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[Diagnosis] Respiratory Disturbance Index
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BiLevel48 Offline

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Post: #1
Respiratory Disturbance Index
Well, hello to all here at the Apnea board! I have a question. My question is in the regards to the Respiratory Disturbance Index! I have Medicare AND Medicaid. I am curious. Let's say that we have a patient who underwent a PSG AND this was a FULL NIGHT PSG. No SPLIT-NIGHT TITRATION WAS CONDUCTED! The Apnea-Hypopnea Index was 3.1 however, the Respiratory Disturbance Index WAS 48. Could the patient still qualify for Positive Airway Pressure THERAPY? I know those RERAs would make up that majority of the Sleep Disordered Breathing events.
03-29-2015 05:54 PM
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trish6hundred Offline

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Post: #2
RE: Respiratory Disturbance Index
Hi BiLevel48,
WELCOME! to the forum.!
I'm not sure of the answer to your question but hang in there, someone will be along to help you.
Much success to you with your CPAP therapy.

trish6hundred
03-29-2015 09:09 PM
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retired_guy Offline

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Post: #3
RE: Respiratory Disturbance Index
To that I would add other symptoms if they exist:

The "feelie" stuff. How do you feel, are you bright eyed and bushy tailed all day, or did you fall asleep in your tomato soup again?

When you're out driving around, like to the neighbors house; Do you find yourself in the middle of a cow pasture having just experience a little 10 minute power nap?

How about night time adventures? Do you find you log more steps on your cute little step counter at night going back and forth to the bathroom than you do during the day?

These symptoms along with the RERA's might make me try cpap therapy. Actually, RERA's are only obstructive events that were never allowed to grow up.

I know in my case that once I knocked down my regular apnea events and then took one more little step to smooth out the chunky "flow limits" I finally arrived at my perfect sweet spot.

So yeah, if a person is experiencing daytime symptoms (or nighttime) even in the absence of AHI over 5, then I believe quality of life can be much improved by use of therapy. It's just that the insurance/medicare guys won't necessarily agree.
(This post was last modified: 03-29-2015 09:25 PM by retired_guy.)
03-29-2015 09:24 PM
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BiLevel48 Offline

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Post: #4
RE: Respiratory Disturbance Index
(03-29-2015 09:24 PM)retired_guy Wrote:  To that I would add other symptoms if they exist:

The "feelie" stuff. How do you feel, are you bright eyed and bushy tailed all day, or did you fall asleep in your tomato soup again?

When you're out driving around, like to the neighbors house; Do you find yourself in the middle of a cow pasture having just experience a little 10 minute power nap?

How about night time adventures? Do you find you log more steps on your cute little step counter at night going back and forth to the bathroom than you do during the day?

These symptoms along with the RERA's might make me try cpap therapy. Actually, RERA's are only obstructive events that were never allowed to grow up.

I know in my case that once I knocked down my regular apnea events and then took one more little step to smooth out the chunky "flow limits" I finally arrived at my perfect sweet spot.

So yeah, if a person is experiencing daytime symptoms (or nighttime) even in the absence of AHI over 5, then I believe quality of life can be much improved by use of therapy. It's just that the insurance/medicare guys won't necessarily agree.
WOW! Ty so much. I totally agree with you. I think even if a person is suffering from RERAs and even if the Apnea-Hypopnea Index IS AROUND 1.4 or lower. I think that if they are suffering from Excessive Daytime Sleepiness, or overall just feeling like they were drug in by the cat, they really should be qualified for A Positive Airway Pressure DEVICE! I think that Medicare really need to fix some of the stuff that they will qualify patients for. I think that ANY sort of Sleep Dosordered breathing no minor how minor it may seem,UST be considered MAJOR, IF IT IS EFFECTING A PERSON AND THEIR QUALITY OF LIFE! Patients with an Apnea-Hypopnea Index OF 1.3 If their apnea a are long enough to be the result of MASSIVE Oxygen Desaturation Events, it CAN STILL DESTROY a patient and their quality of life Philips Respironics QOL! I think that the scoring system needs to be improved a lot.
03-29-2015 09:47 PM
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zonk Offline

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Post: #5
RE: Respiratory Disturbance Index
According to AASM diagnostic criteria for OSA:
a positive test for OSA is established if either of the following criteria using the AHI or the RDI is met:

AHI or RDI greater than or equal to 15 events per hour, or
AHI or RDI greater than or equal to 5 and less than or equal to 14 events per hour with documented symptoms of excessive daytime sleepiness (EDS); impaired cognition; mood disorders; insomnia; or documented hypertension, ischemic heart disease, or history of stroke

Polysomnography (PSG) shows more than 5 scoreable respiratory events (eg, apneas, hypopneas, RERAs) per hour of sleep and/or evidence of respiratory effort during all or a portion of each respiratory event.

Read more: http://emedicine.medscape.com/article/295807-differential
03-29-2015 09:50 PM
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vsheline Offline

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Post: #6
RE: Respiratory Disturbance Index
(03-29-2015 09:24 PM)retired_guy Wrote:  Actually, RERA's are only obstructive events that were never allowed to grow up.

By definition, each one of the RERA (Respiratory Effort Related Arousal) events did "grow up" enough to cause at least a mini-arousal from sleep, fragmenting sleep, perhaps preventing reaching deep restorative sleep.

Membership in the Advisory Member group should not be understood as in any way implying medical expertise or qualification for advising Sleep Apnea patients concerning their treatment. The Advisory Member group provides advice and suggestions to Apnea Board administrators and staff on matters concerning Apnea Board operation and administrative policies - not on matters concerning treatment for Sleep Apnea. I think it is now too late to change the name of the group but I think Voting Member group would perhaps have been a more descriptive name for the group.
(This post was last modified: 03-30-2015 12:38 AM by vsheline.)
03-30-2015 12:32 AM
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PsychoMike Offline

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Post: #7
RE: Respiratory Disturbance Index
(03-29-2015 05:54 PM)BiLevel48 Wrote:  Well, hello to all here at the Apnea board! I have a question. My question is in the regards to the Respiratory Disturbance Index! I have Medicare AND Medicaid. I am curious. Let's say that we have a patient who underwent a PSG AND this was a FULL NIGHT PSG. No SPLIT-NIGHT TITRATION WAS CONDUCTED! The Apnea-Hypopnea Index was 3.1 however, the Respiratory Disturbance Index WAS 48. Could the patient still qualify for Positive Airway Pressure THERAPY? I know those RERAs would make up that majority of the Sleep Disordered Breathing events.

Potentially.

I'm not sure about Medicare or Medicaid, but in my case, my AHI was only 6, but my RDI was in the 50's. Diagnosis for me was Upper Airway Resistive Syndrome (UARS). Not quite the same as obstructive sleep apnea (OSA) but still sleep disordered breathing. My insurance coughed up for CPAP therapy just fine.
03-31-2015 11:37 AM
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kdmorris410 Offline

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Post: #8
RE: Respiratory Disturbance Index
(03-29-2015 05:54 PM)BiLevel48 Wrote:  Well, hello to all here at the Apnea board! I have a question. My question is in the regards to the Respiratory Disturbance Index! I have Medicare AND Medicaid. I am curious. Let's say that we have a patient who underwent a PSG AND this was a FULL NIGHT PSG. No SPLIT-NIGHT TITRATION WAS CONDUCTED! The Apnea-Hypopnea Index was 3.1 however, the Respiratory Disturbance Index WAS 48. Could the patient still qualify for Positive Airway Pressure THERAPY? I know those RERAs would make up that majority of the Sleep Disordered Breathing events.

I have private insurance and mine was similar. My AHI was just 5, but my RDI was 36. At first, my insurance didn't want to cover it because the AHI was "mild", but since I was symptomatic (tired, tired, tired), they did end up covering it. And I'm a whole new person!
03-31-2015 12:29 PM
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BiLevel48 Offline

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Post: #9
RE: Respiratory Disturbance Index
(03-31-2015 12:29 PM)kdmorris410 Wrote:  
(03-29-2015 05:54 PM)BiLevel48 Wrote:  Well, hello to all here at the Apnea board! I have a question. My question is in the regards to the Respiratory Disturbance Index! I have Medicare AND Medicaid. I am curious. Let's say that we have a patient who underwent a PSG AND this was a FULL NIGHT PSG. No SPLIT-NIGHT TITRATION WAS CONDUCTED! The Apnea-Hypopnea Index was 3.1 however, the Respiratory Disturbance Index WAS 48. Could the patient still qualify for Positive Airway Pressure THERAPY? I know those RERAs would make up that majority of the Sleep Disordered Breathing events.

I have private insurance and mine was similar. My AHI was just 5, but my RDI was 36. At first, my insurance didn't want to cover it because the AHI was "mild", but since I was symptomatic (tired, tired, tired), they did end up covering it. And I'm a whole new person!

That is wonderful that they did cover it. Sleep disordered breathing even VERY mild forms can really take an impact on the body of a patient and it can just destroy your energy levels. It will often make you feel like the cat had you for his dinner last night or at least tried to have you for his dinner. Sleep Apnea AND UARS CAN REALLY take your body into states THAT NOBODY wants to be in!
03-31-2015 12:44 PM
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