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Permalink Reply by Saz RPSGT on August 20, 2009 at 9:52pm

You guys are officially a couple of "Hosers".

RERAS stands for Respiratory Event Related Arousal. This is a generic term for any breathing disturbance. Many labs (including my own) use this interchangeably with UARS. Upper Airway Resistance Syndrome.

RERAS/UARS are basically hypopneas that don't have a 3% SpO2 desaturation or less. So it's an airflow restriction, not a complete ceasation like obstructive apnea, that causes an arousal.

AHI is the apnea hypopnea index. A measure of how many apneas (obstructive, mixed, central) and hypopneas that you have per hour of sleep.

RDI is the respiratory disturbance index. This will always be higher. It includes the apneas and hypopneas just like the AHI, but it also includes RERAS/UARS.

I think the relationship between severity of diagnosis and how you feel is personal. (sorry for the cop-out) Even if you're "just" having UARS, you're still suffering from fragmented sleep and are going to wake up feeling like crap.

Let me know if I explained the RDI/AHI/UARS/RERAS and BLAH/BLAHS okay. :^) I tend to get wordy when typing...and talking.

Godspeed little doodle.

Jason

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Permalink Reply by BeeAsleep on August 20, 2009 at 10:05pm

I LOVE WORDY! :>D

We are a super-hose-head family now...:>D My husband has had 3 sleep studies, 2 of them 15 years ago. He has been snoring and tossing and flipping and kicking in bed or 15 years.(and not the fun kind) He is exhausted each day. I can't tell you how glad I am that he was finally diagnosed and will be able to breathe at night. (And he won't snore above the sound of my ResMed) :>D

I didn't know if those numbers of RDI and RERAS were anything to worry about or will the CPAP take care of them? What are they, like asthma or some lung breathing problem? Does it matter?

I imagine that everyone does feel differently with OSA and that a high number doesn't necessarily mean feeling worse...I think that is interesting. You would think that not breathing A LOT would mean you feel worse. Humans are interesting huh?

Thanks so much for your reply, I do appreciate it a lot!

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Permalink Reply by Saz RPSGT on August 21, 2009 at 12:24am

Remember, RERAS is a generic term that encompasses Obstructive Apnea, Obstructive Hypopnea, Mixed Apnea, Central Apnea, and UARS

Yes, UARS does cause you to wake up from sleep., so they are something to worry about. The CPAP will take care of them if CPAP was titrated accordingly.

For example (I need to upload some actually screenshots for this...but not now.)

A patient is having Obstructive apnea at 5cmH20. Technician increases to 8cmH20, which opens up the airway enough so some air gets through, but breathing is disrupted and a 4% desaturation occurs. Now it's a Hypopnea by definition. So the technician increases CPAP to 10cmH20 and it still looks like a hypopnea visually, but there isn't a desaturation of greater than 3%, but you are still waking up from them. Now it's a UAR by definition. Then the tech increases to 12cmH20 and sleep is consolidated without waking from breathing disruptions.

So UARS is officially the lamest, smallest, runtiest sleep disordered breathing event you can have, but they're tough to spot by untrained eyes and still make you feel like absolute garbage in the morning.

I think UARS is undertreated since many insurances only pay for CPAP for people with high AHIs. Remember, UARS only counts under the RDI. This is changing, but there are still top labs that I score for that don't want me scoring them. For these labs they usually pop up under the heading of Leg Movements with arousal, or PLMs with arousal.

Crap...again with the wordiness.

Jason

BeeAsleep said:

I didn't know if those numbers of RDI and RERAS were anything to worry about or will the CPAP take care of them? What are they, like asthma or some lung breathing problem? Does it matter?

I imagine that everyone does feel differently with OSA and that a high number doesn't necessarily mean feeling worse...I think that is interesting. You would think that not breathing A LOT would mean you feel worse. Humans are interesting huh?

Thanks so much for your reply, I do appreciate it a lot!

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Permalink Reply by susan mccord on August 21, 2009 at 1:04am

Jason, you're a crack-up !!! LOL That "hoser" thing always makes me laugh.....

Hey, I have a full set of reports from both my sleep study and the titrated study in June. I have yet to see an MD, am scheduled for 9/1. My question is: I don't have a clue what ANY of these results mean. I understand the narrative, of course, but not all the abbreviated stuff. Is there any reasonable way I could post what the scores are (there are a LOT of them) on SG and have you just go down the list and identify them for me? That sounds cumbersome to me, but I really feel a need to know. Talk about WORDY! If that's too much info to ask for on here, that's okay. I certainly understand if it is. Or if it's just too time-consuming, same. I don't know enough to even know if what I'm asking for is unreasonable for SG time available. You guys already have a lot to deal with as is. If you don't have time, maybe I could get info from my DME tech. Do you think he'd know. I never thought to ask him till just now. He's not a respiratory therapist, but he has had apnea and CPAP for 26 years himself.

ALSO, I've been reading some of your info here re: pressure as related to the UARS thing you're talking about. I have some concerns. Also concerned because they Rx'd a pressure of 9 but said I wasn't tested at that level, so I should have close clinical supervision after testing to ID the proper Rx range. Apparently I was continuing to have "episodes" at 7, but they didn't test after that and just decided to start me at 9. I wonder all the time if I'm getting enough air to be safe. Does that make sense to you that they'd just guesstimate my Rx? It doesn't to me, but then what do I know?? I have never even spoken with an MD throughout all this. So much for close f/u.....I was diagnosed just over the line into severe near the end of June '09. It's not clear to me how they could just pick a # if they don't know whether or not it's sufficient related to a test score of how I responded......

Please feel free to be as honest as you need to be re: time. I'm not here to monopolize you.

Thanks for your consideration of all this.

Susan McCord :-)

J. Sazama RPSGT said:

You guys are officially a couple of "Hosers".

RERAS stands for Respiratory Event Related Arousal. This is a generic term for any breathing disturbance. Many labs (including my own) use this interchangeably with UARS. Upper Airway Resistance Syndrome.

RERAS/UARS are basically hypopneas that don't have a 3% SpO2 desaturation or less. So it's an airflow restriction, not a complete ceasation like obstructive apnea, that causes an arousal.

AHI is the apnea hypopnea index. A measure of how many apneas (obstructive, mixed, central) and hypopneas that you have per hour of sleep.

RDI is the respiratory disturbance index. This will always be higher. It includes the apneas and hypopneas just like the AHI, but it also includes RERAS/UARS.

I think the relationship between severity of diagnosis and how you feel is personal. (sorry for the cop-out) Even if you're "just" having UARS, you're still suffering from fragmented sleep and are going to wake up feeling like crap.

Let me know if I explained the RDI/AHI/UARS/RERAS and BLAH/BLAHS okay. :^) I tend to get wordy when typing...and talking.

Godspeed little doodle.

Jason

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Permalink Reply by Duane McDade on August 21, 2009 at 1:15am

Keep it simple Sazama RSPGT. I have found that english works best on this site. The way to say it better might be RDI envolves everything that wakes you up that has to do with breathing, snoring, etc, etc. Now you used RERA for RDI. RERA's are "other" Some labs use the snore arousals and non quailifing effort that you cant use APNEA or HYPOPNEA because of teh lack of DE-SATS. AHI is actual How manty times you wake up an hour because of having APNEAs or HYPOPNEAs. Keep up the great work! Peace and Love ........Duane

J. Sazama RPSGT said:

Remember, RERAS is a generic term that encompasses Obstructive Apnea, Obstructive Hypopnea, Mixed Apnea, Central Apnea, and UARS

Yes, UARS does cause you to wake up from sleep., so they are something to worry about. The CPAP will take care of them if CPAP was titrated accordingly.

For example (I need to upload some actually screenshots for this...but not now.)

A patient is having Obstructive apnea at 5cmH20. Technician increases to 8cmH20, which opens up the airway enough so some air gets through, but breathing is disrupted and a 4% desaturation occurs. Now it's a Hypopnea by definition. So the technician increases CPAP to 10cmH20 and it still looks like a hypopnea visually, but there isn't a desaturation of greater than 3%, but you are still waking up from them. Now it's a UAR by definition. Then the tech increases to 12cmH20 and sleep is consolidated without waking from breathing disruptions.

So UARS is officially the lamest, smallest, runtiest sleep disordered breathing event you can have, but they're tough to spot by untrained eyes and still make you feel like absolute garbage in the morning.

I think UARS is undertreated since many insurances only pay for CPAP for people with high AHIs. Remember, UARS only counts under the RDI. This is changing, but there are still top labs that I score for that don't want me scoring them. For these labs they usually pop up under the heading of Leg Movements with arousal, or PLMs with arousal.

Crap...again with the wordiness.

Jason

BeeAsleep said:

I didn't know if those numbers of RDI and RERAS were anything to worry about or will the CPAP take care of them? What are they, like asthma or some lung breathing problem? Does it matter?

I imagine that everyone does feel differently with OSA and that a high number doesn't necessarily mean feeling worse...I think that is interesting. You would think that not breathing A LOT would mean you feel worse. Humans are interesting huh?

Thanks so much for your reply, I do appreciate it a lot!

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Permalink Reply by BeeAsleep on August 21, 2009 at 9:24am

I am always so impressed that you guys know so much about sleep, and scoring, and numbers, and all that technical stuff. I appreciate being able to come here and ask...even if I get about half of what you say, I know I am better educated because I asked. Thanks Duane and Jason for your expertise. :>D I did actually get an answer to what I wanted to know. Smiles to all of you for taking your very valuable time to respond!

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Permalink Reply by RockRpsgt on August 21, 2009 at 12:09pm

Me too Bee! The amount of knowledge that gets posted here is very nice. Congrats on yourhubbies Dx. I know it must releive you to know that he is getting treated.

BeeAsleep said:

I am always so impressed that you guys know so much about sleep, and scoring, and numbers, and all that technical stuff. I appreciate being able to come here and ask...even if I get about half of what you say, I know I am better educated because I asked. Thanks Duane and Jason for your expertise. :>D I did actually get an answer to what I wanted to know. Smiles to all of you for taking your very valuable time to respond!

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Permalink Reply by BeeAsleep on August 21, 2009 at 1:33pm

I just didn't want to look like a crazed elephant hose head all by myself in bed at night. Now we BOTH look like crazed elephant hose heads. :>D

Rock Hinkle said:

Me too Bee! The amount of knowledge that gets posted here is very nice. Congrats on yourhubbies Dx. I know it must releive you to know that he is getting treated.

BeeAsleep said:

I am always so impressed that you guys know so much about sleep, and scoring, and numbers, and all that technical stuff. I appreciate being able to come here and ask...even if I get about half of what you say, I know I am better educated because I asked. Thanks Duane and Jason for your expertise. :>D I did actually get an answer to what I wanted to know. Smiles to all of you for taking your very valuable time to respond!

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