Hyponea and RERA

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CPAPSteve
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Hyponea and RERA

Post by CPAPSteve » Thu Jul 23, 2020 8:19 am

So I was digging around in Sleepyhead (I haven't migrated to Oscar yet) and was looking at my AHI score and looking at the events that make up my tiny AHI score and while the score is very low 0 - 0.3 is the average that I seem to have a couple of RERAs and Hyponeas.

Can someone explain to me what each of those are beyond the dictionary terms that are on the web? I believe hyponeas are a precursor indicator of a possible obstructive event and a RERA is an unclassified event that could potentially lead to a stoppage of breathing. When I zoom into sleepyhead's flow rate for the RERA and hyponea I don't see anything that seems out of the normal. Only the CAs and the OSA's are where the flow rate is obvious that I've stopped breathing for 10 seconds or longer. Possibly junk data?

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khauser
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Re: Hyponea and RERA

Post by khauser » Thu Jul 23, 2020 8:43 am

You will probably get a more complete answer, but I learned a heck of a lot from this video: https://www.youtube.com/watch?v=-gie2dhqP2c

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Miss Emerita
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Re: Hyponea and RERA

Post by Miss Emerita » Thu Jul 23, 2020 10:25 am

I second khauser's suggestion -- very informative video. And here's some information that goes beyond a definition:

http://www.apneaboard.com/wiki/index.ph ... ndex_(RDI)

http://www.apneaboard.com/wiki/index.php/Hypopnea

One thing to keep in mind: our machines don't know if we're awake or asleep, and data collected while we are actually awake may yield a flag for a RERA or hypopnea. The same is true for central apneas, and even (very occasionally) obstructive apneas.
Oscar software is available at https://www.sleepfiles.com/OSCAR/

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Pugsy
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Re: Hyponea and RERA

Post by Pugsy » Thu Jul 23, 2020 11:33 am

RERA just means your breathing "looks like" the breathing pattern of an arousal related breathing pattern when compared to known arousal breathing when compared to asleep vs awake breathing.
We gave to have been asleep for sure as the first criteria. Then have some sort of airway related issue cause the arousal as the second criteria. Since our machine's can't measure sleep status...they make an educated guess based on the air flow pattern that "looks like" what is known to be a for sure arousal related pattern based on known in lab documented airway related stuff.

Remember in the lab sleep studies they know for sure you are asleep or not...and they can clearly see the asleep breathing and then the minor changes that might point to a minor airway issue that might in turn cause an arousal. So the machine is saying your breathing looks like the breathing of someone who has an arousal from some sort of airway issue. It's an educated guess since the machine doesn't know for sure if you are or were asleep or not. It is probably fairly close and a decent educated guess. It is an indicator of poor sleep quality though. When I see people with a lot of RERAs flagged we know that there were some arousals. We don't know for sure they were airway related (because we don't know sleep status) but we know they might have been airway related hence we usually treat them as such because there's really no other choice. Do something about them because they do point to less than optimal sleep quality in all probability and even though arousals can come from other things and look like they are airway related....we still treat them like they are because to ignore them means poor sleep quality, that might be improved upon, ends up still being a problem.

RERA isn't some sort of "event" though...all it means is your breathing "looks like" the breathing known to be shown as associated with some sort of airway restrictive issue. It is unlikely that you will see much of a change in the flow rate with the RERA flag.
You may or may not see a flagged event happen just prior to the RERA flag.

Hyponeas....think of them as OAs that haven't grown up to meet OA criteria.

Hyponea....40 to 79% air flow reductions that last at least 10 seconds or more.
OA....80 to 100% air flow reductions that last 10 seconds or more.

Hyponeas are still bad news...and that's why they get flagged and the machines will want to kill them with more pressure when using auto adjusting algorithms.

We don't know or can't see the difference in air flow reduction easily with what we have available to us in the flow rate.
I know I have seen hyponeas flagged and I sit here and scratch my head as to why. I can only assume it was more on the low side of the flow rate reduction. Maybe a 50% that isn't easy to spot but they can still disrupt sleep and if you have enough of them back to back they can still cause desats.....so they are still potential troublemakers.
In terms of how they can affect sleep...if you have a hyponea with a 75% reduction in air flow that lasts at least 10 seconds....it probably is just as bad for you as an OA at 80% air flow reduction. That 5 % difference just to get a label is really insignificant in terms of what it does to the body.

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