sleep Apnea' at the top?

RERA stands for Respiratory Effort Related Arousal ( See: http://www.clevelandclinicmeded.com/med ... breathing/ and look for the discussion on Upper Airway Resistance Syndrome on the page).

You posted "URA" but the report says "UAR" which likely stands for Upper Airway Resistance. There is a term kicking around amongst the medical folk called "Upper Airway Resistance Syndrome (UARS See: http://www.ncbi.nlm.nih.gov/pubmed/10208219 ). Some posit that UARS precedes Obstructive Sleep Apnea (OSA).

If I were you I would do what I could to reduce stress in my life, start working with a good dietitian (must understand the word “microbiome”) and a good personal trainer. Treat your body better, it will be better able to deal with the world.

Have a great week!

Todzo

[Todzo]

Also, if xPAP ever enters the picture talk with your doctors about [1,2].

[1]: Gilmartin G, McGeehan B, Vigneault K, Daly RW, Manento M, Weiss JW, Thomas RJ.
Treatment of positive airway pressure treatment-associated respiratory instability with enhanced expiratory rebreathing space (EERS).
Source: J Clin Sleep Med. 2010 Dec 15;6(6):529-38. Division of Pulmonary, Critical Care and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.
Link: http://www.ncbi.nlm.nih.gov/pubmed/21206741

[2]: Dynamic CO2 therapy in periodic breathing: a modeling study to determine optimal timing and dosage regimes
Yoseph Mebrate, Keith Willson, Charlotte H. Manisty, Resham Baruah, Jamil Mayet, Alun D. Hughes, Kim H. Parker and Darrel P. Francis
J Appl Physiol 107:696-706, 2009. First published 23 July 2009; doi: 10.1152/japplphysiol.90308.2008
Link: http://www.ncbi.nlm.nih.gov/pubmed/19628721

[SleepyonMagnoliaSt]

First of all, did you ask whether they used the AASM Recommended or Alternative criteria for scoring hypopneas? If Recommended, this study could be worthless if you had hypopneas associated with arousals. If you had enough of those, you do have OSA, even if the lab doesn't "count" it as such ("A rose by any other name...". Secondly, they mention RERAs, so you could have UARS. What's this business where the sleep doc says that UARS doesn't exist?! Hello?? It's not even a controversial diagnosis! Third, as noted by someone else, you hardly got any REM time (and your REM latency was extraordinarily delayed) so who knows what you would have looked like in REM, let alone in REM supine?

IMO, it is NOT clear that you don't have SDB.

If this lab doesn't, why don't you find a lab that uses the AASM Alternative criteria for scoring hypopneas AND scores RERAs, then restrict your sleep to 6 hours a night and go into a sleep study like that? If all that REM-rebound doesn't show SDB with that kind of scoring, THEN you could be more confident you don't have SDB.

The field of Sleep Medicine is a hot mess.

I've not ever been able to talk to anyone in the sleep lab about whether or not they used REcommended or Alternative for the sleep studies. The sleep doctor didn't know because she's not affiliated with the hospital I had the sleep study in. It really is all an insane mess!

Would a private lab be a place to look? I do think we have 1 or 2 of those around here. I could probably ask them directly about their scoring.

Thank you for all this advice!

[SleepingUgly]

Looking at your report again, it's curious that they say RDI=0 but they note RERAs. I wonder if the RERAs were primarily in the tiny bit of REM time you had, which averaged into nothing when combined with none in NREM... Someone needs to explain that.

I would think you'd be able to call this lab and ask about their scoring of hypopneas.

[SleepyonMagnoliaSt]

I definitely do NOT have apnea right? Why does it say RERA's and URA noted? What's that mean?

This is the only information my GP was provided with. But I think I've been barking up the wrong tree and it's time to find out what else could be causing my issues (even though I've had tons of blood work and so much more)

Also why does it say 'Diagnosis: Sleep Apnea' at the top?

RERA stands for Respiratory Effort Related Arousal ( See: http://www.clevelandclinicmeded.com/med ... breathing/ and look for the discussion on Upper Airway Resistance Syndrome on the page).

You posted "URA" but the report says "UAR" which likely stands for Upper Airway Resistance. There is a term kicking around amongst the medical folk called "Upper Airway Resistance Syndrome (UARS See: http://www.ncbi.nlm.nih.gov/pubmed/10208219 ). Some posit that UARS precedes Obstructive Sleep Apnea (OSA).

If I were you I would do what I could to reduce stress in my life, start working with a good dietitian (must understand the word “microbiome”) and a good personal trainer. Treat your body better, it will be better able to deal with the world.

Have a great week!

Todzo

Thank you for the help. I did mean UAR but was on my phone lol

I eat very healthy and have a regular exercise regimen. Unfortunately a dietitian and trainer are not something I can afford LOL

But I will definitely work on my stress!