Respiratory disturbance index (RDI)

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The respiratory disturbance index (RDI) — or respiratory distress Index — is an formula used in reporting polysomnography (sleep study) findings. Like the apnea hypopnea index (AHI), it reports on respiratory events during sleep, but unlike the AHI, it also includes respiratory effort-related arousals (RERAs). RERAs are arousals from sleep that do not technically meet the definitions of apneas or hypopneas, but do disrupt sleep. They are abrupt transitions from a deeper stage of sleep to a shallower.

A RERA is characterized by increasing respiratory effort for 10 seconds or more leading to an arousal from sleep, but one that does not fulfill the criteria for a hypopnea or apnea. The gold standard for measuring RERAs is esophageal manometry, as recommended by the American Academy of Sleep Medicine (AASM). However, esophageal manometry is uncomfortable for patients and impractical to use in most sleep centers. RERA is reported as an event by some CPAP machines. Since the machine cannot detect esophageal pressure, RERA is flagged when increasing flow limitation or flow reduction is followed by an increased respiratory flow rate suggesting an arousal or recovery breathing.

Some research studies have found that a high RDI was significantly correlated with excessive daytime sleepiness, and that this correlation was stronger than that for the frequency of oxygen saturation decreases below 85%, but other studies have found only a weak correlation.

RERA Rule for Adults [Recommended] (Consensus)

If electing to score respiratory effort-related arousals, score a respiratory event as a RERA if there is a sequence of breaths lasting at least 10 seconds characterized by increasing respiratory effort or by flattening of the inspiratory portion of the nasal pressure (diagnostic study) or PAP device flow (titration study) waveform leading to arousal from sleep when the sequence of breaths does not meet criteria for an apnea or hypopnea.


RDI = (RERAs + Hypopneas + apneas) / TST (in hours). That is, RDI means the average number of episodes of apnea, hypopnea, and respiratory event-related arousal per hour of sleep. (TST is "total sleep time".)

See also