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RERA events

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RERA events

Postby spacecasedeb » Thu Dec 14, 2006 9:15 pm

:?: Hi. I'm a newbie too and just completed my first split night sleep study. I've been reading a lot of the postings but haven't seen anything about RERA events.
My RDI results on the Pre Cpap test is 77/hr:
RERA - 65
Hypopneas - 5
Obstructive apneas - 7
Most of the postings I've seen posted have a larger number of Hyponeas or Obstructive Apneas rather than RERA events.
My Sleep efficiency Pre cpap was 77% and 78% w/cpap. Not much difference.
The difference was in the sleep stages. Pre cpap was 0 in stage 3/4 and REM.
W/cpap was 1% stage 3/4 and 19% REM. That sounds like an improvement.
The "impression" (same as diagnosis??) was Severe Obstructive Apnea.
I'm scheduled to take the 2nd test with titration of cpap next week.
Can anyone educate me on the difference between the Respiratory events?
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Postby Linda » Sat Dec 16, 2006 10:35 am

Hi there, and welcome!

You had me rushing to read our listing of sleep study terms.
It says that RERAs are Respiratory Effort Related Arousals. It says "Episodes that are not apneas or hypopneas, often related to loud snoring, that generally do not cause a decrease in oxygen saturation." Maybe this helps. Doesn't quite make sense, if your number is including the apneas and hypopneas, does it? Are you sure you have the correct number of apneas/hypopneas? Are they all obstructive? Any Centrals? Are you reviewing a sleep study report, or were these numbers relayed to you from your doctor?

Here's that link:
Click here for link to sleep study terms

If you were experiencing 77 apneas/hypopneas per hour, that's the severe category, for 30 or more is severe. Is there an AHI given?


The following is from the Mayo Clinic and it refers to RERAs.

Sleep-Disordered Breathing
During sleep, air should move freely and rhythmically in and out of the lungs via the nose and/or mouth just as while awake. When this normal breathing pattern is disrupted during sleep, "sleep-disordered breathing" is said to occur. Sleep-disordered breathing refers to a range of breathing disturbances, including apneas, hypopneas, snoring, and respiratory effort-related arousals.

When airflow completely stops during sleep, it's called an apnea. When airflow slows significantly, but not completely, it's called an hypopnea. In obstructive sleep apnea (OSA), apneas and hypopneas occur because of complete or near-complete blockage of the upper airway (throat). In central sleep apnea (CSA), apneas and hypopneas occur because the brain and central nervous system fails to generate a rhythmic signal to breathe. OSA is much more common than CSA. CSA typically occurs only in people who have experienced heart failure, stroke, or kidney failure.

Snoring occurs when air flows through a narrowed throat. The turbulence created by the air as it passes relaxed tissues causes them to vibrate, and that vibration is the sound of snoring. Because snoring and OSA are both due to narrowing of the throat, people who snore are more likely to have OSA.

Sometimes the throat narrows enough to cause loud snoring and hard breathing, but not enough to produce apneas or hypopneas. Breathing in this situation can be difficult enough to wake the sleeper, an occurrance referred to as a respiratory effort related arousal (RERA). Most people with OSA have some combination of loud snoring, RERAs, hypopneas, and apneas when they sleep, so the term OSA is commonly used to encompass all of these phenomena.

Click here for article
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Postby spacecasedeb » Sat Dec 16, 2006 3:04 pm

Hi Linda, thanks for the response. The info I posted was from my 1st sleep study results on paper. I haven't talked to the sleep Dr yet.
I don't see anything about AHI, but I'll give you exactly what the split studay report says:
Parametric Analysis Pre CPAP:
Total bed time: 141 min
Latency to sleep onset: 0 min
Total wake time: 31 min
WASO: 31 min
Total sleep time: 110 min
Sleep efficiency: 77% (normal 90%)

Sleep Stage:
1 drowse: 5 min 5%
2 light sleep: 106 min 95%
3/4 slow wave sleep: 0 min
Latency to REM1: N/A min
Overal Arrousal index: 88/hour
Awakenings greater than 1 min: 3

Respiration: (RDI)
Respiratory Events - Events/hr (Index) - Total recorded
RERA: 65 120
Hypoponeas 5 9
Obstructive Apneas 7 13
Mixed Apneas 0 0
Central Apneas 0 0
Total Events: 77 142

Respiratory Events w/desaturation Only 0
" " w/ arousal only 68
" " w/desaturation & arousal 8
" " w/desaturation <90%
Respiratory disturbances ranged in length from 10 sec to 43 sec and were accompanied by oxygen desaturation minimal value of 91%
Snoring: Moderate
Overall respiratory Arousal index: 76/hr
Bilateral leg movement: 0
(End of preCPAP results)

Parametric Analysis w/cpap:
Total bed time: 251 min
Latency to sleep onset: 3 min
Total wake time: 54 min
WASO: 50 min
Total sleep time: 197 min
Sleep Efficiency: 78% (normal 90%)

Sleep Stage:
1 drowse: 36 min 18% (Normal 5%)
2 light sleep 122 min 62% (normal 50%)
3/4 slow wave sleep: 2 min 1% (normal 15-20%)
REM: 38 min 19% (normal 20-25 %)
Latency to REm1: 71 min (Normal 90 min)
Longest wake time: 14 min
Awakenings greater than 1 min: 7
Bilateral Leg EMG:
4 episodes of periodic leg movements in sleep
23 total periodic leg movements in sleep
8 leg jerks ended in arousal
PLMS index: 6/hr
PLMS arousal index: 2/hr
(end of parametric analysis w/cpap)
No respiratory distrubance index was included w/cpap results
Axis A 327.23 Obstructive sleep apnea-Severe
Axis B 89.17 polysomnogram & 93.99 CPAP
Axis C: Depression & obesity (I've been on antidpressents for YEARS and obese for about the last 8 years---never had a problem with obesity until then)
1. Repeat polysomnography with application of positive airway pressure
2. Weight reduction program
End of results
I'm 52 years old - 5'5"- 210 LB.
Hope this makes more sense and that I didn't give you TOO much info this time. I just don't understand why my results have so many RERA-respiratory events listed and all the other posts I've read only refer to the Hypopneas and obstructive apneas. The sleep tech did tell me that my DR ordered additional tests so i had more of those wires attached to my head than she normally attaches on a sleep test. Maybe that would explain why there were RERA results from my test? I won't see my sleep Dr again till after my 2nd test w/cpap (12/20) and after results are available. I just can't wait that long to understand this. :-?
I'm so tired of being tired and having a brain that doesn't seem to work right.
Thanks for any info anyone can offer.
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Postby zzzzzzzzz » Fri Dec 22, 2006 4:13 am

We qualify a RERA as a 30% or more change in breathing (up or down), that is directly responsible for an arousal. There doesn't need to be any O2 desaturation (hypopnea) or Apnea related to it. When associated with PLMs (periodic limb movements) it is sometimes tricky to tell which was the cause of the arousal, the RERA or the PLM.
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