These terms are often used interchangeably, though RERA is the correct
term. UARS stands for Upper Airway Resistance Syndrome. RERA
stands for Respiratory Effort Related Arousal. If you have several
RERAs per night that disrupt your sleep, then your sleep doctor would
diagnost you with Upper Airway Resistance Syndrome, or UARS.
A RERA is the exact same as an Obstructive Hypopnea except for two
differences. A RERA has an SpO2 (blood oxygen level) desaturaton of
only 3% or less where a Hypopnea is of 4% or more. A RERA must
have an arousal associated (it must cause you to wake up). A hypopnea
doesn't have to result in an arousal. The breathing that is allowed is so
low that it results it an awakening that often isn't remembered.
Like other typse of sleep disordered breathing events, RERA's are very
disruptive to sleep. RERA's can be successfully treated with CPAP or
possibly an Oral Appliance Therapy (OAT device).
To the right is one example of a RERA. The belts
that are around the chest and abdomen are still
moving indicating they are trying to breathe.
"Flow" is the sensor that shows breathing. You
can see that this patient is still breathing, but that it
is less that periods where the patient wakes. The
F3,C4,C3, and O2 signals speed up when the
airflow increases (outlined in red). The breathing
also resumes at this point. The oxygen level
drops by 3% or less.
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The unfortunate thing about RERAs is that they don't count toward the overall AHI. The AHI
only counts Apneas and Hypopneas that occur per hour of sleep.
The RDI counts Apneas, Hypopneas, and RERAs. The problem is that Medicare doesn't use
the RDI to approve, and pay for, CPAP. Medicare only uses the AHI. The problem with this
is that many insurance companies just copy Medicare guidelines.
For example, a person could have one RERA per minute of sleep causing an RDI of 60.0.
That's 60 times waking up per hour. You can imagine how exhausted you'd be waking up.
The AHI would be 0.0 and nothing would be done about it from a treatment standpoint.
In situations like this it is important to be working with a Board Certified Sleep Disorders
Physician. A doctor with these credentials will know ways to get you approved for Positive
Pressure therapy. It is often just them knowing what coding to use and how to word the
report. This can make the difference between you getting treated or not.
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