Respiratory disturbance index
{{Short description|Formula used in sleep studies}}
The respiratory disturbance index (RDI)—or respiratory distress Index—is a formula used in reporting polysomnography (sleep study) findings. Like the apnea-hypopnea index (AHI), it reports on respiratory distress events during sleep, but unlike the AHI, it also includes respiratory-effort related arousals (RERAs).Richardson, Mark A., & Friedman, Norman R. (Eds.) (2007). Clinician's Guide to Pediatric Sleep Disorders, p. 75. New York: Informa Healthcare USA, Inc. RERAs are arousals from sleep that do not technically meet the definitions of apneas or hypopneas, but do in some way disrupt breathing during sleep and cause respiratory symptoms that may cause an arousal.
A RERA is characterized by increasing respiratory effort such as dyspneas (and thus decreasing esophageal pressures) for 10 seconds or more leading to an arousal from sleep, but one that does not fulfill the criteria for a hypopnea or apnea.{{cite web|url=http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/pulmonary/sleep-disordered-breathing/Default.htm|title=Sleep-Disordered Breathing|work=clevelandclinicmeded.com}}
Diagnosis
The gold standard method for measuring RERAs is esophageal manometry, as recommended by the American Academy of Sleep Medicine (AASM). However, esophageal manometry is uncomfortable for patients, may disrupt sleep and is impractical to use in most sleep centers.
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 and unreliable correlation.{{cite book|url=https://books.google.com/books?id=T9fwv3B33voC&pg=PA83 |editor-first1=Joris C. |editor-last1=Verster |editor-first2=S. R. |editor-last2=Pandi-Perumal |editor-first3=David L. |editor-last3=Streiner |year=2008 |title=Sleep and Quality of Life in Clinical Medicine |page=83 |location=Totowa, New Jersey |publisher=Humana Press |isbn=978-1-603-27343-5}} More recent studies have found more impressive outcomes of methods in treating patients with RERAs and respiratory events that satisfy the definition of hypopneas in all aspects other than reduction of oxygen saturation levels.Simmons J., Barlow, S, Sleep, Vol 35S A135, 2012{{cite web|url=http://www.houstonsleep.net/HTML/poster_2013_no-ox_OSA-FINAL.pdf|title=Requiring oxygen desaturation for tabulation of hypopneas lowers the sensitivity of NPSG testing and leaves many patients untreated. In-lab NPSG testing needs to improve if it is to be preserved|author1=Jerald H. Simmons |author2=Shaaron Barlow }} (poster)
The American Academy of Sleep Medicine uses RDI to determine the severity of Obstructive Sleep Apnea according to the following range: 5–14.9 for mild, 15–29.9 for moderate, and 30+ for severe, similar to the one used in the AHI.{{cite journal | last=Kapur | first=Vishesh K. | last2=Auckley | first2=Dennis H. | last3=Chowdhuri | first3=Susmita | last4=Kuhlmann | first4=David C. | last5=Mehra | first5=Reena | last6=Ramar | first6=Kannan | last7=Harrod | first7=Christopher G. | title=Clinical Practice Guideline for Diagnostic Testing for Adult Obstructive Sleep Apnea: An American Academy of Sleep Medicine Clinical Practice Guideline | journal=Journal of Clinical Sleep Medicine | volume=13 | issue=03 | date=2017-03-15 | issn=1550-9389 | pmid=28162150 | pmc=5337595 | doi=10.5664/jcsm.6506 | pages=479–504|url=https://aasm.org/resources/clinicalguidelines/diagnostic-testing-osa.pdf}}
Formula
The formula to assessing the RDI is = (RERAs + Hypopneas + Apneas) X 60 / TST (in minutes). That is, RDI means the average number of episodes of obstructive apnea, hypopnea, and respiratory event-related arousal per hour of sleep.{{Cite book|last=Espiritu |first=Joseph Roland D. |chapter=Sleep-Related Breathing Disorders |page=663 |editor-last1=Schmitz|editor-first1=Paul G.|chapter-url=https://books.google.com/books?id=zCt0tpxsjQEC&pg=PA663|title=Internal Medicine: Just the Facts|editor-last2=Martin|editor-first2=Kevin J.|date=2008-04-20|publisher=McGraw Hill Professional|isbn=978-0-07-159343-4|language=en}} (TST is "total sleep time".)
See also
{{Portal|Medicine}}
References
{{Reflist|30em}}